HHS announced that the Trusted Exchange Framework and Common Agreement (TEFCA) has exchanged nearly 500 million health records, as the agency ties technology and AI investments to lower healthcare costs and reduced provider burden.

 

What happened

The Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP/ONC) revealed the milestone during the opening keynote of its 2026 Annual Meeting in Washington, DC, on February 11, 2026. Assistant Secretary for Technology Policy and National Coordinator for Health IT, Dr. Thomas Keane, addressed more than 1,000 in-person attendees and thousands of livestream viewers. Keane outlined ASTP/ONC's accomplishments from its first year under the Trump administration and HHS Secretary Robert F. Kennedy, Jr., covering data exchange growth, information blocking enforcement, prior authorization reform, certification deregulation, clinical AI initiatives, data standardization, behavioral health pilots, and a new AI-focused prize competition.

 

The backstory

TEFCA isn't a Trump-era creation, it's the fulfillment of a mandate written into the 21st Century Cures Act, signed by President Obama in December 2016, which directed ONC to develop or support a trusted exchange framework, including a common agreement among health information networks nationally. From there, the framework took years to build out, in 2019, the nonprofit Sequoia Project was selected as the Recognized Coordinating Entity to oversee implementation. During President Trump's first term, HHS released early TEFCA drafts and laid the network's policy foundation. In January 2022, ONC finalized the Trusted Exchange Framework and Common Agreement documents, and in December 2023, TEFCA formally went live, with then-HHS Secretary Xavier Becerra calling it healthcare's "Big Bang" moment for nationwide data sharing.

 

Going deeper

ASTP/ONC detailed several accomplishments beyond the TEFCA milestone:

  • Information blocking oversight: ASTP/ONC has begun issuing "notices of potential non-conformity" to certain certified health IT developers under 45 CFR 170.580, requesting explanations related to possible nonconformance with Certification Program requirements, including the Information Blocking Condition of Certification and API Maintenance of Certification requirements.
  • Prior authorization reform: The HTI-4 Final Rule adopted regulation standards and certification criteria supporting electronic prior authorizations for both medical and pharmacy benefits, along with a new requirement for real-time prescription benefit capabilities in certified health IT.
  • Certification deregulation: The HTI-5 Proposed Rule, published December 22, 2025, would remove 34 and revise seven of the existing 60 certification criteria.
  • Clinical AI: ASTP/ONC issued an HHS Artificial Intelligence Request for Information (RFI) and a separate Diagnostic Imaging RFI to gather stakeholder feedback on accelerating AI adoption in clinical care, and will soon launch the EHIgnite Challenge, a two-phase prize competition aimed at improving electronic health information exports through AI.
  • Data standardization: The draft USCDI v7, released January 29, 2026, proposes 29 new data elements and one revised element.
  • Behavioral health: ASTP/ONC and SAMHSA announced nine Behavioral Health IT (BHIT) pilot programs.

 

What was said

HHS Secretary Robert F. Kennedy, Jr. said, "Real change is here. We are delivering bold, science-driven dietary guidelines and deploying transformative technology that reduces burden, lowers costs, and puts patients and providers first. These actions prioritize prevention and move us decisively to Make America Healthy Again."

HHS Deputy Secretary Jim O'Neill said, "The Make America Healthy Again movement is about empowering Americans to take control of their health. Under Dr. Keane's leadership, ASTP/ONC is building the policy foundation for technology that gives patients access to their information, real choices in their care, and the tools they need to make the best decisions for their health."

Assistant Secretary Keane said, "As we begin to realize the power of AI applied to healthcare, data liquidity will be a key defining need. By unlocking true interoperability, we are ensuring every American can securely access, use, and benefit from their health information - empowering patients, supporting clinicians, and accelerating better health outcomes nationwide."

 

By the numbers

  • Nearly 500 million health records have been exchanged through TEFCA, up from roughly 10 million in January 2025.
  • HHS projects more than $19.2 billion in administrative cost savings over the next decade from the HTI-4 Final Rule's electronic prior authorization standards.
  • The HTI-5 Proposed Rule's deregulatory actions would save certified health IT developers an estimated $1.53 billion in compliance costs by removing 34 and revising seven certification criteria.
  • ASTP/ONC and SAMHSA committed more than $20 million to nine Behavioral Health IT pilot programs spanning 45 exchange partners across nine states.

 

In the know

TEFCA, the Trusted Exchange Framework and Common Agreement, is described by HHS as a single, trusted national interoperability framework intended to enable secure, seamless health data flow between patients and providers across the healthcare system.

What that means for patients is that instead of medical records being scattered across every provider TEFCA is designed to let records follow patients. ASTP/ONC's own fact sheet on the framework frames the benefit this way, “patients and caregivers gain easier access to their health records in one place, even when moving, changing doctors, or managing care across multiple providers.” For providers and health systems, it means less time managing one-off data-sharing agreements and more complete patient information for coordinated care. For payers and public health agencies, it means more timely, reliable data for care coordination and population health monitoring.

 

Why it matters

This update matters because it shows HHS moving past TEFCA's early rollout phase into measurable, large-scale adoption, with exchanged records growing. The information blocking enforcement action is also notable, since it marks ASTP/ONC's first documented use of its 45 CFR 170.580 review authority against certified health IT developers, giving the requirement enforcement ability rather than leaving it as a paper standard.

 

The bottom line

TEFCA's growth from roughly 10 million to nearly 500 million exchanged records in about a year shows that national health data interoperability is moving from concept to functioning infrastructure, built on a legislative mandate nearly a decade old. Healthcare organizations and health IT developers should track the HTI-5 deregulatory changes, the draft USCDI v7, the new information blocking enforcement activity, and the emerging debate over data-sharing oversight, since all of these will shape compliance obligations in the near term.

 

FAQs

What is health data interoperability?

It's the ability for different healthcare organizations' computer systems to securely share and understand patient information with each other, rather than keeping it locked in separate, incompatible systems.

 

Is participation in TEFCA mandatory for hospitals and health systems?

No, TEFCA participation is voluntary, though the 21st Century Cures Act's information-blocking rules create strong incentives (and penalties) that push providers and health IT vendors toward participating.

 

How is patient privacy protected when records are exchanged through TEFCA?

TEFCA participants must sign a legally binding Common Agreement that sets privacy, security, and permitted-use requirements, and it operates alongside existing HIPAA protections.