The Trusted Exchange Framework and Common Agreement (TEFCA) is an initiative from the Assistant Secretary for Technology Policy (ASTP), formerly known as the Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health and Human Services (HHS), that aims to establish a standardized, secure, and interoperable framework for health information exchange (HIE) across the United States. Launched as part of the 21st Century Cures Act, the TEFCA framework focuses on improving the nationwide exchange of electronic health information across various health information networks (HINs).
At its core, TEFCA serves as a “network of networks,” connecting healthcare organizations, providers, patients, payers, and public health agencies (PHAs) for seamless data sharing. This is accomplished through Qualified Health Information Networks (QHINs), which serve as the backbone of this system and leverage their direct connection to each other to facilitate nationwide interoperability. Each QHIN represents various health systems, HIN, federal care providers, PHAs, payers, and health IT vendors, expanding the data sources that TEFCA participants and sub-participants can access.
The TEFCA framework also includes a common set of policies, standards, and practices to streamline the flow of health data between these different systems. In November 2024, the Common Agreement for Nationwide Health Information Interoperability (Common Agreement) Version 2.1 was published. This agreement describes the technical and legal requirements, as well as expectations, for nationwide data sharing between networks.
TEFCA is managed by the Recognized Coordinating Entity (RCE), the Sequoia Project, which develops, updates, and oversees its implementation and governance. The RCE also solicits and reviews applications from HINs seeking QHIN status and signs the Common Agreement with each designated QHIN.
What Does TEFCA Mean for Public Health?
Public health depends on timely, accurate data to monitor disease outbreaks, develop targeted health interventions, and address population health concerns. However, siloed data systems often hinder these efforts. TEFCA addresses this issue by facilitating real-time health information data exchange between PHAs and their partners. Through TEFCA, PHAs can access real-time critical health data, such as electronic case reporting (eCR), immunization reporting, syndromic surveillance, and lab reports. Over the past year, PHAs along with various partners, including the ASTP, CDC, and QHINs, have been working to demonstrate public health use cases for TEFCA. On July 1st, 2024, two public health use cases went live:
- eCR: Through this use case, participating PHAs will receive eCR via the TEFCA network from participating healthcare organizations.
- Individual query: through this use case, participating PHAs can query individual-level data through TEFCA for case investigations.
TEFCA also aligns with other federal public health modernization efforts, such as CDC’s Data Modernization Initiative (DMI) and Public Health Data Strategy, which seek to improve public health data systems, promote interoperability, as well as improve data sharing between healthcare and public health. Along with similar initiatives, these programs aim to strengthen the public health infrastructure and its readiness to meet 21st-century challenges.
As TEFCA evolves, so does its potential to transform public health. By encouraging collaboration and removing data silos, TEFCA enables public health officials to make data-driven decisions that strengthen our public health response and improve community health.
For more information about TEFCA, visit the ASTP’s official TEFCA page here and blog page HealthITbuzz.
Are you an LHD working on TEFCA? Share your experience with NACCHO by emailing [email protected]
References:
- ASTP/ONC, Trusted Exchange Framework and Common Agreement (TEFCA), healthit.gov.
- CDC, Data Modernization Initiative (DMI), cdc.gov.
- Sequoia Project, TEFCA Recognized Coordinating Entity (RCE), sequoiaproject.org.
