Electronic health records giant Epic announced Monday that more than 1,000 hospital customers and 22,000 clinics using its EHR are now live on a government-backed data exchange, as the company doubles down on a commitment it made last year.
Epic said in an announcement that it marks a significant milestone in "making health information seamlessly and securely available wherever care happens."
In March, Epic reported that more than 2,000 hospital customers and more than 50,000 Epic clinics were either live or preparing to go live on the federal Trusted Exchange Framework and Common Agreement (TEFCA) framework for nationwide health data exchange, according to Becker's Health IT.
The company's goal is to have all its customers live on TEFCA by the end of the year, Epic said in August. The health IT company now commands 42.3% of the hospital EHR market, up from 39.1% a year prior, so shifting all its hospital customers to TEFCA would represent a significant share of U.S. hospitals.
“The energy around TEFCA adoption is clear, and the Epic community is leading the way,” said Rob Klootwyk, Director of Interoperability at Epic in a statement. “We’re proud to partner with our customers to expand safe and secure access to health data so patients can take an active role in their care.”
According to the Sequoia Project, there are 2,816 organizations live on TEFCA and more than 14 million documents have been shared since go-live in December 2023.
Beyond exchanging data for treatment purposes, TEFCA and Epic customers are already facilitating connections that support public health and individual access, the company said.
The Social Security Administration and Department of Veterans Affairs are expected to join the network later this year, Epic said.
The Trusted Exchange Framework and Common Agreement (TEFCA) is a nationwide network to exchange patient data that was mandated by the 21st Century Cures Act back in 2016. TEFCA, which went live in December 2023, was designed to create an infrastructure to enable data sharing between health information networks. TEFCA marks a critical step in establishing universal connectivity across providers and establishes universal governance, policy and a technical floor for nationwide interoperability.
Through TEFCA, the federal government, along with industry partners, is paving the road to enable digital health data to flow more seamlessly between providers and patients. Developed by the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health IT (ASTP/ONC), it is now spearheaded by the Sequoia Project, its recognized coordinating entity.
Epic community members connect to TEFCA through Epic Nexus, a federally designated Qualified Health
Information Network (QHIN) that launched in December 2023.
“Stanford Health Care was one of only a handful of initial Epic Nexus TEFCA participants and I’m thrilled to see so many provider organizations joining this effort,” said Matthew Eisenberg, M.D., Associate Chief Medical Information Officer at Stanford Health Care. “TEFCA exchange extends the integrated interoperability our patients and providers have come to expect over the past decade or more. When we have the patient’s full story at the point of care, we can provide better-informed diagnoses, fewer duplicate tests, and better care plans and outcomes in support of the healthcare quadruple aim.”
The announcement comes as the health IT industry mulls the future of the government-backed data exchange under the Trump administration. There has been speculation that TEFCA may be on the chopping block, either from defunding or outright dismantling by a new lead at HHS' health IT arm, called the Assistant Secretary for Technology Policy/Office of the National Coordinator of Health IT (ASTP/ONC).
Back in August, Carequality, an interoperability network that Epic belongs to, also announced plans to align with TEFCA. Carequality has grown into a framework of more than 50 networks that connect over 600,000 care providers, 50,000 clinics, and 4,200 hospitals. The organization supports the exchange of 1.2 billion documents monthly.
In an April update, Carequality said it was making progress on that strategy to align more closely with TEFCA.
Last fall, health IT industry experts said the move by both organizations to align with TEFCA signaled a "tectonic shift" in the interoperability landscape and the rising influence of the federal government's nascent network.
Epic's announcement today and other commitments by EHR vendors also indicate that TEFCA continues to gain momentum.
In February, Epic rival Oracle Health (formerly Cerner) said it had submitted an application to become a TEFCA-qualified health information network (QHIN). If approved, Oracle would be the ninth TEFCA QHIN, joining Epic, Health Gorilla, eHealth Exchange and others.
"If designated, becoming a QHIN will help us enable providers, public health officials, patients, and payers to securely access data that can help improve care delivery, deliver insight into community health, and accelerate authorizations and reimbursements,” said Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences in a statement. “This builds on our long-standing leadership in driving interoperability to increase industry-wide efficiency and to help ensure patients retain control over their own data.”
EHR vendor athenahealth said in a blog post two weeks ago that more than 3,000 athenaOne providers are connected to TEFCA and the company anticipates full TEFCA integration across all practices by the end of 2025.
"athenahealth is among the first EHR vendors to operationalize TEFCA at scale, leading the way for nationwide interoperability and ensuring that practices can thrive in this next phase of patient-centered, data-driven care," the company wrote in the blog post.
Another EHR vendor, Meditech, rolled out a new advanced network to simplify data exchange across its customer base and other vendor EHRs while also providing an on-ramp to TEFCA, the company announced last fall.
TEFCA is at a crossroads, according to Brendan Keeler, interoperability and data liquidity practice lead at healthcare strategy and software development firm HTD Health. A month ago, news circulated that the contract from the ASTP to the Recognized Coordinating Entity (the Sequoia Project) had been cancelled, based on a list of cancelled HHS contracts that has since been retracted, he wrote in a LinkedIn post.
But, early successes in public health exchange and Individual Access Services testing demonstrate real progress, he noted.
"Challenges remain around governance representation, patient transparency, and establishing sustainable network effects. The next few months will determine whether TEFCA's network effects accelerate or stall under the new administration," Keeler wrote.
A recent Request for Information from the Centers for Medicare & Medicaid Services (CMS) and HHS' health IT office signals that the agency plans to tackle the nation’s data exchange infrastructure. There are several mentions of TEFCA in that RFI that indicate TEFCA may still be alive, many health IT industry experts noted.
The RFI asks for public input about new use cases through TEFCA and policy and technical limitations that hinder participation in TEFCA.
According to Keeler in a LinkedIn blog post on Friday, HHS' budget in brief for 2026 mentions the continued implementation of a nationwide technical floor for healthcare interoperability through TEFCA. (The budget in brief document was not available on HHS' website Monday morning.)
However, the industry will likely see "large-scale changes to its priorities, structure, capabilities, or mission," he noted.