How TEFCA and Qualified Health Information Networks work, the exchange purposes including individual access, what joining means for an app, and how FHIR is phased in.
TEFCA, the Trusted Exchange Framework and Common Agreement, is the US government-backed network of networks for health data: Qualified Health Information Networks (QHINs) connect to each other under one common agreement, and organizations and apps join through a QHIN to query and exchange records nationwide for defined purposes, including individual access. A developer does not connect to TEFCA directly; you join through a QHIN or one of its participants.
How it is organized
Role
Who
What it does
ONC (ASTP/ONC)
US Department of Health and Human Services
Sets the framework and oversees the program
Recognized Coordinating Entity (RCE)
The Sequoia Project
Runs the Common Agreement and designates QHINs
QHIN
Large health information networks, designated since December 2023
Exchange with every other QHIN
Participant / Subparticipant
Health systems, payers, HIEs, health IT companies, apps
Connect through a QHIN and follow its terms
Exchange purposes
Exchange under TEFCA is allowed only for defined purposes: treatment, payment, health care operations, public health, government benefits determination, and individual access services (IAS), where a person uses an app to request their own records across the network. IAS providers have extra privacy and security duties, including identity verification at a high assurance level and a published privacy notice, even when they are not HIPAA covered entities.
What changes for an app
Reach. Instead of registering with each provider, an IAS app connected through a QHIN can locate a person's records across many organizations.
Identity proofing. Before records are released, the person's identity is verified to a high assurance level.
Standards. Exchange started with document-based (IHE) queries; FHIR-based exchange is being added through the program's FHIR roadmap, so plan for both document and FHIR payloads.
Obligations. Joining means signing the QHIN's terms that flow down the Common Agreement, including privacy, security and breach rules.
Where Anpheros fits
TEFCA moves records; an app still needs a place to keep them per person, reconcile duplicates and share them later with consent. Anpheros Platform keeps one FHIR R4 record per person, stores documents next to coded resources, records the source of every item as Provenance and gives access to other apps only with the person's consent. Anpheros is not a QHIN or a TEFCA participant.
Anpheros is hosted in the EU. A US data region and a HIPAA business associate agreement (BAA) are available on request for production customers; production for US patient data starts only after the BAA is signed.
Frequently asked questions
What is a QHIN?
A Qualified Health Information Network: a network designated by the Recognized Coordinating Entity to exchange data with all other QHINs under the TEFCA Common Agreement.
Can a consumer app use TEFCA?
Yes, as an individual access services provider connected through a QHIN or one of its participants, after verifying each person's identity and accepting the privacy and security duties of the Common Agreement.
Does TEFCA use FHIR?
Exchange began with IHE document queries; FHIR-based exchange is being phased in under the TEFCA FHIR roadmap, so apps should handle both CDA documents and FHIR resources.
Is Anpheros part of TEFCA?
No. Anpheros is a FHIR R4 record store with consent; data an app retrieves through TEFCA can be kept there with the person's agreement.
