Based on a Black Book Research flash survey of 97 HIM leaders conducted at AHIMA 2025 last week.
MINNEAPOLIS, MN / ACCESS Newswire / October 22, 2025 / A flash survey of 97 Health Information Management (HIM) leaders indicates that 61% have no FY26 budget line for Trusted Exchange Framework and Common Agreement (TEFCA) onboarding and testing. The findings come as EHR and health IT vendors enable production TEFCA connectivity and national exchange participation expands.
Key Results
• Budgeting: 61% report no FY26 budget set or included for TEFCA onboarding/testing (including QHIN participation, legal review, identity and access management updates, and cutover work).
• Routing decisions: 54% are undecided on routing through a Qualified Health Information Network (QHIN) in 2026; 18% report a QHIN named in a draft or executed agreement.
• Parallel networks: 68% expect to maintain existing HIE connections after TEFCA go-live.
• Interface savings: Among organizations piloting TEFCA-aligned exchange, 42% anticipate net interface cost reductions from retiring state/local HIE connections; 37% are unsure.
• Top concerns: contracting/legal (49%), data quality/reconciliation (46%), security and IAM changes (41%), workflow training (38%).
• Primary 2026 use cases: query-for-treatment (71%), transitions of care (52%), referrals (39%).
Why This Matters
• TEFCA consolidates nationwide exchange through designated QHINs, reducing duplicative point-to-point interfaces.
• Without FY26 planning, organizations are likely to operate parallel networks, incur duplicative testing, and delay measurable benefits from standardized exchange.
• TEFCA participation requires defined steps-contracting, onboarding and conformance testing, IAM/SSO updates, and workflow changes in HIM and care coordination.
Operational Implications
• Workflow readiness: Frontline teams must know when and how to use TEFCA routes for query-for-treatment, discharge/transition packets, and referrals.
• Data quality: Organizations should align reconciliation processes and metadata conventions to reduce record duplication and indexing errors.
• Security and identity: Short-lived service accounts, role-based access, and credential revocation procedures should be updated to reflect QHIN participation.
• Contracting: Participation agreements should specify uptime/response expectations, testing windows, directory/endpoint responsibilities, and cutover requirements.
Financial Implications
• Concentrating budget in FY26 for onboarding and cutover can enable retirement of redundant interfaces and contracts.
• Maintaining parallel HIE connections beyond initial TEFCA go-live extends costs and audit complexity.
• Organizations reporting expected savings tie them to interface rationalization and fewer one-off testing cycles.
“TEFCA has moved from policy to production; the execution risk now sits with budgeting and cutover discipline,” said Doug Brown, Founder, Black Book Market Research. “Organizations that don’t fund FY26 onboarding will operate parallel networks longer than necessary and duplicating interfaces, tests, and spend.”
The playbook is straightforward and technical: (1) select your QHIN path with a defined onboarding window; (2) fund the components-conformance testing, participation fees, legal review, IAM/SSO hardening and identity federation, plus frontline training; (3) set objective cutover criteria and dates to decommission redundant HIE interfaces; (4) wire TEFCA into three initial workflows: query-for-treatment, care transitions, and referrals with step-by-step user instructions; and (5) lock the contract mechanics: time and response SLAs, data-quality obligations, and credential-revocation SLAs tied to the directory/endpoints.
“Treat this like any enterprise platform migration: time-boxed, measurable, and tied to interface retirement, that’s how you convert TEFCA from an infrastructure project into faster retrieval and lower integration cost,: adds Brown.
About the Black Book Research Flash Surveys
Each year at the several Global HIT Conferences, Black Book conducts short, in-field surveys on topics nominated by attendees, emphasizing underreported developments or emerging trends gaining attention in current media cycles. Results are released in rapid “flash” formats to inform operational planning and policy discussions and as a service to industry leaders.
Contact Information
Press Office
research@blackbookmarketresearch.com
8008637590
SOURCE: Black Book Research
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