TEFCA and QHINs: Interoperability 2
by Ben Rosen, Sr. Client Success Manager, Netsmart
Interoperability
What you need to know and how it affects you Part 2
For over two decades, tech companies and government agencies have been moving toward the goal of interoperability in healthcare technology. At long last, standards and protocols are in place — and continually being improved — to support open data exchange networks. As a result, healthcare providers, including human services, post-acute providers, and specialty practices, have more opportunities to participate in alternative payment models and adapt more readily to the evolving payment landscape.
This is part two of a four-part series covering the forces that are driving interoperability, as well as the future vision of open networks, and what it all could mean to your organization. Read Part One Here.
Interoperability in Healthcare
The creation of TEFCA and QHINs
TEFCA (Trusted Exchange Framework and Common Agreement) is a national framework designed to enable seamless, secure sharing of health information across organizations. With respect to EHRs, this framework simplifies data exchange with other providers, payers and public health entities while enhancing compliance with interoperability requirements. TEFCA is touted as a nationwide federal and private data exchange network.
End goal
One of TEFCA’s main goals is to standardize data sharing, therefore reducing the complexity of managing multiple connections and enhancing the interoperability of your EHR with other systems nationwide.
TEFCA was created by the U.S. Department of Health and Human Services’ Assistant Secretary for Technology Policy (ASTP). The ASTP is contracting with the Recognized Coordinating Entity (RCE), The Sequoia Project. The RCE is tasked with governing and maintaining the operations of the entities who are electing to implement the TEFCA network, these entities are referred to as Qualified Health Information Networks (QHINs).
QHINs
The certification process
QHINs are the entities that build the frameworks to allow data exchange as specified by TEFCA and facilitate the national exchange of health information. A single QHIN may represent dozens or even hundreds of healthcare providers, referred to as participants or sub-participants, across sectors (i.e., acute, human services, post-acute) public health agencies, health IT vendors and payers.
Applicants must build their TEFCA connection, which is then subjected to rigorous technology and security testing. QHIN applicants must also sign the Common Agreement that is countersigned by The Sequoia Project. These rigorous standards have a time limit: Each QHIN who applies must have their network built, tested and designated by the ASTP and RCE within 12 months of the application acceptance date. As of this writing there are eight designated QHINs and two candidate QHINs.
Benefits of participating in a QHIN
- Streamlined Data Exchange
- Compliance with Federal Interoperability Mandates
- Access to Broader Patient Data
- Improved Care Coordination
The market is already seeing regulatory rules and guidance tied directly to TEFCA. For instance, HTI 1 rule laid the groundwork for TEFCA and the HTI 2 rule is expanding on the process for designation, as well as codifying definitions and use cases to be exchanged via QHINs. Overwhelmingly, one of the biggest benefits to using a QHIN will be the increased types of data exchanged via the network.
The Same, but Different
Data exchange via TEFCA will look different than what we are used to with other nationwide networks today, such as Carequality, EHealthExchange or CommonWell. Via TEFCA, QHINs will exchange more robust types of data, referred to as Exchange Purposes, and will deal with higher volumes as a network. A few examples of these Exchange Purposes are clinical documentation (CCD-A), benefits determination data, public health research data, and even lab data, just to name a few.
Another benefit will be seamless connectivity. Other QHINs should integrate with EHRs to facilitate data exchange, acting as a hub that connects your system with other networks, providers and stakeholders.
Coming soon in Interoperability Part 3: Not all QHINs are created equal. How to choose the one that’s right for you.
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Ben Rosen is a senior client success manager and business unit owner for the interoperability solution suite at Netsmart. With more than a decade of healthcare experience, Ben has led numerous initiatives to integrate healthcare systems and enhance data sharing across the care continuum. His dedication to advancing healthcare interoperability drives his active involvement in industry initiatives and standards organizations, where he provides insight for frameworks such as HL7 FHIR, USCDI and others. Ben holds a Bachelor of Science in kinesiology from Kansas State University and a Bachelor of Science in nursing degree from the University of Nebraska Medical Center.
©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in the Netsmart blog and is reprinted here with permission. For more information or to request permission to print, please contact Netsmart.
