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Large Health IT Networks Unveil Plans to Become QHIN Under TEFCA

Joining as a QHIN under TEFCA intends to provide greater interoperability offerings and allow organizations to participate in a network that works together to share clinical data.

As the Sequoia project expects to open the TEFCA QHIN application on October 3, several organizations have announced their intentions to apply.

TEFCA, published earlier by ONC, outlines a standard set of principles, terms, and conditions to support the development of a Common Agreement, which establishes the technical infrastructure and governing approach to support data exchange between healthcare organizations.

These networks connect to support health information exchange and further interoperability nationwide.

Epic Systems

On June 16, 2022, Epic Systems became the first EHR vendor to announce its plans to join TEFCA as a QHIN, a move that would let Epic connect to other QHINs to support health information exchange nationwide.

“TEFCA is the next logical step in Epic's long history of supporting interoperability," Doyle, who also serves as software development team leader for interoperability at Epic, told EHRIntelligence in an interview.

“We're excited to be partners on this project,” he continued. “TEFCA is going to benefit all of us. Providers will have easier access to clinical information that they need, and patients will benefit from more complete care.”

Holding over a decade of interoperability initiatives under its belt, Epic began its intermobility work with the launch of Care Everywhere, a platform for standards-based exchange of health information.

“Collectively, our customers exchange 10 million patient charts every single day, half of which are with other vendors,” Doyle noted. “That includes EHRs, state health information exchanges (HIEs), and critically, federal partners, like the Department of Defense, the VA, and the SSA.”

Additionally, Epic worked with ONC, The Sequoia Project, and the broader healthcare community to build consensus around the standards and procedures of TEFCA.

"Our fundamental goal is to help all patients receive informed, personalized care—regardless of where they go to receive it," Dave Fuhrmann, senior vice president of interoperability at Epic, noted in a press release. "Our customers have led the way with large-scale interoperability through Carequality, and we're happy to help with the next stage in the evolution of interoperability."

NextGen Healthcare

On August 15, 2022, Health IT vendor NextGen Healthcare announced its intention to become a QHIN under TEFCA, a move the company underscoring its commitment to interoperability

As of now, NextGen Healthcare supports more than 100,000 providers with its ambulatory EHR and practice management solutions. Additionally, one-third of health information exchanges (HIEs) across the country leverage NextGen Healthcare's interoperability tools.

The company's interoperability work includes NextGen Share, a cloud-based tool that provides access to several national interoperability networks. The secure platform enables NextGen Healthcare to establish a QHIN successfully.

If selected by ONC as a QHIN, NextGen Healthcare will participate in a network of organizations that work together to share clinical data. QHINs will share information with other QHINs, facilitating healthcare interoperability.

"Interoperability is the key to whole person health, and NextGen Healthcare is already a leader in facilitating the open exchange of data," David Sides, president and chief executive officer of NextGen Healthcare, said in a press release.

"With the infrastructure already in place, applying to become a QHIN is the next logical step and aligns with our mission of empowering every member of the care continuum with the data necessary to make the best decisions possible," Sides added.

eHealth Exchange and CRISP

On August 18, 2022 Health Exchange announced that CRISP Shared Services, which provides health information exchange (HIE) infrastructure for five statewide HIEs, intends to be the first participant in eHealth Exchange’s anticipated QHIN status.

This is only possible once eHealth Exchange goes through the application process and is selected to serve as a QHIN under ONC’s TEFCA

“eHealth Exchange has long been a cornerstone of CRISP Shared Services’ ability to share data with organizations across the region, state, and country, including with the federal government,” Brandon Neiswender, acting chief executive officer for CRISP Shared Services, said in a press release.

“Given its long history advancing interoperability and advocating for patients, we know eHealth Exchange will be the right partner to help us navigate this next step in nationwide data sharing.”

When period opens this fall, eHealth Exchange will apply to be a QHIN. If ONC designates eHealth Exchange as QHIN, the network will support nationwide interoperability by connecting to other QHINs.

