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TEFCA will be available in 2022

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Micky Tripathi and Mariann Yeager, CEO, The Sequoia Project (the coordinating entity recognized by TEFCA) | July 13, 2021

Today we are pleased to announce the timeline for the Common Agreement and Trusted Exchange Framework (TEFCA). The 21st Century Cures Act, signed by President Obama in 2016, calls on the ONC to “develop or support a trustworthy exchange framework, including a common agreement among health information networks nationwide.”

In August 2019, ONC granted a cooperation agreement to Project Sequoia to act as a Recognized Coordinating Entity (RCE) to manage a new national network based on the Common Agreement. Since then, ONC and RCE have worked together to collect the input from industry-wide stakeholders to draft and refine the approach to enable the exchange of health information at the national level through different health information networks. The schedule published today, for the completion of the Trusted Exchange Framework, the Common Agreement Version 1 and the Qualified Health Information Network (QHIN) Technical Framework (QTF) Version 1, establishes our goal of having this new network open to participation in the first trimester. (Q1) of calendar year 2022.

Increased value of network sharing

Interoperability of medical records has progressed steadily in recent years following a monumental national effort to achieve high adoption of electronic medical records among hospitals and outpatient practices. Today, national networks facilitate the secure exchange of millions of clinical documents on a daily basis, and state / regional Health Information Exchanges (HIE) provide localized interoperability services in many parts of the country.

However, some important gaps remain. For example, we need the networks to be perfectly connected to each other. While national networks have made considerable progress in this area, inter-network sharing is still not friction-free, with most state / regional HIEs serving only their local markets and many are not connected to any other network in absolute. This presents barriers to better care, higher costs to the healthcare system, and a diminished user experience for both patients and providers. Data from the 2018-2019 American Hospital Association Annual Information Technology Survey Supplement (summarized in ONC Data Summary # 54) found that nearly half of hospitals participate in more than one network and therefore have to manage the load of multiple network connections, legal contracts, network fees, and user workflows.

We also need networks to open up the exchange to support the entire healthcare system, including the most important participant in healthcare – the patient. Today, national networks largely support exchange between healthcare providers for treatment purposes, excluding other critical use cases such as public health, individual access, care management, population health, support payment, research, supply chain awareness and emergency response. The COVID-19 pandemic made it very clear that our clinical and public health systems live in different universes of interoperability. For example, it is not easy for public health authorities and individual physicians to gather information on seemingly simple questions such as: Which of my patients are not yet vaccinated?

The Internet has taught us that networks are more valuable together than apart. The general objective of TEFCA is to establish a universal interoperability floor throughout the country. Networks of many shapes, sizes and capacities exist today and we anticipate that they will continue to provide interoperability services on top of the basic foundation established by the Common Agreement. Throughout our work, one of our long-standing principles has been to build on the successes of networks that are already on the market, do not suppress or replace them. The consistent and reliable services enabled by the Common Agreement will do this by reducing the cost of sharing basic information and thereby freeing up resources for higher value-added services, creating a competitive and equitable playing field for existing and emerging networks. . and fill the gaps in the exchange between networks. The Common Agreement will establish the infrastructure model and governance approach so that users on different networks securely share basic clinical information with each other, all under commonly agreed rules and expectations and regardless of the network they are on.

TEFCA timeline and process

Today, ONC and RCE are announcing a timeline and process to achieve a successful launch of the TEFCA framework within one year. Specifically, our goal is to open participation in the first quarter of calendar year 2022 and there is a lot to do between now and then.

Schedule to put TEFCA into operation

Our work at TEFCA has several key components. Qualified Health Information Networks (QHIN) are networks that agree common terms and conditions of exchange with each other (as specified in the Common Agreement) and functional and technical requirements for exchange (as specified in the QHIN Technical Framework or QTF).

The RCE has already received considerable input from the market over the last two years. There will be more opportunities for additional stakeholder input to the Common Agreement and QTF throughout the remainder of 2021, including the meeting of the Common Agreement Working Group comprised of potential QHINs and their participants.

We welcome input on all aspects of the TEFCA model, including topics such as mandatory and optional exchange purposes, privacy and security policies, mandatory and optional exchange patterns, and the addition of Health Level Seven (HL7®) International® Fast Healthcare Interoperability Resources (FHIR®). ) standard on the QTF waybill. This collaborative process will culminate with the publication of the Common Agreement V1 Final and QTF V1 Final in the first quarter of calendar year 2022, at which time health information networks will be able to apply to become a QHIN and, after approval, begin to be incorporated continuously. base.

As technology and business agreements and user requirements and use cases evolve and emerge over time, so will the Common Agreement and QTF, which will be living documents that will be updated periodically as needed and through the participatory governance process of the RCE to address areas for the future. improvement.

The Sequoia Project plays a critical role in bringing depth and breadth of knowledge, experience and market confidence to the RCE’s role in governing the exchange of health information networks through the Common Arrangement. ONC is pleased to announce that has awarded a new round of funding of $ 942,000 to The Sequoia Project under the RCE cooperative agreement to support RCE activities from August 2021 to August 2022.


We encourage stakeholders to participate in the future of the RCE briefings. You can stay informed of these meetings by adding your name to the RCE contact list at

For detailed information on TEFCA, visit:

Thanks To Source

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