The Role of State and Regional HIEs Under TEFCA

Beth Plumptre
November 30, 2023

When the Office of the National Coordinator (ONC) published the Trusted Exchange Framework Common Agreement (TEFCA) in 2022, it presented this structure as a framework to transfer health information across clinical settings efficiently. TEFCA provides the foundation for the seamless exchange of patient data to support care continuity throughout the country.

However, to operate the information exchange structure, this framework requires the participation of established data-sharing systems like health information exchanges (HIEs) to promote nationwide health information interoperability.

With the ultimate goal of ensuring the secure access and retrieval of patient information, HIEs benefit from the common interoperable data standards and specifications applicable under TEFCA. In this guide, we’ll explore the vital position HIE participation holds in this framework.

What to Know about TEFCA

Pre-TEFCA, the available structures for health data exchange often complicated what should have been readily accessible patient information. While standardization is now common practice for current health information technology systems, previously hospitals, clinics, insurers, and other relevant players would use incompatible technology systems that often struggled to communicate effectively to transmit basic clinical information.

By providing a Trusted Exchange Framework, a patient visiting California from Connecticut can walk into a hospital, safe in the knowledge that their electronic health information can be readily and securely transferred from their primary care electronic health record (EHRs) systems.

This easy collaboration is made possible through a Common Agreement adopted by TEFCA participants where the framework's standardized terms, conditions, and principles are defined. This initiative by TEFCA is part of the broader promise of the 21st Century Cures Act to enhance nationwide interoperability. Within the framework are HIEs whose mission to support provider and individual access services can extend beyond their immediate geographic limits by participating in TEFCA.

How do HIEs Support Data Exchange?

A health information exchange is a secure electronic network that enables providers, healthcare organizations, and other authorized entities to readily access and exchange health data. These networks have set goals: interoperability between health systems, care coordination, and eventually improved individual access services so healthcare truly reflects a patient-centric landscape.

HIEs connect hospitals, clinics, laboratories, pharmacies, and EHRs, allowing providers to tap into a nationwide health information system, making sure that data sharing has fewer hurdles to cross through care coordination. HIEs can operate seamlessly because of their use of standardized protocols like health level seven (HL7) provisions, which stipulate how data should be structured, transmitted, and processed between various systems.

Also promoting interoperability between these HIEs are tools like Metriport's API, which simplifies the access and retrieval of patient health information from HIEs and all their participants.

All these data-sharing interactions have been made possible and supported under TEFCA.

What is the Role of State and Regional HIEs Under TEFCA?

While HIEs provide an internet for healthcare data sharing, these networks are commonly state, local, or regional organizations that support the safe exchange of protected health information. HIE integrations and information sharing require authentication mechanisms and identity verification to ensure only permitted users have access to valuable health information, in line with TEFCA security standards. With local health settings covered; the combined efforts of individual HIEs are part of the building blocks of nationwide TEFCA coverage.

To keep data open for exchange purposes, HIEs ensure that collected information complies with the TEFCA principles of standardization. Here, networks like eHealth Exchange are mandated to prioritize health information technology standards for interoperability that are federally recognized and applicable as industry standards, policies, and best practices.

But while HIEs support data exchange on a state or regional level, Qualified Health Information Networks (QHINs) operate nationally to facilitate seamless health information flow across states and regions. Both CommonWell Health Alliance and eHealth Exchange are among the first designated QHIN under TEFCA. 

Like HIEs, QHINs work to establish common data standards and specifications so health information is consistently structured for easy nationwide exchange, while promising to support non-treatment use cases in the future, such as Operations and Individual Access Services.


State and regional Health Information Exchanges (HIEs) are indispensable for achieving the goals of the Trusted Exchange Framework and Common Agreement (TEFCA). They serve as vital networks for secure and interoperable health data exchange within their communities, edging health systems closer to nationwide networks of trust. 

These networks play a pivotal role in enhancing care coordination, data accessibility, and patient-centric healthcare delivery. By following TEFCA's common agreements and interoperability standards, they contribute significantly to building the foundation of health information exchange, ultimately benefiting patients, healthcare providers, and organizations alike.

Get in touch with the Metriport team today to learn more about the power that HIE participation can unlock for your organization.

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