Trusted Exchange Framework and Common Agreement (TEFCA)

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Trusted Exchange Framework and Common Agreement (TEFCA) outline a set of principles, terms and conditions to facilitate the development of health information exchange network across the nation[1]. The process engages Government, private and public entities to develop a common agreement to allow healthcare stakeholders to exchange information across health information networks (HIN).

The Trusted Exchange Framework (TEF)

The first draft of TEF was published by the ONC (Office of the National Coordinator for Health Information Technology) in January 5, 2018[2]. It provides a framework and vision for how qualified health information networks (QHIN) and the recognized coordinating entity (RCE) function. The framework focused on:

  • Empowering individuals to use their Electronic Health Information to the fullest extent;
  • Enabling providers and communities to deliver smarter, safer, and more efficient care; and
  • Promotes innovation at all levels[3].

TEFCA establishes QHIN to standardize HIE inter-connectivity. Each health information network has to enter into agreements with TEFCA which facilitates the standardized methodology to share information. Once they have made these agreements they are able to become a qualified health information network (QHIN)[4].

A recognized coordination entity is established to act as the governing body of multiple QHINs. Of note, on September 3, 2019 ONC awarded The Sequoia Project a cooperative agreement to serve as the RCE[5].

Draft 2 was published in April 19, 2019[6]. The second draft addresses principles for trusted exchange networks that apply to HINs. It expanded the definition to allow for a larger application pool to be considered for QHIN[7].

The Minimum Required Terms and Conditions (MRTCs)

These are the mandatory terms and condition that bind those who elect to sign the Common Agreement. Under MRTC draft 2, the Common Agreement specifies greater privacy and security protections for all groups who elect to participate. This will also cover entities not covered by Health Insurance Portabilty and Accountabilty Act (HIPAA)[8].

The QHIN Technical Framework (QTF)

The QHIN technical framework (QTF) provides additional information regarding the technical requirements to exchange information among QHINs.



Submitted by Erick Christensen