Health IT Research & Analysis
Quick Stats

Non-Federal Acute Care Hospitals’ Awareness of and Plans to Participate in the Trusted Exchange Framework and Common Agreement (TEFCA)

Last Updated

February 2026

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The Trusted Exchange Framework and Common Agreement (TEFCA) for health information networks was published in January 2022 and the first set of Qualified Health Information Networks (QHINs) were approved to implement TEFCA and began exchanging data in late 2023. A 2025 survey of U.S. hospitals found that over 40 percent of hospitals are aware of TEFCA and currently participate. 

Differences in awareness and plans to participate in TEFCA can provide insight into the hospitals and populations most likely to participate in and benefit from TEFCA. Approximately 5 out of 10 hospitals that participated in national networks (eHealth exchange, CommonWell Health Alliance, or Carequality) or health information exchanges (HIEs) are currently participating in TEFCA, compared to 1 out of 10 hospitals that did not participate in either type of network.

Hospital Awareness of and Plans to Participate in TEFCA, 2025

 Aware of TEFCA and currently participateAware of TEFCA and plan to participateAware of TEFCA and do not know if they plan to participateAware of TEFCA but not planning to participateNot aware of TEFCA
Overall43%37%5%2%13%


Hospital Awareness of and Plans to Participate in TEFCA, by Key Hospital Characteristics, 2025

 Aware of TEFCA and currently participateAware of TEFCA and plan to participateAware of TEFCA and do not know if they plan to participateAware of TEFCA but not planning to participateNot aware of TEFCA
System Affiliation
Multi-Hospital System Member (68%)51%41%3%1%5%
Independent Hospital (32%)25%29%11%5%30%
Critical Access
Critical Access Hospital (31%)30%33%9%4%24%
Not-Critical
Access Hospital (69%)		48%39%4%2%7%
Network Participation
National Network Participant (76%)49%38%4%2%6%
State, Regional, or Local Network (82%)44%39%5%2%9%
Both Network Types (65%)49%40%4%1%5%
Neither (7%)10%22%7%5%56%

Download Excel [xlsx – 27 KB]

Data are from the 2025 American Hospital Association (AHA) Information Technology Supplement to the AHA Annual Survey. Since 2008, ASTP has partnered with the AHA to measure adoption and use of health IT in U.S. hospitals.

The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital’s health IT (typically the chief information officer) was requested to provide the information via a mail survey or secure online site. Nonrespondents received follow-up mailings and phone calls to encourage response.

This quick stat reports results from the 2025 AHA IT Supplement, the response rate for non-federal acute care hospitals (N = 2,351) was 55% percent.

A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, critical access hospital status, location, system affiliation, teaching status, ownership, and EHR certification status. Hospital-level weights were derived by the inverse of the predicted propensity.