Dear eHealth Exchange Participant,

Today is the start of the eHealth Exchange’s 60-day opt-out period for TEFCA participation.

As you are likely aware by now, the eHealth Exchange and six others have advanced as candidate Qualified Health Information Networks (QHINs) to the testing and work plan phase of the Office of the National Coordinator for Health IT’s (ONC’s) Trusted Exchange Framework and Common Agreement (TEFCA). As we anticipate achieving Designated QHIN status soon, the candidate QHINs will soon be offering their network participants and customers the opportunities to opt-in or opt-out of the new QHINs they have created to participate in the federally endorsed network.

Action Required:

If your organization does not wish to exchange with TEFCA-enabled networks via the eHealth Exchange, you must notify by 7/31/2023.

Your organization can change its decision to connect with TEFCA at any time.

The documents below identify the obligations you will be required to comply with and to flow down to all levels of Subparticipants as part of the eHealth Exchange QHIN. It is important that you review the eHealth Exchange TEFCA Requirements webpage prior to making the decision to participate in our QHIN or to opt-out of the QHIN exchange. The resources provided on that page include:

  • eHealth Exchange TEFCA Terms and Conditions
  • Seven (7) Protocols
  • TEFCA Requirements Checklist
  • TEFCA Common Agreement –eHealth Exchange signs this agreement on behalf of our participants engaging in TEFCA exchange. No action or signature is required by our participants regarding this document.

If your organization would like to engage in TEFCA exchange via eHealth Exchange but will not be ready to fulfil the QHIN participation obligations by the end of 2023, we suggest you opt-out for now. Once policy and technical capabilities are in place, contact to opt-in and begin TEFCA exchange.

If you do not respond by 7/31/2023, your organization will be connected to the other Qualified Health Information Networks (QHINS) when the eHealth Exchange is officially designated and goes live in the coming months. At that time, your organization will be legally bound to the eHealth Exchange’s QHIN obligations, including the policy and technical requirements listed above, and testing to on-board to the eHealth Exchange QHIN. There are no additional signatures or fees required as a part of these obligations.

An organization may only participate in TEFCA exchange via a single QHIN. If your organization is active today with multiple candidate QHIN networks, you must select only one to use for TEFCA exchange. This does not preclude you from continuing to participate in multiple networks for non-TEFCA exchange.

Each QHIN may manage their TEFCA opt-in or opt-out process for their networks differently. When you receive these candidate QHIN notices, such as this one, please review each in detail and consider which candidate QHIN most aligns with your organizational needs. If you are unsure or unprepared to make an opt-out or opt-in decision within the timelines presented, we suggest you choose to opt-out of TEFCA as a first step. Then, once you have had time to consider all your options, we hope you will choose to opt-in to this new framework through the eHealth Exchange.

To help our network participants better understand TEFCA and make informed decisions, we’ve developed many educational resources publicly available on our website, and we are adding more all the time. The eHealth Exchange is also hosting exclusive educational workshops focused on the TEFCA Policy Requirements and the TEFCA Requirements Checklist. Please plan to attend at least one policy and one technical review session before deciding whether to participate in TEFCA via the eHealth Exchange. Recordings of these events will be posted on our website.

TEFCA Policy Review TEFCA Technical Review
June 20, 2023
3:00 – 4:00 p.m. ET
June 12, 2023

2:30 – 4:00 p.m. ET

July 10, 2023

11:00 a.m. – 12:00 p.m. ET

July 14, 2023

1:00 – 2:30 p.m. ET

July 24, 2023
12:00 – 1:00 p.m. ET
July 31, 2023

12:00 – 1:30 p.m. ET

Register Now Register Now


As a network originally founded by ONC, ethical exchange is embedded in all that we do to provide a safe and secure network for health information exchange. The eHealth Exchange continues to be the principal way the federal government chooses to share clinical data today, and our expanded commitment to public health pre-dates the COVID-19 pandemic. Our nationwide network is also the network of choice for nearly all state and regional HIEs. We are now preparing to offer our network participants the enhanced exchange of TEFCA for no additional fees, just as we provide Carequality access for no additional cost today.

If you have questions about the TEFCA, the anticipated eHealth Exchange QHIN, or our opt-out process, please contact



Pat Russell

Director of Policy and Governance

eHealth Exchange