The Trusted Exchange Framework and Common Agreement^SM is now available. Within the health information technology (health IT) world, few things have been as elusive as a governance framework for nationwide health information exchange. When ONC was formed in 2004, the concept of a nationwide health information network—where your information could be located across the country in a click—was a big picture vision that drove the federal government’s early health IT infrastructure, standards, policy actions, and investments.

What’s followed as a result of two laws (HITECH Act and 21^st Century Cures Act) and remarkable continuity across four administrations has been steady growth, maturity, and investment from both the public and private sectors. Most health care providers use electronic health records.^1,2,3 Many are connected to and engage in at least one form of electronic health information exchange.^4,5,6 And health information networks are now dotted across the US map supporting communities with a wide range of services.⁷

Today’s milestone marks the beginning of a new era of electronic health information exchange in the US. That world we wanted to see back in 2004—it’s here—and now it’s time to put what we’ve built to use.

Our goals for the Trusted Exchange Framework and Common Agreement (TEFCA^SM) are:

• Goal 1: Establish a universal policy and technical floor for nationwide interoperability.
• Goal 2: Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value.
• Goal 3: Enable individuals to gather their health care information.

The Trusted Exchange Framework is a set of non-binding principles to facilitate data-sharing among health information networks. The Common Agreement will operationalize simplified electronic health information exchange for many across the US and will provide easier ways for individuals and organizations to securely connect. Most notably, the Common Agreement sets a new baseline for the exchange purposes that need to be supported—a common source of friction across networks today. The Common Agreement includes support for treatment, payment, health care operations, individual access services, public health, and government benefits determination.

The Common Agreement is a new legal contract that ONC’s Recognized Coordinating Entity^® (RCE^TM), The Sequoia Project, will sign with each Qualified Health Information Network^TM (QHIN^TM). QHINs will then execute certain corresponding policies within their own networks. Published in tandem is the QHIN Technical Framework, which sets the functional and technical requirements that QHINs need to support to make this new connectivity come online. While road-tested production standards are being used at the start, we are also actively working with the RCE to develop a TEFCA Health Level Seven (HL7^®) Fast Healthcare Interoperability Resource (FHIR^®) Roadmap (TEFCA FHIR Roadmap) to outline how FHIR will also become an established part of TEFCA-based exchange over time.

Thank you to everyone that’s been a part of this work over the years—through the drafts, listening sessions, and webinars you have helped us shape where we have arrived at today. Be on the lookout for opportunities to engage with ONC and the RCE as QHINs onboard, including opportunities to inform continued implementation and future updates to the Common Agreement and QHIN Technical Framework.

In the coming weeks, the RCE will be hosting several webinars to educate the public about TEFCA and how to participate. These resources will be recorded and available on the RCE’s website.

For more information, please visit The Sequoia Project and ONC’s websites.

1. Office of the National Coordinator for Health Information Technology. (May 2019). ‘Non-federal Acute Care Hospital Health IT Adoption and Use,’ Health IT Dashboard. https://www.healthit.gov/data/apps/non-federal-acute-care-hospital-health-it-adoption-and-use.

2. Office of the National Coordinator for Health Information Technology. (May 2019). ‘Office-based Physician Health IT Adoption,’ Health IT Dashboard. https://www.healthit.gov/data/apps/office-based-physician-health-it-adoption.

3. Henry, J., Pylypchuk, Y., & Patel, V. (November 2018). Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities in 2017. ONC Data Brief, no. 41. Office of the National Coordinator for Health Information Technology: Washington, DC. https://www.healthit.gov/sites/default/files/page/2018-11/Electronic-Health-Record-Adoption-and-Interoperability-among-U.S.-Skilled-Nursing-Facilities-and-Home-Health-Agencies-in-2017.pdf

4. Johnson C. & Pylypchuk Y. (February 2021). Use of Certified Health IT and Methods to Enable Interoperability by U.S. Non-Federal Acute Care Hospitals, 2019. ONC Data Brief, no.54. Office of the National Coordinator for Health Information Technology: Washington DC. https://www.healthit.gov/sites/default/files/page/2021-03/Hospital%20Use%20of%20Certified%20HIT_Interop%20v10_1.pdf

5. Henry, J., Pylypchuk, Y., & Patel, V. (November 2018). Electronic Health Record Adoption and Interoperability among U.S. Skilled Nursing Facilities in 2017. ONC Data Brief, no. 41. Office of the National Coordinator for Health Information Technology: Washington, DC. https://www.healthit.gov/sites/default/files/page/2018-11/Electronic-Health-Record-Adoption-and-Interoperability-among-U.S.-Skilled-Nursing-Facilities-and-Home-Health-Agencies-in-2017.pdf

6. Patel V, Pylypchuk Y, Parasrampuria S & Kachay L. (May 2019). Interoperability among Office-Based Physicians in 2015 and 2017. ONC Data Brief, no.47. Office of the National Coordinator for Health Information Technology: Washington D.C. https://www.healthit.gov/sites/default/files/page/2019-05/ONC-Data-Brief-47-Interoperability-among-Office-Based-Physicians-in-2015-and-2017.pdf

7. Adler-Milstein J, Garg A, Zhao W, Patel V. (May 2021). A Survey of Health Information Exchange Organizations in Advance of A Nationwide Connectivity Framework. Health Affairs. Vol. 40(5):736-744. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01497