It’s hard to convey the excitement that was in the HHS Great Hall during the TEFCA^SM Recognition Event on February 13, 2023. It was great to see so many gather with HHS Secretary Becerra to recognize the six applicant organizations that have been approved for onboarding as Qualified Health Information Networks^TM (QHIN^TM)—CommonWell Health Alliance, eHealth Exchange, Epic TEFCA Interoperability Services, Health Gorilla, Kno2, and KONZA.

It was a special opportunity to acknowledge the benefits of public-private partnership and to hear first-hand just what this milestone event means for individuals across the country.

Here are a few of the top takeaways from the event:

We’re Not Slowing Down – Applicants Agree to Go-Live by the End of 2023

TEFCA has been years in the making. It is the product of a sustained commitment to create a more connected and equitable healthcare system. ONC began developing TEFCA in 2017 and substantially updated our processes and policies in 2021 to more effectively meet the needs of the market and interested parties. We and the community are now able to move forward with ambitious timelines to address critical gaps in health care exchange. At the event, representatives from each of the applicant QHINs agreed to go-live by the end of 2023, pledging to beat the required 12-month timeline by nearly two months.

Federal Agency Support for TEFCA

We are grateful to the many federal government organizations who are collaborating on TEFCA and whose leaders spoke about TEFCA’s potential for advancing their missions.

• The Director of the White House Office of Science and Technology Policy and President’s Science Advisor Dr. Arati Prabhakar described the importance of having better information for research and the potential future use of TEFCA for that purpose, which can directly improve important areas such as clinical trials.
• CDC Director Dr. Rochelle Walensky expressed enthusiasm for TEFCA’s ability to better integrate public health with the health care delivery system, catalyze advancement of real-time data-level interoperability by leveraging APIs, and reduce the burden of public health reporting on health care providers.
• CMS Principal Deputy Administrator and COO Jonathan Blum noted CMS and ONC’s efforts to work hand-in-hand to advance TEFCA adoption and highlighted the potential for TEFCA to support key CMS initiatives such as quality measurement, prior authorization, and FHIR API adoption.
• Veterans Administration Under Secretary for Health Dr. Shereef Elnahal spoke to the potential of TEFCA to improve care for veterans—especially in rural areas—and to support the VA’s FHIR API advancement efforts.

TEFCA Focuses on a Universal Floor for Interoperability

The primary goal of TEFCA is to establish a universal governance, policy, and technical floor for nationwide health information interoperability, which will both support existing document exchange mechanisms and create a much-needed technical and business foundation for the advancement of modern data interoperability technologies that are based on FHIR APIs. This will enable critical health information to be quickly and securely shared in real-time among health organizations and with patients across the country, regardless of geographic location. The Common Agreement and associated QHIN Technical Framework and FHIR Roadmap establish that floor.

Trusted Exchange is Built on Privacy and Security

As its name suggests, trust is a key component of TEFCA. The Common Agreement requires strong privacy and security protections for all entities who elect to participate, including entities not covered by HIPAA. A common privacy and security posture helps promote trust and transparency, and guides participation in the critical infrastructure that we will all rely on.

TEFCA Will Be a Game Changer

Another goal of TEFCA is to spark further market innovation by allowing distinct networks to easily connect with each other, much in the same way that cell phone networks connect with each other to provide the experience of a nationwide network-of-networks.

In addition to improving basic provider-to-provider interoperability, TEFCA is focused on addressing interoperability gaps that the private sector can’t tackle on its own and that we as a country should no longer allow to persist:

• An estimated 36% of hospitals are not connected to existing nationwide networks, which means that a provider trying to support improved care outcomes for a patient may have a harder time accessing the patient’s health care record when they are seen at those hospitals.
• Public health agencies have no nationwide system to connect with provider organizations, or with each other.
• Health insurers and providers use a bewildering mix of custom, ad hoc approaches to share information critical to support efficient payment, which can lead to delays in patient care and can add unnecessary costs to the health care system.
• Patients continue to face the challenge of a confusing array of disconnected technological offerings for accessing their own records.

Ultimately, the public-private governance model of TEFCA enables a trust and technical foundation that will provide a mechanism for the health care community to get better, more efficient access to the information needed to improve patient care and public health. Clinicians will be able to share information with public health agencies and health insurers using the same infrastructure they use to share information with each other for clinical care. It’s the next evolution of health interoperability and the basis of the truly digital health care system envisioned in the HITECH Act and the 21^st Century Cures Act. We are excited to work closely with the entire health care community to finally make it real.

Watch the replay of the event, and learn more about TEFCA.