The TEFCA Updates 2022

The Trusted Exchange Framework and Common Agreement (TEFCA), is the primary constituent in the ONC’s roadmap for nationwide HIT interoperability. Since its introduction in 2018, it has been under review and was only published in the dawning weeks of 2022. TEFCA’s publication brings with it notable changes for HIT developers seeking to transform into Qualified Health Information Networks (QHINs). In this blog, we provide you with an essential overview of the Updates.    

The healthcare industry’s current need of the hour is to govern the approach for accessing patient health information for patients, providers, and payers. Electronic Patient Health Information (ePHI) is currently located on disparate health information networks, vastly hampering ease of access and transfer. TEFCA addresses this need by supporting multiple data exchange schema through different health information networks.  

The Year 2022 brings significant updates to TEFCA in the form of Standard Operating Procedures (SOPs), QHIN Technical Framework (QTF) (version 1), and the FHIR Roadmap for TEFCA Exchange. Here’s a look at the updates. 

The Standard Operating Procedures (SOPs) 

The TEFCA SOPs establish the criteria for HIT development companies to deploy QHIN staff and technology. The SOPs also orchestrate the exchange of ePHI through written procedures that are categorized under the following topics:  

  • Advisory Groups: The Advisory SOP introduces the general rules for establishing ‘Advisory Groups.’ These groups are distinct stakeholders who guide the Recognized Coordinating Entity (RCE), the parent organization responsible for developing, implementing, and maintaining the common agreement component of TEFCA. 
  • Conflicts of Interest: All the groups that help the RCE to operate under ONC rules are collectively called Deliberative Bodies. The conflicts of interest SOP directs the RCE and the deliberative bodies to resolve all conflicts of interest by laying down strict guidelines. 
  • Dispute Resolution Process: TEFCA provides QHINs and its governing councils (including the RCE), collaborative means to resolve disputes through the Dispute Resolution process SOPs. The dispute resolution process SOP establishes procedures and the directions for stakeholders to form Dispute Resolution Councils for dispute resolution.   
  • Governing Council: The governing council SOP states the composition, conduct, and functions of governing bodies involved in TEFCA interoperability operations. It also regulates the confidentiality of all information to which various departments have access. 
  • QHIN Security and Insurance Coverage: The QHIN security SOP directs all QHINs to get cyber risk and technology errors insurance and to maintain pre-determined financial reserves to self-insure against cyber-incidents. 
  • Transitional Council: The common agreement component of TEFCA creates a transitional council to support the RCEs decision-making process. The transitional council SOP also furnishes regulations for a transition plan to promote transition councils to governing councils after the first set of QHINs have been designated. 

The QHIN Technical Framework (QTF) 

The technical framework establishes the infrastructure model and the networking requirements that QHINs must demonstrate to achieve ePHI exchange. It also serves as a robust roadmap in the ONC’s quest for semantic interoperability of HIT systems and HIT vendors’ hunt for interoperability solutions in healthcare.    

The following are the areas that the QTF covers to guide HIT development companies to establish the technical infrastructure to become QHINs.   

  • Connectivity: Covers the fundamentals for QHIN-to-QHIN data transfer, including the technical requirements for the error-free transfer of ePHI. 
  • Authentication: Expands on the mechanisms and entities (including personnel) in the process of authenticating ePHI for exchange.  
  • Authorization: The QTF’s guidelines for authorization determine the user’s eligibility to access the requested network or service. 
  • Document Query and Retrieval: The processes for locating and retrieving ePHI including specific information in the form of documents are included in this section of the QTF. 
  • Patient Identity Resolution: Outlines the technological processes required to ascertain patient identity before allowing access to the ePHI exchanging networks. 
  • Directory Services: The directory services of the QTF enable entities associated with the ePHI transfer mechanisms to manage information associated with healthcare organizations. 
  • Auditing: The auditing section of the QTF outlines the procedures to troubleshoot and help healthcare facilities track improper use of the technological framework. 
  • Error Management: Provides methods to ascertain the cause of system errors with all other appropriate details to resolve network issues. 

FHIR Roadmap for TEFCA Exchange 

TEFCA emerges as a strong catalyst for the adoption and acceleration of FHIR as the holy grail of HIT interoperability. But the current FHIR implementation projects focus mainly on the point-to-point exchange of FHIR APIs. They dont consider the bigger picture of networks for nationwide ePHI transfer.   

The FHIR roadmap for TEFCA exchange clears the clouds of doubt by endorsing two important paths towards data exchange through FHIR. They are as follows: 

  • Facilitated FHIR exchange: Designated QHINs’ network infrastructure will facilitate unbrokered FHIR API exchange between various pre-identified Participants and Sub-participants, who can be part of other QHIN as well.  
  • Brokered FHIR exchange: Going by the way of other Interoperability Standards, such as EDI, usage of FHIR APIs with QHIN by Participants and Sub-participants can be chargeable to both parties. 

Sail Through The TEFCA Journey With Us 

Upon scrutiny of the TEFCA resources on the RCE website, one obvious conclusion is the decision-makers of HIT development firms will need herculean support from technology experts in the healthcare IT space.  To be precise, both brokered and unbrokered FHIR exchange workflows require extensive healthcare software development and HL7 FHIR expertise.   

With multiple ONC implementation guides to refer to (ranging from CCDA, USCDI, and FHIR API), the scale and complexity of TEFCA implementation are guaranteed to be massive and vast. However, only powerful technical partnerships and synergy of thoughts can help HIT development. An experienced technical partner well versed with US healthcare regulations and healthcare software development could supplement your strategy to quality as a QHIN. 

Email us and connect with our team of HIT wizards today at  Nalashaa can help you sail through your TEFCA Health IT journey in 2022 and beyond! 


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Puneeth Salian

Puneeth Salian

A writer in Healthcare domain, who is also a science and technology enthusiast. Enjoys creating interesting pieces that elucidate the latest Healthcare IT trends and advancements.
Puneeth Salian

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