Trusted Exchange Framework and Common Agreement (TEFCA)


The U.S. Department of Health and Human Services announced that ONC published the Trusted Exchange Framework, Common Agreement - Version 1, and Qualified Health Information Network (QHIN) Technical Framework - Version 1 on January 19, 2022. Entities seeking QHIN designation can begin reviewing the requirements and considering whether to voluntarily apply. (See ONC's Health IT Buzz Blog post for more on the announcement. Also, view the press release.)

The overall goal of the Trusted Exchange Framework and Common Agreement (TEFCA) is to establish a universal floor for interoperability across the country. The Common Agreement will establish the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other—all under commonly agreed-to expectations and rules, and regardless of which network they happen to be in. The Trusted Exchange Framework describes a common set of non-binding, foundational principles for trust policies and practices that can help facilitate exchange among HINs.

Recognized Coordinating Entity

In 2019, ONC issued a Notice of Funding Opportunity and subsequently awarded a cooperative agreement to The Sequoia Project to serve as the Recognized Coordinating Entity (RCE) and to develop, update, implement, and maintain the Common Agreement. The RCE is also responsible for soliciting and reviewing applications from HINs seeking QHIN status and administering the QHIN designation and monitoring processes. Since 2019, ONC and the RCE have worked together to gather industry-wide stakeholder input to draft and refine the approach to enabling nationwide health information exchange across different health information networks. In FY 2021, ONC awarded a new round of funding of $942,000 to The Sequoia Project under the RCE cooperative agreement to support RCE activities from August 2021 to August 2022.

To view TEFCA documents, register for educational sessions, and review requirements for QHIN designation, please visit the RCE website at

Publication of TEFCA

Section 4003(b) of the 21st Century Cures Act requires the National Coordinator to publish the Trusted Exchange Framework and the Common Agreement on its public Internet website and in the Federal Register. In accordance with Section 4003(b), the Trusted Exchange Framework and the Common Agreement are here:

In addition, the Trusted Exchange Framework and the Common Agreement were published in the Federal Register on January 18, 2022.