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ONC Commits to Support for FHIR in Updated TEFCA Standards

Analysis  |  By Eric Wicklund  
   November 08, 2023

The agency has released several adjustments to the first draft of the interoperability guidelines and expects to unveil version 2.0 next spring

Healthcare leaders have a bit more clarity on FHIR, thanks to an update to the Trusted Exchange Framework and Common Agreement (TEFCA) released last week.

The Health and Human Services Department recently updated TEFCA to what it calls “version 1.1,” with specific tweaks and clarifications. Officials said the updates to the QHIN (Qualified Health Information Network) Technical Framework, FHIR (HL7 Fast Healthcare Interoperability Resources), and standard operating procedures will be unveiled during the Office of the National Coordinator for Health IT (ONC) annual meeting on December 14-15.

[See also: TEFCA Advocates Urge Patience—and Preparedness—as Interoperability Plan Moves Forward.]

Of particular interest is the news that TEFCA will support FHIR-based transactions. Supporters say this is a key element to the industry’s acceptance of TEFCA as a roadmap to interoperability, while critics argue that many organizations aren’t yet ready to embrace FHIR.

“We have … committed to having TEFCA support FHIR-based exchange because API scalability needs TEFCA, and we are pleased to report that this will soon be a reality as well,” Mark Knee, an ONC deputy division director, and Jawana Henry, an interoperability systems branch chief and health coach at the ONC, wrote in an ONC blog last week. “The Common Agreement Version 2.0 is actively under development with a publication goal of no later than the end of Spring 2024. This version will include participation enhancements and technical updates to require support for Health Level Seven (HL7) FHIR-based transactions within 2024.”

"We're thrilled to see FHIR-based exchange make it into Version 2.0 of the Common Agreement,” Steven Lane, chief medical officer for Health Gorilla, one of the seven HHS-designated candidate QHINs, said in an e-mail to HealthLeaders. “ONC's FHIR roadmap for TEFCA exchange pointed us in this direction long ago, and it’s great to see we’re moving down the path. There was a lot of debate around TEFCA without FHIR, so we're glad to see the issue finally put to rest."

“Last week’s announcement is an indication we are getting close to a critical step in the launch of TEFCA,” Paul Wilder, executive director of the CommonWell Health Alliance, a non-profit trade association and a candidate QHIN, said in an e-mail to HealthLeaders. “We expect to have live production QHINs next month. It also acknowledges TEFCA is a living, learning framework that embraces iterative improvement with a scaled approach to FHIR being next. The rapid advancement of TEFCA and an explicit mention of FHIR indicates a desire to put FHIR at scale on the TEFCA speed ramp with significant steps expected in 2024.”

Also part of the process is the recent release of proposed disincentives for healthcare organizations engaged in information blocking. Health system leaders are particularly interested in this hotly-debated issue and will likely make their feelings know to ONC as this moves forward.

“The hard work of aligning the 21st Century Cures Act’s key priorities in API adoption, nationwide network interoperability, and Information Blocking is now being realized,” Knee and Henry wrote in their blog. “The launch of TEFCA this year, support for FHIR next year, and the recent release of draft rules to close remaining gaps in enforcement of Information Blocking are mutually reinforcing initiatives that will significantly advance interoperability in the coming years.”

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


TEFCA, authorized by Congress through the 21st Century Cures Act, aims to create a nationwide interoperability framework.

Federal officials say the framework is a work in progress, with adjustments made along the way, and they expect to have a new version released in spring 2024.

Recent adjustments include proposed penalties for healthcare organizations engaged in information blocking and support for HL7 FHIR-based transactions.

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