TEFCA and the QHIN designation explained
The short answer: TEFCA (Trusted Exchange Framework and Common Agreement) is the U.S. federal framework for nationwide health information exchange, administered by The Sequoia Project on behalf of ONC. A QHIN (Qualified Health Information Network) is a designated network operator authorized to exchange clinical and administrative data nationwide under TEFCA. Designated QHINs as of 2026 include eHealth Exchange, Health Gorilla, Epic Nexus, MedAllies, KONZA, and CommonWell.
Key takeaways
- TEFCA = the framework; QHIN = the designated network operator under it
- The Sequoia Project is the recognized coordinating entity (RCE) for ONC
- Designated QHINs as of 2026: eHealth Exchange, Health Gorilla, Epic Nexus, MedAllies, KONZA, CommonWell, and others
- TEFCA exchange runs primarily over FHIR R4
- Health systems typically connect to a QHIN rather than to TEFCA directly
The numbers
How TEFCA fits with existing networks
Before TEFCA, U.S. health information exchange happened over a patchwork of regional HIEs and national networks like Carequality, CommonWell, and eHealth Exchange. TEFCA is the federal framework that gives these networks a common legal and technical structure to operate under. QHINs are the operating entities; participants connect through a QHIN.
Sources & references
Frequently asked questions
What is the difference between TEFCA and a QHIN?
TEFCA is the framework — the federal legal and technical structure for nationwide health information exchange. A QHIN is a network operator designated under TEFCA. Health systems connect through a QHIN, not directly to TEFCA.
Which QHINs are designated as of 2026?
Designated QHINs include eHealth Exchange, Health Gorilla, Epic Nexus, MedAllies, KONZA, CommonWell, and others. The list is published and maintained by The Sequoia Project on behalf of ONC.
Related in this pillar
Cerner-to-Epic data migration — step-by-step
How to migrate from Oracle Health (Cerner) Millennium to Epic — three workstreams, clinical-data mapping patterns, defensible archival, and the credentialed go-live bench.
Meditech Magic to Expanse migration playbook
Migrate from Meditech Magic to Meditech Expanse — community-hospital playbook covering Magic data extraction, Expanse onboarding, defensible archival, and go-live support.
FHIR R4 explained for healthcare CIOs
FHIR R4 explained for healthcare CIOs — what FHIR is, why R4 is the deployed version in 2026, how it relates to USCDI v3 and the 21st Century Cures Act, and where R5 fits.
21st Century Cures Act — information blocking explained
The 21st Century Cures Act information-blocking rule — what it requires, who it applies to, what counts as information blocking, and what the penalties are.
Bring this to your team
Book a 30-minute walkthrough with the InterScripts experts who wrote this. We will tailor it to your systems, retention obligations, and federal compliance posture.
Schedule a meeting