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How TEFCA aims to change interoperability

The release of the interoperability framework means The Trusted Exchange Framework’s data exchange objectives are now underway.
By admin
Feb 18, 2022, 6:18 PM

TEFCA is finally here. After years of development and debate, this wide-ranging roadmap to health data interoperability has been finalized and published with the goal of establishing a “universal floor of interoperability” across the health IT ecosystem.

While this landmark framework is non-binding and doesn’t include incentives or penalties to spur adoption, it does codify and promote many of the interoperability efforts already gaining momentum in the healthcare industry, including the use of shared technical standards and patient ownership of personal health data.

Here’s a breakdown of the Trusted Exchange Framework and Common Agreement (TEFCA), which will guide the next generation of interoperability activities across the United States.

What is TEFCA?

In 2016, the 21st Century Cures Act directed the Office of the National Coordinator (ONC) to develop a trusted exchange framework and common agreement to unify disparate health information exchange (HIE) efforts across the nation.

TEFCA is the product of that two-part mission. The Trusted Exchange Framework outlines the principles of interoperability, while the Common Agreement forges a “network of networks” to execute these goals. Newly established Qualified Health Information Networks (QHINs) will voluntarily enter a contractual agreement to provide infrastructure and offer guidance about seamless data exchange.

The framework includes seven guiding principles, including standardization, transparency, cooperation, privacy and security, access, equity, and public health. These principles are designed to ensure data is used safely to promote better outcomes, reduce spending, and generate better patient experiences.

How will TEFCA change the interoperability landscape?

TEFCA signals a sea change in the way stakeholders approach data interoperability. It’s a shared recognition that business barriers are now dissolving as value-based care and consumerism take hold and that the new marketplace will require more openness from providers and technology developers.  

TEFCA will give the industry the extra push it needs to break through lingering reluctance to proactively coordinate care and give patients more control over how they view, manage, and share their own information.  

The result will be a health system where providers, public health entities, patients, and caregivers can easily access the data they need to make informed decisions about care.

What happens next?

The final Trusted Exchange Framework has been published, but the Common Agreement is still under construction. Once completed, prospective QHINs can start their applications and begin the challenging process of turning TEFCA’s vision into reality. QHINs will need to leverage their relationship-building skills in addition to their technical competencies to unite disparate systems. 

Meanwhile, interested parties can join information sessions and review past presentations to get involved with making interoperability happen in their own communities.

The ONC anticipates that TEFCA’s work will begin in earnest during the first part of 2022 and will continue for many years to come. This critical milestone represents the start of a new era in interoperability, one that aims to finally overcome the deep-seated challenges of data exchange and create an open, accessible, patient-centered environment to encourage truly collaborative, data-driven care.


Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.

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