TEFCA: Trusted Exchange Framework and Common Agreement
TEFCA is ONC's framework establishing the technical and policy rules for nationwide health data exchange. Networks that meet TEFCA requirements are designated as QHINs and form the backbone of US-wide interoperability.
The TEFCA architecture
TEFCA defines two layers:
- Trusted Exchange Framework — high-level principles and minimum requirements for trusted health data exchange.
- Common Agreement — the contractual / operational rules of participation, including supported exchange purposes (treatment, payment, healthcare operations, public health, individual access services, government benefits).
Designated QHINs (Qualified Health Information Networks) sign the Common Agreement and exchange data with each other under uniform terms.
Why TEFCA matters operationally
Pre-TEFCA, cross-network exchange required bilateral agreements between networks (CommonWell-to-Carequality bridges, etc.). TEFCA replaces the patchwork with a standardized framework. For providers, a connection to one QHIN gives access to data across all designated QHINs — a meaningful reduction in integration burden.
Where Vizier fits
Vizier reads from EHR connectors that themselves participate in QHIN exchange (Epic, Cerner / Oracle Health, AthenaHealth, Allscripts / Veradigm, MEDITECH all participate either directly or through their health system customers). Cross-system encounter data flows into the EHR connector and into Vizier's analytics layer with no separate TEFCA integration.