When people call or text a friend, they rarely think about whether their phones are on the same network or use the same operating system. That’s because interoperability is a given; phones connect seamlessly regardless of the manufacturer or carrier.
But in health care, electronic health record (EHR) systems are more complex than typical consumer devices and cannot exchange information as easily. This can disrupt care if doctors struggle to share their patients’ records with other physicians. It also can make it difficult for state, Tribal, local, and territorial health departments to collect and use high-quality data from health care providers and facilities—information that these agencies need to detect, prevent, and respond to infectious diseases, environmental hazards, and other threats.
Unfortunately, according to the Office of the National Coordinator for Health Information Technology (ONC), about three-quarters of hospitals experience challenges reporting data to public health agencies. Part of the issue is the complexity of interfaces and processes used for reporting health information. Adding to this challenge is the fact that parties often connect to one another individually, with each connection requiring its own set of legal and technological agreements—and with them, significant investments of staff, time, and money.
TEFCA—the Trusted Exchange Framework and Common Agreement—is designed to alleviate these problems by serving as a one-stop data-sharing hub for providers, public health agencies, payers, and other health care stakeholders. Rather than signing multiple individual agreements with different parties under different terms, they can join one of TEFCA’s qualified health information networks (QHINs). The networks cover all of their participants under agreed-upon technological standards (e.g., IHE Profiles, HL7 FHIR) and legal expectations and rules for data sharing. In turn, the networks connect with each other, allowing all TEFCA participants to easily exchange data.
Congress authorized ONC to develop TEFCA in the 21st Century Cures Act of 2016, and the nonprofit Sequoia Project is the official “recognized coordinating entity” charged with developing, implementing, and maintaining the Common Agreement.
| Rather than negotiating individual agreements and setting different interoperability standards for each data partner, TEFCA’s network of qualified health information networks (QHINs) provides common technical and legal standards that allow providers, public health agencies, payers, and other health care stakeholders to share data. |
Within two years of TEFCA’s launch in 2022, QHINs covering most U.S. hospitals and tens of thousands of providers in every state have signed up to participate in TEFCA-based data exchange. In 2024, the Centers for Disease Control and Prevention (CDC) started funding Public Health Data Modernization Implementation Centers to help public health agencies join QHINs and get real-time data from health care providers to inform local decision-making and interventions that improve community health. By next year, CDC will help public health agencies use TEFCA to collect case report data and for case investigations by providing technical assistance. Early adopters—including the health departments for Alaska, Washington, and Southern Nevada—will provide valuable lessons for their peers.
Although there are fees to join one of TEFCA’s networks and associated legal and operational costs for staff and IT equipment, it is still expected to be more efficient and cost-effective than forging multiple one-off data-sharing agreements. And by accessing a steady stream of more timely, accurate, and complete data from a wider range of sources, public health agencies will have a clearer and more up-to-date view of their communities’ health. That should improve their ability to quickly detect emerging threats, precisely identify hot spots and prevent and control the spread of infectious diseases and environmental hazards, and share clear information with health care providers and the public. Such an approach also could help reduce the health inequities that threaten certain communities and populations disproportionately.
State and federal lawmakers should recognize that significant and sustainable investment, technical support, and workforce development are needed to enable all public health agencies to take advantage of the seamless flow of health information that will be made possible by TEFCA.
Sheri Doyle is a senior officer with The Pew Charitable Trusts’ public health data improvement project, and Josh Wenderoff is a senior officer with Pew’s health programs.