Officials noted that the eHealth Exchange is well suited for the QHIN role, holding nearly 13 years of experience supporting interoperability across a network of diverse participants, which includes 64 regional and state HIEs. the application

“The eHealth Exchange is thrilled that CRISP Shared Services is moving forward with TEFCA participation through our to-be-designated QHIN,” said Jay Nakashima, executive director of eHealth Exchange. “We are diligently preparing to be a QHIN on behalf of members such as CRISP Shared Services.”

“This will provide a seamless experience for the organizations coming forward with intentions to participate in this federally endorsed framework for patient data sharing,” Nakashima continued.

CommonWell Health Alliance

Health data sharing network CommonWell Health Alliance has announced its plan to become one of the first Qualified Health Information Networks (QHIN) in the Trusted Exchange Framework and Common Agreement (TEFCA).

Currently, the CommonWell network facilitates the federated exchange of patient information for more than 27,000 provider sites representing 171 million individuals. Its CommonWell Connector and collaboration connections, like the Carequality Framework, exchange data with more than 50,000 clinics, hospitals, and specialty centers, CommonWell said.

“TEFCA has the potential to increase the level of empowerment by individuals and their care providers by enabling them to get the data they need to make the best care decisions—something CommonWell has been focused on since day one,” Paul L Wilder, executive director of CommonWell Health Alliance, said in a public statement. “CommonWell is more than prepared to transition to QHIN status, help build TEFCA, and take the nationwide exchange of EHI to the next level.”

With its more than 75 member companies, alongside its work with ONC, CommonWell said it is ready to fulfill the role of QHIN and help build the next phase of nationwide interoperability.

“The healthcare world has known for years that TEFCA would become a reality, and our mission has always been aligned to be part of this,” said Nick Knowlton, chairman of the board of directors at CommonWell Health Alliance and vice president of strategic initiatives at ResMed.

“CommonWell looks forward to working with the ONC, the Sequoia Project, and all other QHINs to collaborate, share best practices, and build the future of interoperability—better and together,” Knowlton added. “As a team and community, we have always been and will continue to be a strong advocate for patients and providers alike.”


The clinical data exchange network Kno2 has pledged to apply for TEFCA participation as a QHIN, the organization announced on September 7.

With a single connection to the Kno2 network, organizations can integrate their product to communicate with anyone participating in the healthcare ecosystem, Kno2 stated.

Kno2 said its work with direct secure messaging, Carequality, and many of the nation’s HIEs makes it well positioned to become a QHIN.

Kno2 added that it has been an active participant in the Common Agreement Workgroup, which assisted in defining the concept and proposed execution for TEFCA, since the Workgroup’s inception.

“I’m proud of the team for its tireless efforts working closely with various stakeholders to bring clarity to the governance and standards that are now included in the published QHIN application,” Jon Elwell, CEO of Kno2, said in the press release. “Our work is helping make QHIN-based exchange possible.”

If selected as a designated QHIN, the network intends to deliver broad access to all organizations participating in TEFCA. While some QHINs target larger users, Kno2 said it wants to connect and represent the needs of historically overlooked healthcare segments such as post-acute, therapies, EMS, vision, dental, behavioral health, and specialty providers.

“Applying for QHIN designation is exciting for us as we have the entire foundation established for optimized sending, receiving, and finding patient information already within the platform,” said Therasa Bell, co-founder, president, and CTO at Kno2. “Thus, this effort goes well beyond doing the fundamental work to become a QHIN.  This effort will be about maximizing the value of the workflows each participant receives from QHIN-to-QHIN exchange.”

Health Gorilla 

Health Gorilla announced their intention to become one of the first designated QHINs under TEFCA in October 2021.

"Health Gorilla is a proven leader in interoperability and is more than prepared to become a Qualified Health Information Network,” Jitin Asnaani, VP of strategy & corp dev at Bamboo Health and former executive director at CommonWell Health Alliance, said in a press release at the time of the announcement.

