QHIN, TEFCA and 21st Century Cures ACT Glossary of Terms

Health Gorilla recently announced our intention to become one of the first Qualified Health Information Networks (QHIN) under the Trusted Exchange Framework and Common Agreement (TEFCA). Health Gorilla has been adhering to the 21st Century Cures Act and TEFCA standards since they were released in 2016, but we realize that the legislation and technology vernacular attached to this qualification can be overwhelming and convoluted. 

In an effort to make this information more widely available and understandable we have created a glossary of terms to help the healthcare community understand and navigate the changes coming in the first quarter of 2022. If there are any terms that you are familiar with and are not currently represented in the list, please reach out to Ryan Kelly to have it added.

  • 21st Century Cures Act - Enacted by congress in December 2016 by the Obama administration to prevent the blocking of electronic health information between health systems, apps, and devices.
  • Trusted Exchange Framework and Common Agreement (TEFCA) - Describes the high-level rules that Health Information Networks should follow for trusted exchanges of digital health information.
  • The Office of the National Coordinator for Health Information Technology (ONC) - A division of the Office of the Secretary, within the U.S. Department of Health and Human Services, responsible for supporting the adoption of health information technology and promoting nationwide standards-based health information exchange.
  • The Sequoia Project - A non-profit 501(c)(3) that was awarded cooperative agreement by the ONC as the Recognized Coordinating Entity (RCE) for TEFCA  in August 2019.
  • Recognized Coordinating Entity (RCE) - The Sequoia Project was assigned as the RCE for TEFCA by the ONC and is responsible for developing the common agreement, which was released for public comment in September of 2020.
  • Qualified Health Information Network (QHIN) - A group of organizations working together to ensure interoperability between the networks they represent.
  • Subparticipants - A defined role in TEFCA that participates in the exchange of information through the Trusted Exchange Network. Subparticipants enter into a contract with Participants, which contains flowdown terms that define participation requirements. Subparticipants may choose to onboard additional Subparticipates to expand the "network of networks' approach of TEFCA. Examples of Subparticipants may include but are not limited to, a physician practice, hospital, pharmacy, or public health agency.
  • Participant - A defined actor role in TEFCA that participates in the exchange of information through the Trusted Exchange Network. Participants enter into a contract with a QHIN, which contains flow-down terms that define participation requirements. Additionally, Participants can onboard and connect Subparticipants as an additional layer of participation in TEFCA. Examples of participants may include, but are not limited to, Health Information Networks, electronic health information vendors, and other healthcare systems, a health IT developer, a payer, or a federal agency.
  • End User - An individual or organization utilizing the services of a QHIN Participant to send and/or receive electronic health info.
  • Interoperability - The ability of different computerized products or systems to readily connect and exchange information with one another, in either implementation or access, without restriction.
  • Health Information Network (HIN) - An individual or entity that determines, controls, or has the discretion to administer any requirement, policy, or agreement that permits, enables, or requires the use of any technology or services for access, exchange, or use of electronic health information.
  • Query-based Exchange – In this scenario, information is requested and “pulled” among the QHINs, Participants, and Subparticipants.
  • Electronic Health Information (EHI) - Digital patient data collected and shared for healthcare delivery and public health purposes.
  • Enterprise Master Patient Index (EMPI) - A database used to maintain updated and accurate patient information registered by a healthcare organization.
  • Message Delivery - Exchange method used to “push” information into the connected network of QHINs, Participants, and Subparticipants, to a specified entity or provider.  
  • Record locator services (RLS) - The ability to identify where records are located based upon criteria such as a Person ID or of other types of data.
  • HIPAA Privacy Rule - National standards that protect individuals' medical records and other personal health information. It applies to health plans, health care clearinghouses, and certain health care providers that transactions electronically. 
  • HIPAA Security Rule - Applies to covered entities and business associates is designed to guarantee the privacy of individuals’ electronic personal health information.
  • Fast Healthcare Interoperability Resources (FHIR) - An interoperability standard for the electronic exchange of healthcare information.
  • CCD - An electronically generated, patient-specific clinical summary document.
  • IHE - Promotes the synchronized use of established standards like DICOM and HL7 to address specific clinical needs that support optimal patient care.