https://www.techtarget.com/searchhealthit/feature/Epics-TEFCA-expansion-lessons-from-1000-hospitals-and-whats-next
Epic, EHR provider for 48% of the nation's large health systems, has surpassed 1,000 hospitals connected to the Trusted Exchange Framework and Common Agreement (TEFCA) through Epic Nexus.
For Epic, interoperability is personal. After a patient managed by CEO Judy Faulkner's husband, pediatrician Gordon Faulkner, died when their medical history was inaccessible in an out-of-town emergency department, Judy launched Care Everywhere. The network connected Epic's sites to let patients' records follow them nationwide.
"Gordon told Judy, if they would have known about the medical history, they would have known what to do," said Rob Klootwyk, director of interoperability at Epic. "That was the start of Care Everywhere."
Despite the success of Care Everywhere and other public and private efforts, interoperability in the U.S. remains a fragmented patchwork of networks. Now, TEFCA aims to unify it. "TEFCA is the coalescing of all of that complication. It's going to become the litmus test for the country of, 'Are you connected?'" said Klootwyk. "Our goal remains — maybe a little bit lofty — to get 100% [of our hospitals] live by the end of the year."
With 183 additional organizations pledged, the EHR vendor is set to more than double its current participation. Epic reports about 15% of its customers are still evaluating joining.
For Stanford Health Care, which had already been exchanging data across multiple networks, TEFCA was the "last mile" — a way to access data from providers not previously reachable. "We were early adopters for TEFCA because it was an extension of what we had already been working on," said Dr. Matthew Eisenberg, Stanford's associate chief medical information officer.
Stanford's patients and providers are already benefiting. "We are seeing data flowing we hadn't before," Eisenberg said. "Medicine is an information business. If you have the full story, you're more likely to make the right decision."
Because of Epic's previous interoperability work, connecting to TEFCA is straightforward technically. "It's basically plug and play," said Klootwyk.
But while the technical lift is minimal, the legal and compliance process can be more time-consuming. Health systems must complete participation agreements and vet each of their sub-organizations individually. "It's a lot of flow-down," Klootwyk said. "But once they're live, they're plugged in."
That vetting matters, given the responsibility that comes with sharing health data nationally. "Once you get in, you have the keys to all of this," said Klootwyk. Under HIPAA, each organization is accountable for ensuring data is shared appropriately for treatment purposes. "There has to be a licensed provider involved with an individual patient delivering care," explained Eisenberg. "Are you billing for those services? Do you have a notice of privacy practices? What are you going to do with that data?"
Another challenge is transitioning from existing networks like Carequality without duplication. "We joked about it internally as a 'Ghostbusters' moment — don't cross the streams," said Klootwyk. To address this, Epic designates TEFCA as the preferred network while retaining existing connections as backup.
"The goal is more data, not more noise," Klootwyk said.
Epic's customer support teams are assisting hospitals that haven't yet joined TEFCA as they consider participation. Next, the vendor will focus on expanding data exchange use cases beyond treatment, including closed-loop referrals, patient applications for self-access, payer and public health data exchange, and image exchange. "Image exchange vendors were largely not actors in health, but they have key information about patients," Klootwyk highlights.
With Epic's milestone, the company hopes for a more connected healthcare system. As Eisenberg put it: "I just want people to learn about it, participate. If you're not already exchanging information for the betterment of patients, then get involved."
Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.
02 Jul 2025