TEFCA FAQs

Like Carequality, we expect that TEFCA will open access to additional exchange partners and eventually, will support additional use cases beyond query for treatment and individual access.

Joining a QHIN is not a requirement. However, if your organization is an eHealth Exchange Participant and you did not opt-out, your organization will be connected to the other Qualified Health Information Networks (QHINs). Your organization will be legally bound to eHealth Exchange’s QHIN obligations, including the policy and technical requirements, and testing to on-board to the eHealth Exchange QHIN. There are no additional signatures or fees required as a part of these obligations.

If you are unsure or unprepared to make an opt-out or opt-in decision, we suggest you choose to opt-out of TEFCA as a first step. Then, once you’ve had time to consider all your options, we hope you will choose to opt-in to this new framework through eHealth Exchange.

Once you have met all the requirements you can elect to opt-in to eHealth Exchange’s QHIN at any time.

No action or signature is required by our Participants.  eHealth Exchange signs the TEFCA Common Agreement on behalf of our Participants engaging in TEFCA exchange.

As a network originally founded by ASTP/ONC, trusted exchange is embedded in all that we do to provide a safe and secure network for health information exchange. 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. As a Designated QHIN, we can now offer our network Participants the enhanced exchange of TEFCA for no additional network participation fees, just as we provide Carequality access for no additional cost today.

You can participate in more than one QHIN if you have different technical nodes (accommodating entities that may want to connect multiple, unique data systems to TEFCA exchange).  If you join a QHIN, this does not preclude you from continuing to participate in multiple networks for non-TEFCA exchange.

Your current eHealth Exchange participation will not change.  However, if an organization is part of a non-eHealth Exchange QHIN, they will not be able to exchange with your organization. Only eHealth Exchange Participants will be able to exchange with you, just as it works today.

Currently eHealth Exchange participants can access TEFCA for no additional network participation fees, just as we provide Carequality access for no additional cost. 

eHealth Exchange periodically reviews the fees that are charged to participants to ensure that costs are covered.  Any fee changes will be communicated well in advance of when the fee change will take effect.

If your organization chooses to exchange with TEFCA, your IT team should expect additional network traffic:

• eHealth Exchange does not know what the volume increase might be so plan on monitoring network traffic closely.
• Other TEFCA QHINs will only be querying your organization for specific patients who have current and past addresses within your organization’s service area.

Exchange Purposes are the reasons for which data can be exchanged using the TEFCA framework. TEFCA Exchange is authorized for the following Exchange Purposes under the Common Agreement: Treatment, Individual Access Services, Payment, Health Care Operations, Public Health, and Government Benefits Determination. 

QHINs must support all of the Exchange Purposes, providing the technical capability to enable themselves and their Participants/Sub-participants to receive and respond to queries for all of the authorized Exchange Purposes even if the QHIN and its Participants/Sub-participants do not initiate or respond to transactions for all of the Exchange Purposes in production.

QHINs, Participants, and Sub-participants must respond to any requests transmitted for Exchange Purposes that are identified as having a “required” response in the Exchange Purposes SOP (currently responses are required for Treatment and Individual Access Services).

Initially, TEFCA does not require exchange using FHIR.  The FHIR Roadmap for TEFCA Exchange can be found here:  TEFCA FHIR Roadmap.

The RCE Onboarding and Designation SOP requires each QHIN candidate to have a representative and participatory group to oversees strategic, operations and management issues related its QHIN and provides governance to its QHIN Participants.

The QHIN Governance Committee operates as a consensus body who provides deliberations and decisions over the following “Governance Functions”:

• Technical framework of the Designated QHIN
• The resolution of disputes regarding use of eHealth Exchange QHIN
• eHealth Exchange QHIN security incident(s)
• Enforcement of eHealth Exchange QHIN participant compliance with all flow-down requirements
• Change management to implement changes for the eHealth Exchange QHIN

Visit QHIN Governance to review a listing of current committee representatives.