What’s the Hype about TEFCA? A Quick Guide for Healthcare Leaders on What it Can & Can’t Do 

TEFCA is the health IT acronym on everyone’s lips. But what exactly is it? And more importantly, why does it matter for healthcare organizations? 

First, TEFCA stands for the Trusted Exchange Framework and Common Agreement. TEFCA is a public-private effort to standardize healthcare data exchange on a national scale. A total of seven qualified health information networks (QHINs, pronounced “Q-hins”) are live on TEFCA, as of February 12, 2024. 

These QHINs are different from existing health information exchanges and networks (HIEs/HINs) because of their national scale and standardization: Most HIEs/HINs are expected to plug into QHINs, and all QHINs interface with each other. That means provider organizations can now connect and begin exchanging health records with virtually any other provider also plugged into the network. And, since QHINs will evolve as TEFCA evolves, their value will only grow. The second version of the framework is already set to expand mandatory data exchange for individual patients and “healthcare operations,” which brings patients and health insurers into the mix as well (but we’ll get to that later). 

Suffice to say, TEFCA is kind of a big deal. It’s another step toward establishing the level of interoperability necessary for healthcare organizations to realize the true potential of health data. But “step” is the key word — TEFCA is no silver bullet. Here’s what healthcare leaders need to know about TEFCA today — and how to position your organization for success:  

1. It’s time for an interoperability strategy.

Putting the regulatory details aside for a moment, the healthcare industry is changing rapidly, which is an important context for understanding TEFCA. The industry’s new entrants — virtual, urgent and concierge care providers — know data, and they know consumers. Their businesses were built on modern technology platforms. As a result, they’re not encumbered by old ways of connecting backend systems to frontend workflows. Their technology allows them to offer more seamless consumer experiences and provides built-in agility so they can better meet their clinical and financial objectives as healthcare continues to evolve. 

For legacy healthcare organizations, this means the game is changing. The days of relying on clinically integrated networks to survive are gone. Consumers have more care choices than ever before, and legacy healthcare organizations are competing directly with digital giants to be the go-to for health information and services.  

Developing a patient-centric interoperability strategy can help level the playing field. Legacy organizations already have the data AND the established trust, they just need to use these tools more effectively to activate patients. Seamless data exchange promotes access to real-time, comprehensive patient information, which in turn supports enhanced care coordination, reduces duplication and powers the proactive insights and personalized experiences people want and deserve.  

Most importantly, interoperability is the key to long-term growth and sustainability. It unlocks business value by increasing workforce efficiency, alleviating administrative burden, and improving care quality. Collectively, these solutions will also support more accurate risk-adjustment, so organizations are better prepared to shift to value-based care. This is exactly what policymakers are working to help the industry achieve with TEFCA and their other interoperability mandates.

2. TEFCA opened a new pathway to interoperability.

Here’s how it works: Every QHIN can interface and respond to data queries from the others, so healthcare organizations only need to participate with one network to benefit. Under TEFCA, providers can query and exchange data for a variety of purposes, including treatment, payment, operations, public health, government benefits and individual access services, or patient-initiated data requests. Currently TEFCA only requires responses for treatment, but some of the QHINs are already surpassing these expectations. Notably, KONZA — a QHIN serving consumers in Kansas, Missouri, Louisiana, Georgia, South Carolina, New Jersey and Connecticut — is already responding to patient-initiated data requests. Also, Commonwell Health Alliance has long responded to patient data requests.

The real promise behind TEFCA is that it helps overcome the fragmented way in which patients experience care, which is a direct result of siloed data and technology systems. The average patient diagnosed with a chronic disease has health data spread across tons of different apps, portals, and provider organizations. Managing a chronic condition is hard enough; forcing patients to log into dozens of accounts and remember dozens of passwords only adds insult to injury.  

TEFCA helps address this by ending what we like to call “portalitis.” Under TEFCA, consumers will be able to painlessly and securely access their health data, and control how it’s used for downstream services of their choice. (Note, consumers will still have to verify and authenticate themselves through a trusted digital ID service provider to access that data. Digital IDs will become more commonplace under TEFCA, easing log-in friction points. Eventually, when patients won’t need to remember their logins anymore to get their health data or access healthcare services digitally, we’ll end “portalitis” forever.) 

In this way, TEFCA is a major first step to patient-centric interoperability — and legacy organizations need to take advantage of it or they will lose ground to new entrants. 

3. TEFCA is just a step in the right direction.

Here’s the catch: TEFCA is voluntary, and we are only in the early stages. TEFCA’s long-term success is heavily reliant on participation. Ideally, the framework will become more valuable over time. But right now, that value is still hypothetical. 

Another potential risk is cost. QHINs are not funded under TEFCA, so they have to charge their customers to cover their costs and earn a return to be financially sustainable. And because TEFCA launched on legacy infrastructure (CCD-A and IHE), there’s a higher data processing burden that is likely to make TEFCA interoperability more costly.

The intent was to get TEFCA up and running, and then move toward more updated standards. The good news is the next version of TEFCA will support HL7 FHIR, or Fast Healthcare Interoperability Resources, which is shorthand for the most up-to-date standards for data exchange (and is critical for consumer-focused, agile-minded organizations). The key distinction between old and new is the ability to extract specific data elements on the fly, significantly reducing the data processing burden and making data more fluid. These so-called “open standards” support integrations between different systems and healthcare partners, which will untether healthcare organizations from legacy technology systems built on proprietary standards.

FHIR-based Application Programming Interfaces (APIs) truly open a world of possibilities for health systems. With APIs, a health system can freely accept data from another health system — or a pharmacy, lab, or payer. They can also exchange data directly with patients who have consented to share their information through the patients’ right of access. This not only allows health systems to access more dynamic patient information, but it also allows them to do it at no cost, because patients cannot be charged to access their own data. To put it simply: FHIR-based APIs are faster, more flexible, and more affordable, making TEFCA 2.0 all the more valuable. 

It’s also worth noting that TEFCA isn’t the only framework marching the industry toward FHIR. The recent HTI-1 final rule doubles down on the mandates for FHIR-based APIs, underscoring the importance of open standards interoperability as the future of healthcare, with or without TEFCA. These regulations aim to support a shift from system-centric to patient-centric care by supporting choice and competition in the marketplace.   

The big Takeaway is healthcare organizations cannot afford to wait for TEFCA to solve their interoperability challenges. 

At the end of the day, data exchange is the means and not the end goal. The more a healthcare organization knows about a patient, the better they can meet their needs. They can recommend the right services, at the right time, in the right venue of care — and, with the right technology in place, guide patients to take the next best action, like self-scheduling an appointment without picking up the phone or making sure Mom has her medication refilled on time. This will require the exchange of full patient records, as well as the ability to collect data from a broad variety of sources and then extract specific data points, analyze them, surface personalized insights, and use them to make care connections. 

Laying the foundation for a multi-threaded interoperability strategy today will position health systems to grow alongside nontraditional players and prepare them for the opportunities of tomorrow. 

Get Started 

Find out how b.well can help your health system hit the ground running with TEFCA and FHIR-based APIs by connecting with our team here.

PS — Want to learn more about TEFCA? Check out this in-depth interview with Jill DeGraff, b.well’s senior vice president of regulatory, featured in Healthcare IT Today

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