eHealth Exchange is a Designated QHIN under TEFCA

eHealth Exchange is among the country’s first Qualified Health Information Networks (QHINs) to achieve designation status under ONC’s Trusted Exchange Framework and Common Agreement, also known as TEFCA.

We’re ready to help HIEs, health systems, digital health platforms, and others who want to connect to the federally-endorsed TEFCA network.

What Does TEFCA Mean For Your Organization?

TEFCA is designed to scale EHI exchange nationwide and help ensure that health care providers, HINS, health plans, individuals, and many more stakeholders have secure access to their electronic health information when and where it is needed. Currently, participation in TEFCA is voluntary. The benefits of TEFCA as outlined by the RCE include the expected benefits of interoperability:

Many eHealth Exchange network participants report these benefits today, in addition to streamlined disability determinations, simplified public health reporting, and reduced time and cost to connect with new data exchange partners. The RCE also predicts that TEFCA participants will see reduced hassle and cost of having to participate in multiple health exchange initiatives, though TEFCA is not meant to replace existing networks today.

TEFCA logo

What is TEFCA? TEFCA outlines a common set of principles, terms, and conditions to support the development of a Common Agreement that would help establish a floor for universal interoperability and a federally endorsed on-ramp for nationwide exchange of electronic health information (EHI) across disparate health information networks (HINs).

The non-profit The Sequoia Project was selected in 2019 to be the Recognized Coordinating Entity (RCE) responsible for developing, implementing, and maintaining the TEFCA in collaboration with ONC.

TEFCA Resources for eHealth Exchange Participants

TEFCA Checklist

(Includes Technical Obligations)



TEFCA QHIN Frequently Asked Questions

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 do not opt-out 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, and testing to on-board to the eHealth Exchange QHIN. There are no additional signatures or fees are required as a part of these obligations.


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’ve had time to consider all your options, we hope you will choose to opt-in to this new framework through the eHealth Exchange.


Once you have met all the requirements you can elect to opt-in to the 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 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.

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.

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 we plan 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. 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:


  • The 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.

We’re unfortunately not sure precisely when eHealth Exchange’s prospective QHIN might go-live with TEFCA, but we hope it happens by late 2023. 


Remember that:


  • eHealth Exchange and other QHINs must first complete TEFCA testing.
  • Multiple QHINs must complete TEFCA testing and be ready to go-live simultaneously.

Initially TEFCA requires you to exchange for treatment and individual access services. TEFCA plans on expanding required use cases in the future. Although there is no exact timeline or finalized technical specifications, we expect to payment, operations, public health, and government benefits determination use cases to be added to TEFCA. It is important to note you will have to respond to any additional use cases required by TEFCA in the future. 

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.

Our Journey to QHIN Designation

After a rigorous application process combined technical infrastructure and policy changes, as well as conformance and production testing, eHealth Exchange has become a Designated QHIN. Follow our QHIN journey as we share updates below:

Pioneering Network Participants To Pursue TEFCA

Thank you to the network participants who have announced intentions to be among the first participants in eHealth Exchange’s QHIN.

These pioneers represent 11 HIEs serving up to 126 million patients across 14 states and Washington, DC. 

Interested in joining us to expand access and connectivity to a broad range of organizations, public and private?

The eHealth Exchange Can Help

eHealth Exchange has achieved QHIN Designation on behalf of its network members. eHealth Exchange has worked closely with the RCE and ONC to implement the technology and policies necessary and has passed all testing requirements to become Designated QHIN. This means a seamless addition of TEFCA for its members that choose to opt-in to TEFCA-based exchange. On the fence about opting-in to TEFCA? No problem! eHealth Exchange participants are already enjoying the time and money saving advantages for a nationwide, secure health information network with innovative use cases.

Have Questions About TEFCA and eHealth Exchange?

Have questions regarding TEFCA, or eHealth Exchange as a Designated QHIN? Click the button below and contact us with your questions.