Qualified Health Information Network (QHIN) updates

Most (if not all) Surescripts Network Alliance participants and other healthcare organizations can connect to a QHIN. QHIN participants can include medical practices, health systems, pharmacies, health plans, accountable care and other care management organizations, and PBMs, among others. Our team can help assess how a QHIN connection could benefit your organization. Check out our QHIN Readiness Guide for help deciding if and how your organization should connect to a QHIN.

Key benefits include: 

• A simpler approach to data exchange with less need for one-off connections 
• The ability to exchange information for different types of purposes 
• Reduce barriers to connection and improve access to information 
• Exchange data with a broader range of health care organizations 

TEFCA establishes a set of technical, data access and security requirements to create the trust needed for providers to confidently send and receive clinical information. This could help healthcare providers: 

• Efficiently access more complete clinical records, allowing them to make more informed decisions, reduce duplicative tests and better coordinate care 
• Ensure that primary care providers are notified about hospital admissions, discharges and other healthcare interactions outside their practice 
• Reduce the administrative burden of sharing data with public health agencies, which often have unique reporting requirements and connection method 

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

TEFCA will enable easier access to clinical and administrative information that can help health plans and pharmacy benefit managers improve care for their members more efficiently. Connecting to a QHIN could help them:

• Gain a more holistic view of their members’ clinical history, helping identify and close care gaps while supporting the industry's shift towards value-based care
• Leverage TEFCA’s payment and healthcare operations use cases to power care management, population health and risk adjustment programs
• Reduce dependency on outdated technology such as faxes and phone calls to providers, easing administrative burden
• Inform prior authorization and other processes intended to help ensure appropriate, affordable and safe care
• Exchange data with public health agencies, helping manage public health emergencies in a more efficient and collaborative manner

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

• Reduce dependency on outdated technology such as faxes and phone calls to providers, easing administrative burden
• Gain a more holistic view of their patients’ clinical history, helping identify and close care gaps while supporting the industry's shift towards value-based care
• Inform medication therapy management and other processes intended to help ensure appropriate, affordable and safe care
• Exchange data with public health agencies, helping manage public health emergencies in a more efficient and collaborative manner

For more on the opportunities that come with connecting to a QHIN, read our QHIN Use Case Guide.

The Common Agreement currently requires health information exchange among QHINs for the purposes of treatment and individual access services (that is, allowing patients to access and share their health information).

In the future, health information exchange by QHINs will also include these purposes:

• Healthcare operations (query response required for care coordination, HEDIS and quality measure reporting by February 2026)
• Payment
• Public health
• Government benefits determination

See TEFCA’s Standard Operating Procedure for detailed definitions of each of these exchange purposes.

Yes. TEFCA is a reciprocal partnership. Within the parameters set forth in the Common Agreement and in accordance with applicable law, QHIN participants must generally contribute data in order to receive data. The Common Agreement and applicable Standard Operating Procedures set forth the requirements for TEFCA Exchange activities, including the authorized Exchange Purposes for which information can be requested or shared via TEFCA, as well as requirements around use, disclosure and response to requests for such information.

No. Once you connect to our QHIN via Interconnect, you’ll be able to access patient and clinical information from any other QHIN.

To make a QHIN decision, we recommend starting with two high-level questions:

1. How easy will it be for participants to establish and maintain their connection to this QHIN?
2. Is this QHIN equipped to go beyond basic connectivity to innovate and solve larger challenges over time?

For more criteria to evaluate, read our QHIN Evaluation Guide.

Possibly. Currently, some organizations struggle to respond to various requests in accordance with the information blocking rule. These organizations could potentially meet certain parts of their obligations by making the data available to a QHIN, which is required to make the health information available to requestors in compliance with TEFCA’s standards.  

However, TEFCA participation alone does not provide a formal exception to information blocking or create a safe harbor.

We are excited to have received QHIN designation. We believe that participating in the QHIN process is the best way we can reinforce the interoperability we enable today and support the nation’s progress toward greater healthcare interoperability. We also expect that this will help unlock even more efficiency and value from our network for Surescripts Network Alliance® participants.

A QHIN adds more clinical endpoints to the Surescripts network, helping locate and exchange more records. TEFCA also provides for payment and exchange use cases that could power additional functionality such as care coordination, care management, quality measurement and risk adjustment.

Surescripts Health Information Network LLC is also helping to shape the future development of TEFCA by joining the Governing Council—one more avenue to surface the needs and perspectives of Surescripts Network Alliance participants across the industry.