TEFCA Continues to Scale
TEFCA has entered its next phase.
It is operating at volume.
It is expanding across the ecosystem.
It is scaling as national infrastructure.
Participation continues to grow. Exchange activity is increasing. Use cases are broadening. What began as alignment around a Common Agreement is steadily becoming embedded in how health information moves across the country.
This is what maturation looks like.
From Governance to Performance
The early phase of TEFCA focused on building a durable foundation:
- A strong Common Agreement
- Clearly defined Exchange Purposes
- Accountable QHIN operations
- Auditability and trust by design
That foundation is now supporting growth.
As adoption accelerates, the focus naturally shifts toward performance — repeatable onboarding, consistent operational execution, identity confidence at scale, and predictable exchange across diverse environments.
Strong governance makes scale possible. Operational refinement makes scale sustainable.
National Visibility Reflects Expanding Influence
TEFCA and related exchange priorities were featured prominently at the 2026 ASTP Annual Meeting — reinforcing that national interoperability is a central pillar of the federal health IT agenda.
The visibility of TEFCA — including Individual Access Services (IAS) — on the main stage reflects a framework that is gaining traction and expanding its role across the health IT ecosystem. National visibility signals a network that is accelerating and deepening its operational impact.
Interoperable exchange is increasingly discussed alongside AI, data liquidity, and broader modernization efforts. That alignment positions TEFCA as foundational infrastructure within the national health IT strategy.
Treatment Exchange at Volume
Treatment exchange continues to mature as adoption increases.
The next level of scale emphasizes:
- Consistency across networks
- Reliable identity confidence at volume
- Meaningful consumer involvement, enabling individuals to securely access and direct their health information at scale
- Seamless integration into clinical workflows
- Operational efficiency that supports both large health systems and smaller providers
As transaction volume increases, predictability and performance become defining characteristics. Exchange becomes embedded — not exceptional.
IAS: Scaling Consumer-Directed Exchange
IAS represents one of the most forward-looking components of TEFCA — consumer-directed access within a governed national framework.
With continued ecosystem engagement and growing visibility, IAS is expanding in both scope and utilization.
Scaling IAS means:
- Supporting increasing onboarding velocity
- Preserving usability while strengthening assurance
- Maintaining trust and performance as participation grows
- Enabling sustainable expansion across networks
This is infrastructure evolving to meet rising demand.
Maturation Through Collaboration
Durable national networks evolve as they grow.
Processes become more refined.
Operational models become more repeatable.
Collaboration becomes more structured.
Shared stewardship becomes essential.
QHINs, participants, subparticipants, vendors, ASTP, and the RCE all contribute to this evolution. As adoption expands, coordination and alignment strengthen the entire ecosystem.
Scale is sustained through partnership.
The Bigger Picture
TEFCA continues to scale because its foundation is strong and its ecosystem is engaged.
It is being relied upon.
It is being elevated in national forums.
It is expanding in operational reach.
It is becoming embedded in how health information moves across the United States.
National interoperability advances through steady expansion, disciplined governance, and collective stewardship.
TEFCA is demonstrating exactly that trajectory.
As someone deeply engaged in the operational realities of national exchange, I see firsthand the discipline, collaboration, and shared commitment driving this progress. TEFCA’s continued scale reflects sustained investment, thoughtful governance, and an ecosystem committed to evolving together. The opportunity ahead is significant, and the work underway positions TEFCA to meet it with confidence and durability.
Dianne Koval, RHIA, CCEP, CHPS
Vice President, Operations
Centauri Health Solutions, Inc.