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You have heard the term "interoperability" buzzing around–but what does it really cover, and how does it impact your medical practice? Let's break it down in plain language.

Interoperability meaning

Interoperability in healthcare IT simply means that different tech systems can talk to each other like old pals. Imagine your patient records smoothly moving between devices, apps, practices, and hospitals without hiccups. That's EHR interoperability–making your tech work seamlessly together, to give you and your patients a better care experience.

Because interoperability enables practices to communicate with other practices on different IT platforms and with organizations that are part of other healthcare systems, data interoperability links a practice to its broader healthcare community.

Why should you care about interoperability?

  • Supercharged efficiency: With systems chatting effortlessly, sharing patient information becomes a breeze. Providers can get up to speed quickly, making teamwork smoother than ever.
  • Personalized care: When you already have the lowdown on patients' histories, treatments can be more tailored. More background leading to less chance of duplicative or ineffective treatment is ALWAYS a good thing–on both sides.
  • Time and money saver: If you’re not wrangling with data, you have more time for patients (and yourself!). Another win-win: automated tasks save your practice money.
  • Smart insights: Mix and match data from different sources for eye-opening insights. Identify health trends early, address potential issues proactively, and gain a comprehensive view of patient health.
  • Tight security: You might be wondering about security, right? When you are partnered with a health IT vendor with top-notch encryption and safeguards, your patients' information stays locked up safe and sound. So, while interoperability lets data flow freely, it's got your back when it comes to careful, restricted access.

What is TEFCA?

TEFCA, short for the Trusted Exchange Framework and Common Agreement, is a set of policies and standards developed by the U.S. government. Its primary purpose is to establish a foundation for secure and seamless health data exchange among different entities within the healthcare ecosystem. TEFCA was introduced as part of the 21st Century Cures Act, signed into law in December 2016.

Core components of TEFCA

Trusted Exchange Framework (TEF): This component defines the principles, policies, and procedures that govern trusted health information exchange. It outlines the requirements for organizations that wish to participate in the exchange of health information, emphasizing trust and security.

Common Agreement (CA): The Common Agreement is a standardized set of rules and terms that participating organizations must adhere to when sharing EHI. It ensures consistency and interoperability in health data exchange. The CA defines the technical, operational, and business requirements for participating entities.

Objectives of TEFCA

Interoperability: TEFCA promotes interoperability by establishing common standards and requirements for health data exchange. This enables different healthcare organizations and networks to communicate effectively, regardless of their underlying technology or systems.

Security and privacy: Protecting patient data is paramount. TEFCA emphasizes the need for robust security measures and privacy protections to safeguard EHI during its exchange.

Patient access: TEFCA ensures that patients have access to their own health information, empowering them to make informed decisions about their healthcare. Patients can securely access their records across different healthcare providers.

Reduced administrative burden: By standardizing data exchange processes and requirements, TEFCA aims to reduce administrative complexities and costs associated with health information sharing.

Scalability: The framework is designed to be scalable, accommodating the evolving needs of the healthcare industry as it continues to adopt digital technologies and innovations.

Significance of TEFCA

Facilitating coordinated care: With TEFCA in place, healthcare providers can access a patient's complete medical history, regardless of where the data originated. This enables better-informed decisions and more coordinated care.

Improving patient outcomes: The seamless exchange of EHI leads to improved patient outcomes, as healthcare providers have access to comprehensive and up-to-date information.

Enhancing efficiency: TEFCA streamlines data exchange processes, reducing administrative burdens and saving time for healthcare professionals.

Supporting innovation: Standardized data exchange paves the way for innovative healthcare technologies and solutions that can benefit both patients and providers.

TEFCA, the Trusted Exchange Framework and Common Agreement, is a pivotal initiative in the realm of healthcare data exchange. It sets the stage for secure, interoperable, and efficient sharing of electronic health information, ultimately benefiting patients and healthcare providers alike. As the healthcare industry continues to evolve and embrace digital transformation, TEFCA will play an increasingly vital role in shaping the future of healthcare data exchange.

What are interoperability standards?

There are so many different interoperability standards out there. Let’s break them down into simple categories.


  • HIPAA privacy rule: A national standard delineating protocols for safeguarding the confidentiality of individuals' medical records and personal health data. It pertains to health plans, healthcare clearinghouses, and healthcare providers engaged in electronic healthcare transactions.
  • HIPAA security rule: A national framework that sets forth standards for preserving the confidentiality, integrity, and accessibility of electronically protected health information. Covered entities handling electronic health data must comply with these security regulations.


  • HL7's Version 2.x (V2): A versatile messaging standard facilitating clinical data exchange, adaptable for both centralized and decentralized systems.
  • HL7 Version 3 Clinical Document Architecture (CDA®): An XML-based standard that delineates the composition and semantics of clinical documents, fostering information exchange.
  • CDA (C-CDA): An extensive compilation of CDA templates resulting from collaboration among HL7, IHE, and HITSP. It dictates the structural framework for healthcare documents.


  • FHIR® (Fast Healthcare Interoperability Resources): An HL7 standard for electronically sharing healthcare data. FHIR's resources define standardized formats and elements for health data interchange, alongside standardized application programming interfaces (APIs).
  • DICOM (Digital Imaging and Communications in Medicine): The quintessential standard governing the communication and administration of medical imaging data. DICOM streamlines the transmission of medical images across systems.


  • Object ID (OID): An internationally unique ISO identifier, widely adopted for crafting distinctive identifiers within HL7 and other contexts.
  • National Council of State Boards of Nursing ID (NCSBN ID): A unique identifier, automatically generated for registered nurses and licensed practical/vocational nurses. It's openly accessible through the Nursys database and managed by NCSBN.
  • Enterprise Master Patient Index (EMPI): A central data registry within healthcare institutions, tasked with sustaining uniform and accurate patient data management across various departments.
  • National Provider ID (NPI): A distinctive 10-digit identifier allotted to healthcare providers, serving as a standardized identification system. NPIs are recorded in the NPI Registry.


  • Conformity Assessment: IHE International administers the IHE Conformity Assessment Scheme, forming the bedrock for certifying product conformity with selected IHE Profiles.
  • eHealth Exchange Testing Program: This program rigorously assesses compliance with HIE (Health Information Exchange) standards, an indispensable prerequisite for joining the eHealth Exchange network.
  • ONC Health IT Certification Program: A voluntary certification initiative spearheaded by the Office of the National Coordinator for Health IT (ONC), attesting to the conformity of health IT products with established standards. Operating as a third-party conformity assessment scheme, it aligns with ISO and IEC principles, championing the availability of certified health IT for diverse programs and initiatives.

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Roy Gill Headshot

Roy Gill, MD, FAMIA

VP, Clinical Affairs and Patient Safety at NextGen Healthcare

I joined NextGen in 2009, working first as a Physician Consultant, Director of Clinical Content under the Chief Medical Officer, and now as Vice President of Clinical Affairs and Patient Safety. A Family Physician by training with nearly 20 year of practice experience, I became interested in Clinical Informatics (CI) in the late 1990's as my institution was adopting an EHR. I became a Physician Champion and began to dive even deeper into Informatics. I eventually earned a Graduate Certificate in CI from Oregon Health and Science University and became Board Certified in CI in 2015 (as well as earning a Six Sigma Black Belt somewhere along the way). It's an exciting time to be working at NextGen, as we vastly improve attention to improving outcomes, patient safety, client needs, quality, and the evolving needs of our clinicians and the industry.