“For years, they have operated successfully under the constantly evolving federal regulations for health IT and have built a robust and secure health information exchange platform that will benefit health care providers, the rapidly growing digital health community, and other QHINs," said Asnaani, who serves as a Health Gorilla Board Member.

Health Gorilla officials said that the vendor is committed to supporting the legal, functional, and technical requirements for those health information networks designated as QHINs, through a process engine that offers:

  • Master patient index (MPI) and record locator services (RLS)
  • IAL2 verification and identity proofing for providers and patients
  • A platform that supports a broad range of standards, including FHIR, HL7, C-CDA, and IHE Profiles
  • A comprehensive security program
  • A comprehensive governance program to ensure the highest level of compliance with industry regulations and certify exchange purposes of Participants and Subparticipants


Surescripts expressed its intent to seek TEFCA participation as a QHIN, the organization announced in mid-April 2023. 

The health information network highlights its large-scale infrastructure and capabilities making it well-suited for TEFCA participation.

“We support the goals of TEFCA and are committed to innovation that fundamentally changes the interoperability landscape to support healthcare professionals, patients and their families,” said Tara Dragert, chief product officer of Surescripts.

Serving over 99 percent of American patients, Surescripts connects more than 2 million healthcare professionals and organizations through trusted healthcare intelligence. In 2022, the company facilitated 21.7 billion health information transactions, adhering to national data standards designed for interoperability.

Surescripts' Record Locator & Exchange, which utilizes the HL7 Fast Healthcare Interoperability Resources (FHIR) standard, allows providers to locate, exchange, and access clinical history information across all 50 states, regardless of care setting or EHR.

As stated in the Surescripts 2022 National Progress Report, released shortly before its TEFCA participation announcement, the Carequality interoperability via the Record Locator & Exchange platform has seen increased adoption by clinicians and organizations.

This platform, based on the HL7 Fast Healthcare Interoperability Resources (FHIR) standard, has successfully enabled over 250,000 clinicians from 31,314 organizations across all 50 states to efficiently locate and access patient information.

“The FHIR standard makes up a critical part of the Surescripts infrastructure and is already a core component of several of our solutions,” Mark Gingrich, chief information officer of Surescripts, said. “We’re committed to moving the industry forward by helping to scale the adoption of the FHIR standard to meet the interoperability goals in the 21st Century Cures Act. It’s something we have championed for a long time through participation in HL7 accelerators, including the Argonaut Project, the DaVinci Project and FAST, and we intend to continue to champion it as a QHIN.”

ONC selects six QHINs for TEFCA implementation

In February 2023, the Office of the National Coordinator for Health Information Technology (ONC) selected its initial group of six Qualified Health Information Network (QHIN) candidates to implement the Trusted Exchange Framework and Common Agreement (TEFCA). 

The selected healthcare organizations that have been qualified by the ONC and Sequoia Project include:

  • Common Health Alliance
  • eHealth Exchange
  • Epic TEFCA Interoperability Services 
  • Health Gorilla
  • KNO2
  • Konza
Despite this initial selection, organizations continue to apply, aiming to be a part of the initiative that seeks to create a network of networks supporting national healthcare interoperability.

The United States Qualified Health Information Network (USQHIN)

The United States Qualified Health Information Network (USQHIN), a wholly owned subsidiary of Velatura Public Benefit Corporation (Velatura) focused on supporting interstate data exchange at national scale, announced in November 2023 that it will submit its formal QHIN application in January 2024.

“Interoperability is essential for enhancing care coordination, improving the patient experience, and unlocking the full potential of whole-person healthcare," Tim Pletcher, DHA, executive director of USQHIN, said in a press release.

"USQHIN is a leader in the safe, secure, and timely exchange of healthcare information, and becoming a QHIN is the next logical step in our journey to improve the care continuum by making valuable data available at the point of care," Pletcher said. "Achieving QHIN status would enable us to utilize our experience and expertise to influence policy and decision-making around interoperability and FHIR-based exchange."

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