Getty Images/iStockphoto

Who are the TEFCA Qualified Health Information Network (QHIN) Candidates?

The TEFCA QHIN applicants' health information networks collectively process billions of annual transactions across all fifty states.

Earlier this month, ONC approved the first group of Qualified Health Information Network (QHIN) candidates to implement the Trusted Exchange Framework and Common Agreement (TEFCA).

TEFCA aims to create a network of networks to support national healthcare interoperability. The Trusted Exchange Framework is a set of non-binding, foundational health information exchange principles, while The Common Agreement establishes the technical infrastructure and governing approach to support health data exchange.

Collectively, the QHIN applicants have networks that cover most hospitals and tens of thousands of providers, according to an ONC HealthITBuzz blog post.

Once ONC onboards the six candidates, they will officially be designated QHINs under TEFCA. Read on for perspectives from the prospective TEFCA QHINs.


CommonWell Health Alliance operates a health information exchange (HIE) network of 35,000 clinical sites and about 194 million registered patients.

According to Paul Wilder, executive director of CommonWell Health Alliance, TEFCA's goal is similar to what CommonWell set out to accomplish when it formed ten years ago.

"The way TEFCA is designed was kind of our vision from the beginning," Wilder told EHRIntelligence in an interview. "The primary difference is TEFCA acknowledges there are multiple versions of CommonWell that should interoperate, and we have zero issue with that. There has to be some level of consolidation to make this work."

"We're not inherently hyper-competitive about this," he emphasized. "QHINs are going to compete, and that competition is there to keep us honest and make sure we're providing better services every day. There's enough growth for everybody, and we're looking forward to everybody being the best QHIN they can be and making this TEFCA thing work."

Wilder likened TEFCA to a "national highway" for HIE, which should streamline interoperability efforts. Currently, health IT vendor participation in interoperability networks varies, which can be confusing for healthcare organizations.

TEFCA will be the final destination for health data regardless of vendor, similar to how cell phones can connect no matter the carrier, he said.


eHealth Exchange is a network of networks connecting federal agencies and non-federal healthcare organizations with over 14 billion annual transactions.

"We have a hub and spoke technology, so our participants have a single set of APIs that allows them to connect all the other players in our network," Kathryn Bingman, VP of interoperability adoption at eHealth Exchange, said in an interview.

According to Bingman, if eHealth Exchange is officially designated a QHIN later this year, all its participants will become part of the network at no added cost. Participants who don't want to become part of the eHealth Exchange QHIN may opt out in writing within 60 days of notification.

"We think that TEFCA has the right goals," she said. "It provides a great technical floor for interoperability, rigorous standards, and simplified and secure connectivity."

"We spent a lot of time unpacking the TEFCA common agreement and the SOPs, and we have developed protocols to provide additional details about the required flow-downs and guidance on what our participants will need to do to comply," Bingman said. "We want everybody to participate in TEFCA. That's our ultimate goal."

She pointed out that while participation in TEFCA is currently voluntary, eHealth Exchange is "confident that CMS is going to provide some incentives and maybe even require that people participate in the future."


EHR giant Epic applied for QHIN status through its subsidiary, Epic TEFCA Interoperability Services. According to Matt Doyle, R&D team lead at Epic, participation in TEFCA was a logical next step for the vendor.

"Interoperability is in our DNA, and it's in our customers' DNA," Doyle said in an interview. "They see this as valuable to patients and providers both, and that's a win-win for everyone involved."

In 2008, Epic launched its CareEverywhere network, which supports health data interoperability across the vendor's US customers (1,700 hospitals and 34,000 clinics). Epic was also a founding member of the Carequality interoperability framework, which supports national HIE across disparate EHR vendors.

"One of the great successes of Carequality is that 70 percent of hospitals participate and can share data in real time," Doyle emphasized.

However, that also means that almost a third of hospitals are not exchanging data on a national level, he said.

"The goal of TEFCA is to invite those folks off the interoperability sideline so that they can see the same benefits that the rest of us have seen," Doyle explained.


Health Gorilla is a data sharing platform that supports secure national HIE.

Steve Yaskin, CEO and co-founder of Health Gorilla, said that the company's investment in protecting patient privacy and safeguarding patient data has prepared Health Gorilla to be a QHIN.

"Participating in national health information exchange can seem like a risky endeavor for many healthcare organizations, but with QHINs, ONC is establishing secure on-ramps that allow for trusted exchange across the country," Steve Yaskin, CEO and co-founder of Health Gorilla, said in an emailed statement.

"With the QHIN application approval in hand, we demonstrated our ability to meet requirements around network governance, functionality, and privacy," Yaskin said. "We believe that federal involvement will help to create a safe and trusted environment for healthcare organizations to participate in national data exchange. We're pleased to move forward in the process toward official designation later this year."


Kno2 is a healthcare interoperability platform that connects stakeholders across the care continuum via a single application programming interface (API).

"Kno2 has over 50 EHR platforms and 70 digital health platforms relying on Kno2 to deliver meaningful connectivity to the myriad of networks, frameworks, and endpoints that are necessary to effectively communicate across the healthcare ecosystem," Jon Elwell, CEO of Kno2, said in an emailed statement.

"Carequality, Commonwell, Direct Secure Messaging, HIEs, and proprietary systems like referral management platforms all play a role in truly delivering the promise of interoperability," he noted. "Not one network, not one standard, not one framework solves the problem. This background prepared Kno2 well for the next evolution of a fully connected healthcare system, QHIN."


KONZA National Network has operated a nationwide health information exchange and analytics company since 2010.

"With over 12 years of experience building HIEs, KONZA provides the expertise and stability the healthcare community will expect from a QHIN," Laura McCrary, president and CEO of the Kansas Health Information Network and KONZA National Network, wrote in an emailed statement.

"Successful health information exchange is built on a foundation of trust and transparency, and TEFCA brings the promise of trust and transparency," she said. "The vigorous vetting process that is required to become a QHIN will identify organizations that excel in security, governance, technical interoperability, service, data use, business acumen, public health, and commitment to improving patient care.

"Through TEFCA, healthcare providers will be able to confidently choose a QHIN that has met the stringent requirements set forth by the US Department of Health and Human Services and the Office of the National Coordinator for Health Information Technology," McCrary added.

Dig Deeper on Clinical documentation

Cloud Computing
Mobile Computing