HHS’s Major Milestone in Health Data Exchange

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The U.S. Department of Health and Human Services (HHS) recently announced a significant advancement in health information technology, marking a new era in nationwide health data exchange. This step, governed by the Trusted Exchange Framework and Common AgreementSM (TEFCA), now operational, promises to reshape how we access and share health information.

Understanding TEFCA: A Leap Forward in Health Data Exchange

TEFCA, as envisioned by the 21st Century Cures Act, has been a multi-year, collaborative effort between the public and private sectors. Spearheaded by the Office of the National Coordinator for Health Information Technology (ONC) and The Sequoia Project, Inc., TEFCA aims to enhance patients’ access to their records and facilitate the secure exchange of electronic health information among healthcare providers and plans.

This initiative is significant because it addresses a longstanding challenge in healthcare: the efficient and secure sharing of patient information. With TEFCA, various health stakeholders, including patients, providers, public health professionals, health insurers, and others, can safely share critical health information. This exchange is pivotal for improving care delivery, advancing public health initiatives, and ultimately ensuring better health outcomes.

The Role of Qualified Health Information Networks (QHINs)

A crucial element of TEFCA is the establishment of Qualified Health Information Networks (QHINs). These entities are responsible for facilitating the network-to-network exchange of health data. The inaugural group of QHINs includes eHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies. These networks have undergone a rigorous onboarding process and are now set to start exchanging data under the policies and technical requirements of the Common Agreement.

The role of QHINs is to provide shared services and governance to route queries, responses, and messages across networks securely. Including various participants, such as patients, hospitals, health systems, payers, and public health agencies, ensures a more comprehensive and integrated approach to health data management.

Implications for Public Health Practice

The operationalization of TEFCA has significant implications for public health practice. Firstly, it streamlines health data sharing, which is crucial in responding to public health emergencies, tracking disease outbreaks, and conducting health research. Enhanced data exchange capabilities also mean improved health surveillance and better-informed policy decisions.

Furthermore, TEFCA enables a more patient-centric approach to healthcare. Patients can have increased access to their health records, empowering them to make informed decisions about their health and care. This level of transparency and accessibility is a game changer in fostering patient engagement and trust in the healthcare system.

Looking Ahead: Future Enhancements

TEFCA is not the end but the beginning of a journey towards a more interconnected and efficient health data ecosystem. Common Agreement Version 2.0 is already under development, including enhancements to support Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) based transactions. This update, expected by the first quarter of 2024, will further streamline the exchange process and enhance data interoperability across different health IT systems.


The operationalization of TEFCA by HHS is a landmark achievement in health information technology. It signifies a transformative step towards a more integrated, efficient, and patient-centered healthcare system. As we witness the roll-out of TEFCA and the onboarding of more QHINs, the potential for improved public health practices and outcomes is immense. The future of health data exchange is here, and it’s filled with possibilities for better health for all.

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