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
What every reader should walk away with
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
By the numbers
The data that defines this market
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
Where this analysis comes from
Frequently asked
Answers to the questions buyers ask
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.
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This guide is reviewed and maintained by the InterScripts editorial team and reflects current customer engagements, federal program activity, and 2026 regulatory updates.