How Does TEFCA Work?

Health care providers, patients, payers, state agencies, public health professionals, and other stakeholders are able to use the policies, technical specifications, and network connectivity requirements of the TEFCA to send and receive electronic health information seamlessly.

Currently, stakeholders often must join multiple networks to get the information they need to support patient care. In contrast, joining a HIN that participates in the network created by the Common Agreement enables access to and exchange of information from varied sources.

Participants in the network…
are able to exchange electronic health information for specific health care purposes, including treatment, quality improvement, public health, and patient access.

To help ensure that rules to enable seamless exchange are in place, HINs and health IT developers will need to modify existing data use agreements in order to flow down certain obligations for exchanging data to their network participants.

HINs and health IT developers…
have a variety of options for participating in the Common Agreement, including by joining an existing HIN that meets the requirements of the Common Agreement or by forming their own Qualified Health Information Network (QHIN).

Use Cases and Exchange Purposes

In TEFCA, use cases are called Exchange Purposes, or XPs. The Exchange Purpose identifies the reason for which information can be requested or shared through TEFCA exchange. Only these six Exchange Purposes are authorized under the Common Agreement today:

  1. Treatment 
  2. Payment
  3. Health Care Operations
  4. Public Health 
  5. Government Benefits Determination 
  6. Individual Access Services

Technical Requirements

Technical requirements are detailed in the QHIN Technical Framework (QTF) and related Standard Operating Procedures (SOPs).

When TEFCA was being developed, exchange of clinical information through health information networks often relied on established standards including Integrating the Healthcare Enterprise (IHE®) profiles and HL7® Consolidated Clinical Document Architecture (C-CDA). ONC and the RCE’s initial work on TEFCA has sought to build upon existing infrastructure by starting with such IHE-based exchange of CCDA content. This is in alignment with the Cures Act direction to “avoid the disruption of existing exchanges.”

However, the healthcare information technology landscape continues to evolve and TEFCA is evolving with it to continue to add value to the market and help advance industry progress. The HL7® Fast Healthcare Interoperability Resources® (FHIR) standard uses a modern approach to standards and interoperability and has already gained wide support in the United States. Adoption is expected to accelerate as FHIR APIs for general use are now required in all ONC-certified EHR systems as of the end of 2024 and in patient access APIs by Centers for Medicare and Medicaid (CMS)-regulated payers, and are proposed for provider access, payer-payer exchange, and prior authorization APIs by CMS-regulated payers.


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