Electronic health records giant Epic recently announced plans to transition its customers to a new government-backed data exchange by the end of next year.

"By the end of 2024, our goal is that the full Epic community will have committed to transition to TEFCA with plans to be live by the end of 2025," the EHR vendor wrote in an Aug. 16 news release.

The Trusted Exchange Framework and Common Agreement (TEFCA) is a nationwide network to exchange patient data that was mandated by the 21st Century Cures Act back in 2016. TEFCA, which went live in December, was designed to create an infrastructure to enable data sharing between health information networks. TEFCA marks a critical step in establishing universal connectivity across providers and establishes universal governance, policy and a technical floor for nationwide interoperability.

 Through TEFCA, the federal government, along with industry partners, is paving the road to enable digital health data to flow more seamlessly between providers and patients. Developed by the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health IT (ASTP/ONC), it is now spearheaded by the Sequoia Project, its recognized coordinating entity.

On the same day, Carequality, an interoperability network that Epic belongs to, also announced that it plans to align with TEFCA. Carequality has grown into a framework of more than 45 networks that connect over 600,000 care providers, 50,000 clinics, and 4,200 hospitals. The organization support the exchange of 940 million documents monthly.

"As consensus builds around TEFCA, Carequality is focused on making improvements to the framework’s policies and procedures to continue to support the exchange of nearly 1 billion clinical documents monthly. This ongoing improvement is critical to ensure there is no net loss in healthcare connectivity, especially as some begin to transition frameworks," the organization wrote in a blog post.

Carequality is made up of dozens of implementer organizations that in turn onboard their participant organizations to the framework. Epic connects its provider customers to Carequality as an extension of its Care Everywhere network.

While the two announcements may seem, at first glance, rather minor developments, the moves by both organizations to align with a federal government-backed medical records exchange network signal a "tectonic shift" in the interoperability landscape and the rising influence of the federal government's nascent network, according to Dave Cassel, an interoperability expert who served as executive director of Carequality for six years.

Cassel, now chief customer officer at Health Gorilla, noted in a blog post that both announcements signal that Carequality, which was founded more than 10 years ago, will be eventually "ceding the stage to TEFCA" in the larger industry-wide movement toward universal connectivity.

Epic highlighted in its statement that it will continue to support connectivity through Carequality "during the transition to TEFCA to ensure the success of national healthcare interoperability."

"My reading of it is that Epic’s customers will be transitioning to TEFCA between now and the end of 2025, and that Epic’s support for Carequality will not continue into 2026," Cassel wrote.

Carequality said it has aligned, or is in the process of aligning, its own policies with TEFCA, including leveraging existing Carequality policies now to address community concerns about required responses to queries, accelerating the ongoing consideration and adoption of policy revisions to align with TEFCA’s approach to the definition of treatment and instituting stronger directory integrity controls. The organization also is incorporating TEFCA Delegate policies into its existing On-Behalf-Of policies to increase transparency and controls.

"We are strategically and methodically evolving to meet the needs of our dynamic community now, while making a plan to converge with TEFCA in the future," the organization wrote.

"We realized Carequality being eclipsed by TEFCA was a distinct possibility from the moment drafts of the 21st Century Cures Act emerged that directed ONC to 'develop or support' a national exchange framework. Eight years later, what was a possibility now seems highly likely," Cassel wrote in his blog post.

"For now, however, the two frameworks must continue to operate. As both Carequality and Epic stated, it is absolutely a good thing for the two to be aligned, and for migrations to be as smooth as possible," he noted.

Epic applauded Carequality's decision to align with TEFCA and use the same definition of treatment. The company also commended Carequality's new delegate policies that will "allow healthcare organizations to review and approve organizations requesting records on their behalf, just as they can under TEFCA."

"100% of the Epic community participates in the Carequality framework, which today connects more than 70% of U.S. hospitals, 50,000+ clinics, and more than 600,000 care providers. TEFCA is the nation’s best opportunity to get the remaining 30% of U.S. hospitals off the sidelines and reinforce trust between data exchange networks and care organizations," said Epic officials in a statement.

As one of the largest health IT vendors in the industry, Epic's commitment to moving customers over to TECFA is noteworthy and will likely help to drive adoption, health IT experts say.

"They're signaling to everyone else, 'You better move over to TEFCA because we're moving over to TEFCA, otherwise you won't have access to Epic sites," said Brendan Keeler, interoperability and data liquidity practice lead at healthcare strategy and software development firm HTD Health. "They're trying to lead. They're saying 'You can do the work and move over by 2025 or you can be left behind.'"

There have been several major developments on the interoperability front this summer.

Epic rolled out a new feature that makes it easier for patients to release their medical records to the health or wellness apps they use. The new individual access services (IAS) capability gives patients more direct control over their health data, according to Epic executives.

Individual access services is one of the "exchange purposes" under TEFCA that facilitates sharing patients' data. The other exchange purposes include treatment, payment, healthcare operations, government benefits determination and public health.

"Epic customers will move from Carequality to TEFCA and, as a result, there will be provider to provider exchange, but also provider to patient exchange via TEFCA. So the individual access services, which Carequality and existing networks don't really do that, will be available. So patients through TEFCA will be able to access their data," Keeler said.

The move to align with TEFCA also comes as the health IT industry strives to establish more standard "rules of the road" for sharing data.

Earlier this year, there was controversy following a dispute between Epic and venture-backed health tech company Particle Health over healthcare data exchange practices. Epic cut off data requests from some Particle Health customers, citing concerns about potentially inappropriate disclosures of protected health information and privacy risks to patients’ medical data.

Both companies are connected to Carequality, which means they agreed to an “interoperability framework,” which is a collection of legal, governance and technical documents used to operationalize trusted exchange of health information nationwide, according to the organization.

Health IT experts say the rift between the two companies exposes larger challenges with health data exchange including a lack of transparency and clarity on the rules of the road along with the need for better gatekeeping.

As adoption of TEFCA grows, the ability to more easily exchange patient data across hospitals, clinics, payers and patients will become "real," Keeler noted. The health information networks will broaden beyond provider-to-provider exchange to include provider-to-patient and provider-to-payer.

"People should be excited by the possibility of less waste and friction in the system because payers and providers will communicate effectively for patients and patients will have access to their data in a way that is way easier than they have today," he said. "There won't be the risk of privacy violations that came about in the spring. The tactical idea of just being able to access your data and your payer not blocking your prior authorization because they're able to access clinical data when they need it, to approve it. There's a lot of friction that gets reduced in a TEFCA world."