The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) and its Recognized Coordinating Entity (RCE), The Sequoia Project, Inc., today announced the publication of the Trusted Exchange Framework and the Common Agreement (TEFCA). Entities will soon be able to apply and be designated as Qualified Health Information Networks (QHINs). QHINs will connect to one another and enable their participants to engage in health information exchange across the country.
The 21st Century Cures Act, passed in 2016, calls for the development of a trusted exchange framework and a common agreement. The Trusted Exchange Framework is a set of non-binding but foundational principles for health information exchange, and the Common Agreement is a contract that advances those principles. The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road.
The Common Agreement supports multiple exchange purposes critical to improving health care and has the potential to benefit a wide variety of health care entities. This flexible structure allows stakeholders—such as health information networks, ambulatory practices, hospitals, health centers, federal government agencies, public health agencies, and payers—to benefit from TEFCA through improved access to health information. Individuals will also be able to benefit from TEFCA and seek access to their health information through entities that offer individual access services.
Also available today is the TEFCA Health Level Seven (HL7®) Fast Healthcare Interoperability Resource (FHIR®) Roadmap (TEFCA FHIR Roadmap), which outlines how TEFCA will accelerate the adoption of FHIR-based exchange across the industry.
“Operationalizing TEFCA within the Biden Administration’s first year was a top priority for ONC and is critical to realizing the 21st Century Cures Act’s goal of a secure, nationwide health information exchange infrastructure,” said Micky Tripathi, Ph.D., national coordinator for health information technology. “Simplified nationwide connectivity for providers, health plans, individuals, and public health is finally within reach. We are excited to help the industry reap the benefits of TEFCA as soon as they are able.”
The Sequoia Project serves as the TEFCA RCE under a cooperative agreement with ONC. The RCE is charged with developing, updating, implementing, and maintaining the Common Agreement and stewarding the QHIN Technical Framework, which is the technical specification for how QHINs connect to one another. In addition, the RCE plays a central role in designating, onboarding, and providing oversight of QHINs.
“The release of TEFCA today marks the beginning of the implementation phase,” said Mariann Yeager, CEO of The Sequoia Project. “This is a very exciting milestone that reflects the thoughtful feedback of public and private stakeholders throughout the process. We look forward to supporting everyone as they review the Common Agreement and identify their role in this new public-private paradigm advancing health information exchange nationwide.”
The RCE will be hosting a series of public engagement webinars 
to provide further information about TEFCA (the first of which will be on January 18 at 12:00 ET). This will help entities interested in participating in or leveraging the benefits of TEFCA fully understand how it works and help prospective QHINs decide whether they should sign the Common Agreement. Following an application and review process, entities that have signed may be designated QHINs. It is anticipated the initial QHINs will onboard to the network-of-networks to begin sharing data with one another this year.
To register for the RCE’s upcoming webinars and to sign up for their contact list, please visit RCE.SequoiaProject.org .
For more information from ONC about TEFCA, please visit HealthIT.gov/TEFCA.