TEFCA in 2026: Which Networks Are Live and What Hospitals Should Weigh

The RCE list of Designated QHINs, checked on 27 September 2026, names 11 networks. In a hospital procurement review, a network proposal’s TEFCA claim needs supporting evidence. Weigh designation status alongside the participation documents, proposed hospital obligations, and evidence relevant to the intended workflow.

How the TEFCA framework works

TEFCA, the Trusted Exchange Framework and Common Agreement, is a nationwide framework for electronic health information sharing. ONC, now ASTP/ONC within HHS, created it to reduce barriers to sharing records among healthcare providers, patients, public health agencies, and payers.

For your team, start with that definition before discussing a particular connection. Keep the framework’s purpose distinct from the proposal you are evaluating. Specify whose records you want to exchange, which workflow you want to support, and what evidence would demonstrate success.

A QHIN is a Qualified Health Information Network. The Sequoia Project serves as the Recognized Coordinating Entity, or RCE, responsible for administering designation and monitoring. It also develops, updates, implements, and maintains the Common Agreement.

Use those roles to organize the review: look to the RCE for designation status and to the participation documents for terms. Then have your team explain how the proposed connection would serve the hospital’s stated objective.

Which networks are designated and what “live” means

The RCE’s Designated QHIN roster identifies the organizations below as of September 27, 2026. Each has completed onboarding and is recognized for TEFCA exchange. Here, “live” refers to that designation status; keep any claims about a particular hospital connection subject to separate evidence.

Candidate QHINs are still in onboarding; Designated QHINs have completed that process. The RCE accepts applications on a rolling basis and warns that its designated list may change. Recheck the roster when reviewing a proposal rather than treating this dated list as permanent.

Use the table to establish status, then request evidence for the specific service being proposed. Avoid ranking networks by familiarity alone. Have each prospective partner describe the connection your hospital would use and show how you would evaluate it.

Checking the Common Agreement and its version

ONC describes the Common Agreement as a legal contract signed by all QHINs that establishes participation terms. Its resources page lists Versions 2.1, 2.0, and 1.1, alongside a separate Exhibit 1 and the QHIN Technical Framework, or QTF.

Version 2.1 is the most recently listed Common Agreement version. The resource listing does not explicitly label it the current version or explain changes between versions. Avoid using the order of downloads as a substitute for checking which documents govern a proposed arrangement.

Request the exact documents and version identifiers referenced in your hospital’s proposed agreement. Have counsel distinguish the QHIN’s commitments from any obligations your organization would accept. Take questions about your own circumstances to counsel or the relevant regulator.

For the review meeting, place each proposed obligation beside its document reference and responsible hospital team. Mark unresolved interpretations as questions. This is a suggested review method, not a statement that TEFCA imposes a particular hospital obligation.

What more than one billion exchanged records means

HHS announced more than one billion health records exchanged through TEFCA on June 26, 2026. ASTP/ONC had reported nearly 500 million as of February 11, 2026. Attribute each figure to its agency and retain its date whenever you use it.

Read the unit carefully: the agency reported health records exchanged. Do not relabel the total as unique patients, hospitals, or successful clinical decisions. Those would be different claims from the exchange-volume statement.

For a hospital decision, pair the national figure with questions about your proposed use. What would your team test? Which records would you expect to retrieve, and how would you judge whether the result supports the intended workflow?

Keep those questions separate from the agency’s cumulative total in your decision memo. Use the total as evidence of exchange activity, while requesting direct evidence for any promised local benefit. Do not project a later total from these dated figures.

What hospitals should consider before connecting

Build your evaluation around designation, participation terms, and the workflow you want to support. The RCE establishes designation status, while ONC describes the Common Agreement’s role in setting participation terms. Treat the following questions as an evaluation agenda rather than a list of regulatory requirements.

Start by naming the proposed QHIN and confirming its status against the RCE roster. Ask the prospective partner to identify the documents your hospital would sign and the responsibilities it expects your team to assume. Request written answers for counsel and procurement to review.

Next, choose a concrete workflow for a demonstration. Specify the people involved, the information sought, and the evidence you want to see. Include an unsuccessful retrieval in your proposed evaluation, and have the partner explain how your staff would investigate it.

For broader planning, consider the questions raised in One Model, Many Hospitals: The Sprawl Problem when defining which hospital teams would own the connection. Name an owner for reviewing documents, assessing the workflow, and resolving unanswered questions.

During procurement, use Vendor SLA Promises That Do Not Match Clinical Reality as a companion discussion about promised service. Request the proposed support terms, escalation contacts, and acceptance criteria without assuming designation answers those questions.

Before making a recommendation, separate confirmed statements from open questions in the decision memo. Attach the dated roster reference and the precise contract references. Give your decision makers an explicit account of what your team has checked and what still needs an answer.

Frequently Asked Questions

What is TEFCA?

TEFCA is the Trusted Exchange Framework and Common Agreement, a nationwide framework for electronic health information sharing. ONC created it within HHS to reduce barriers to sharing records among providers, patients, public health agencies, and payers.

How many QHINs are designated?

The RCE roster identifies 11 Designated QHINs as of September 27, 2026. These organizations completed onboarding for TEFCA exchange. Applications remain open on a rolling basis, and the roster can change.

How much data has moved through TEFCA?

HHS announced more than one billion health records exchanged through TEFCA on June 26, 2026, following the February 2026 milestone. This is a dated exchange total, not a count of unique patients.

What agreement do QHINs sign?

QHINs sign the Common Agreement, which ONC describes as a legal contract establishing participation terms. The Sequoia Project develops and maintains it in its role as the Recognized Coordinating Entity.

Sources

• Trusted Exchange Framework and Common Agreement (TEFCA), ASTP/ONC, updated September 3, 2026.
• Designated QHINs, The Sequoia Project, TEFCA RCE, accessed September 27, 2026.
• TEFCA reaches nearly 500 million health records exchanged, ASTP/ONC, February 11, 2026.
• HHS Expands Secure Access to Health Records Through the TEFCA Network, Announces Milestone of One Billion Health Records Exchanged, HHS, June 26, 2026.

This article is for general information and is not legal, regulatory or medical advice.