TEFCA Network Reaches Nearly 500 Million Records Exchanged
The Trusted Exchange Framework and Common Agreement (TEFCA) has become a major national interoperability network, with nearly 500 million health records now being exchanged. This growth, along with the upcoming National Provider Directory, is standardizing how provider and hospital data is shared, directly impacting EHR interface design and configuration.
- The Trusted Exchange Framework and Common Agreement (TEFCA) was established by the 21st Century Cures Act to create a universal on-ramp for nationwide health information exchange. The Office of the National Coordinator for Health Information Technology (ONC) released the final framework in January 2022. - At the core of TEFCA is a "network of networks" model built on Qualified Health Information Networks (QHINs). These QHINs are the central connection points that must complete a rigorous application and onboarding process to facilitate data exchange under a common legal agreement and technical framework. - In December 2023, the first five QHINs were officially designated: eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies. As of August 2025, the number of QHINs had grown to 10, connecting over 9,200 organizations. - Epic, which holds 36% of the U.S. market, is a significant participant through its QHIN, Epic Nexus. By December 2024, Epic Nexus had already connected 625 hospitals to the TEFCA network, with a goal for the entire Epic community to be live by the end of 2025. - A key technical standard for TEFCA is HL7 FHIR (Fast Healthcare Interoperability Resources), which enables more granular and efficient data exchange using modern web standards. While initial exchanges used older formats, TEFCA is phasing in FHIR-based exchange, with requirements for QHINs to support it by January 1, 2026. - For ICU nurses, a major source of frustration with current EHRs is physician-centric design, which leads to click fatigue, redundant data entry, and workflows that interfere with direct patient care. Studies show that higher EHR satisfaction among nurses is linked to higher self-reported well-being, and poor usability is a top complaint from healthcare providers about their IT systems. - The National Provider Directory is a related initiative that aims to create a centralized, accurate source of healthcare provider information. This directory is expected to align with and support TEFCA by providing a reliable way to identify providers' digital contact information for interoperable data exchange. - Initial exchange purposes supported by TEFCA include treatment, individual access to records, and public health. The framework is designed to expand over time to include other use cases like payment and healthcare operations.
