TEFCA is a US framework, established under the 21st Century Cures Act and operationalized by the ONC with a Recognized Coordinating Entity, that creates a nationwide floor for health information exchange. It defines a common set of principles (the Trusted Exchange Framework) and a legal contract (the Common Agreement) that connect networks through certified Qualified Health Information Networks (QHINs), so participants can exchange data across the country under one trust arrangement rather than thousands of bilateral deals. It became operational in 2023.
TEFCA
TEFCA is the attempt to give US health data exchange a single national trust floor. Instead of thousands of point-to-point agreements, it establishes a common legal contract and a set of certified Qualified Health Information Networks (QHINs) through which any participant can reach any other — the connective tissue above the individual FHIR and document APIs.
- A framework plus an agreement - The Trusted Exchange Framework sets principles; the Common Agreement is the enforceable contract that binds participants.
- QHINs as the backbone - Certified networks interconnect, so joining one reaches the whole.
- FHIR, arriving - Historically document-and-query based, TEFCA is incorporating FHIR-based exchange as it matures.
TEFCA is worth cataloguing because it operates one layer above what my scoring reads: I measure the FHIR CapabilityStatement a provider publishes; TEFCA governs whether a query can legally and technically cross the country to reach it. It is the difference between an API existing and a nationwide network being able to use it — and, like the rest of US health interoperability, its promise depends on the messy work of making the underlying contracts consistent, discoverable, and usable, which is exactly where the sector’s scores say the effort is still needed.
Referenced in API Evangelist papers
This regulation shows up in my published research. These reports read the machine-readable evidence provider by provider — and put this regulation in the context of a real sector.
The State of US Healthcare APIs
The nationwide exchange framework that sits above the point-to-point FHIR APIs the reports score.
Implemented by these standards
A regulation is the law; a standard is the machine-readable contract that makes it real. These are the technical standards that implement this regulation, catalogued at standards.apievangelist.com.
HL7 FHIR
TEFCA increasingly incorporates FHIR alongside document-based exchange.
