TEFCA Hits Half-Billion Record Exchange Milestone

The Department of Health and Human Services hit a major milestone this week, reaching half a billion health records exchanged through the Trusted Exchange Framework and Common Agreement (TEFCA), according to Deputy Secretary Jim O’Neill.  

The Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP/ONC) launched TEFCA in 2023 to create a unified, secure and interoperable network for sharing electronic health information nationwide. It has seen exponential growth in the past year, increasing from 10 million records exchanged in January 2025 to 500 million. O’Neill, who also serves as the acting director of the Centers for Disease Control and Prevention, attributes it to HHS’ focus on “strengthening and scaling a single, trusted, interoperable backbone.” 

“Treating patients without a full picture of their health can lead to care gaps, medication errors and adverse events,” he said at the ASTP Annual Meeting Thursday. “The ability to exchange access and user health information is crucial to solving many of the problems that have plagued our health system for years. Technology can address issues of affordability, quality and access in enabling research into the root cause of chronic disease, and with AI, create clinical tools that would transform how we provide care in this country.” 

TEFCA enables providers, payers, public health professionals and patients to access and securely share health information regardless of where the information is stored, according to ASTP, which refers to the network as “universal floor for interoperability.” 

Tom Keane, assistant secretary for technology policy and the national coordinator for health information technology, said his office is pivoting from regulating the base functionality of the electronic records system — as it has with previously proposed rules — to regulating interoperability. Keane said the agency will likely propose its next rule, HTI-6, this summer. 

“It means regulating application programming interfaces. It means making sure that they adopt the most advanced standards for data and exchange, including possible successor standards. It means that robotic process automation and agentic AI should be able to exchange information. It means that the APIs actually have to perform,” he said. “It means that the ability to onboard and use the API has to be accessible.” 

In December 2025, the ASTP/ONC proposed the fifth iteration of its Health Data, Technology, and Interoperability rules, HTI-5. It is intended to reduce the “burden” on health IT developers by streamlining certification requirements and removing redundancies. It would also enable better electronic health information access by updating what the agency calls “information-blocking regulations.”  

The Health Data, Technology and Interoperability rules are the result of President Donald Trump’s goals outlined in the Unleashing Prosperity through Deregulation executive order issued shortly after he took office. In the order, he calls on federal agencies to “alleviate unnecessary regulatory burdens” in order to promote innovation and global competition.

HTI-5 published in the Federal Register on Dec. 29, 2025, and will be available for public comment through Feb. 27.