Health Information Exchange

ONC Publishes Updated Common Agreement for TEFCA

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As part of the 21st Century Cures Act, the Office of the National Coordinator for Health IT (ONC) published Trusted Exchange Framework and Common Agreement (TEFCA) Version 1.1 on the Federal Register on Nov. 7, 2023.  

TEFCA’s goals are to improve nationwide interoperability, simplify health information exchange and enable individual access to health information.  

“HIMSS’s longstanding priorities include interoperability and access to health information to improve patient safety,” said Tom Leary, HIMSS senior vice president and head of government relations. “The release of the Common Agreement Version 1.1 reinforces the government’s commitment to ensure health information is available to the right person at the right place at the right time across the care continuum. HIMSS continues to ensure TEFCA is successful and appreciates ONC’s work to move its implementation forward.” 

Version 1.1 is a legal contract, the “Common Agreement” between The Sequoia Project (Recognized Coordinating Entity® (RCESM) and each of the Qualified Health Information Networks (QHINs). ONC lists specific changes in Version 1.1: Common Agreement Version 1.1 - Release Notes (   

The Common Agreement reminds the QHINs that participants are not required to include individual access services, where individual patients may access their own data. QHINs will be required to create their own privacy framework with individual patients.  

Additionally, TEFCA information (TI) is differentiated from Protected Health Information (PHI). TI is exchanged between QHINs in the TEFCA network for one or more of the exchanged purposes pursuant to the framework detailed in the Common Agreement.  

There are separate rules for TI versus PHI. TI is only covered by the Common Agreement, while the TI is in transit on the network. Once TI is received by a QHIN participant or sub participant, that is a covered entity or business associate and is incorporated into the recipients’ system of records. Once the information is outside of TEFCA, it is no longer TI and is governed by HIPAA and other applicable law 

The QHINs that are going live by early 2024 are expected to be announced at the ONC Annual Meeting on Dec. 14-15, 2023. Standard operating procedures for QHINs are expected to be published in 2024. 

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