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Boosting health record sharing in rural areas through TEFCA
By participating in TEFCA, Bryan Health aims to improve trust in sharing EHR data and boost interoperability in rural communities.
On Nov. 20, 2025, Nebraska-governed nonprofit health system Bryan Health announced that it would join the Trusted Exchange Framework and Common Agreement (TEFCA), a federal initiative focused on secure sharing of health information across the United States.
Participating in TEFCA allows Bryan Health, which serves close to 300,000 patients in Nebraska, Kansas, Iowa and Missouri, to expand information sharing in rural environments. It uses outreach clinics, mobile services and telemedicine to reach rural communities.
Because Epic's community has a qualified health information network (QHIN) called Epic Nexus, the move to TEFCA was relatively easy for Bryan Health, according to Krisha Ellinger, the health system's IT applications director. QHINs like Epic Nexus connect with other QHINs.
"Once approved, it was a matter of updating a couple of settings in our Epic environment, and we were live," added Jennifer Jacoby, IT applications manager for revenue cycle services at Bryan Health.
The size of small practices and the question of whether government agencies, like CMS, will regulate participation in health exchanges create potential challenges to interoperability, according to Bridgett Ojeda, vice president and CIO at Bryan Health.
However, timely access to patient information is a critical concern for smaller communities in rural areas, Jacoby noted.
"Being able to provide them with that appropriate documentation and results for those patients in a timely and efficient manner not only benefits that organization, but it benefits those patients who would otherwise have to travel to a larger organization to receive care," Jacoby said.
Jacoby noted that larger EHR platforms, like Epic, bring tools like Epic Nexus that enable easier implementation of TEFCA. She added that Epic provides a checklist that outlines the steps to implementation for providers, ensuring they're following the rules.
Adding smaller community hospitals to TEFCA
Although Bryan Health itself did not experience any significant challenges in moving to TEFCA, it will continue to maintain its TEFCA vetting processes as it works with smaller community hospitals to add organizations to the EHR, Jacoby said.
When health systems participate in frameworks such as TEFCA, they undergo vetting to ensure the networks can be trusted for data sharing. Jacoby added that it's a longer process for health organizations that don't have large EHRs.
"From a standpoint of Bryan, it was very simple, and especially with our smaller rural communities, we just included them in our instance of TEFCA, as they are supported by our EHR," Jacoby said.
The health system has been using Epic for almost a decade. Rob Klootwyk, director of interoperability at Epic, was encouraged to see Bryan Health sign on to TEFCA as part of an effort to modernize health information exchange.
"At the end of the day, this work is about making people's lives better, not just in Nebraska but nationwide," Klootwyk said in a statement. "We will continue to champion this effort around the country."
Epic had planned to get all hospitals using its EHR platform on TEFCA by the end of 2025. It had surpassed 1,000 hospitals as of summer 2025. In November, another EHR vendor, Oracle Health, also secured QHIN status under TEFCA.
TEFCA ensures that QHINs are meeting technology and security requirements and that only the right people are accessing patient information, according to Ellinger.
Additionally, exchanges such as TEFCA focus on the sharing of data beyond treatment purposes, and TEFCA incorporates standards for exchanging payment and imaging data, Ellinger noted.
How TEFCA boosts interoperability & closes rural care gaps
For Bryan Health, joining TEFCA has increased the number of its health record trading partners, which can include insurers, providers, government agencies and medical supply companies, such as Medline.
Joining TEFCA brought almost 700 additional trading partners to Bryan Health, adding to the existing number of approximately 1,500 trading partners. Also, by joining TEFCA, Bryan Health increased the number of records exchanged each month from more than 600,000 to 800,000.
"TEFCA opens the door to allow us to exchange with folks that may be participating in TEFCA, but who were not participating in some of the other exchanges that we were," Ellinger said.
Ojeda stressed the importance of having a complete view of a patient's journey when they come from another facility, such as a rural pain clinic. The goal is to avoid care gaps and maintain visibility of patient records.
"We have been a big proponent of making sure that the continuity of care for our patients are upheld, and TEFCA is just another one of those options to allow for that," Ojeda said.
For example, instead of receiving a separate fax about a patient, physicians can now view a patient record through TEFCA, Ellinger said.
"It's a great opportunity to be able to make sure that the patients and their caregivers have the information they need to take care of them," Ellinger said.
Enhanced interoperability through frameworks such as TEFCA can scale access to care in rural communities across the country, noted Jennifer Stoll, chief external affairs officer at OCHIN, a nonprofit healthcare consultancy.
"Trusted and secure data exchange is fundamental to effective care coordination," Stoll said. "OCHIN is encouraged by the potential for TEFCA to measurably improve the health of rural communities by ensuring the right information is available at the right time to help providers effectively manage their patients' health, including chronic conditions as they age."
Brian T. Horowitz started covering health IT news in 2010 and the tech beat overall in 1996.
