HIO Participation in TEFCA Lags, Financial Sustainability Varies
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A new national survey reveals that adoption of the Trusted Exchange Framework and Common Agreement (TEFCA) remains slow, with only a minority of health information organizations (HIOs) fully participating and a significant number still undecided about future involvement. The survey, conducted in 2025, also highlights the diverse financial situations of HIOs, with roughly one-third achieving full cost recovery through participant fees.
The findings, discussed during a recent Civitas Networks for health event, paint a picture of a sector still navigating the complexities of national interoperability. While the promise of seamless data exchange is driving innovation, practical implementation faces hurdles.
TEFCA Adoption Remains Uneven
only 22% of HIOs are currently active participants in TEFCA, the national framework designed to enable nationwide health information exchange. Perhaps more concerning,24% of organizations surveyed indicated they are unsure whether they will participate in the future.This hesitation suggests ongoing concerns about the costs, technical requirements, and potential benefits of joining the framework.
“The uncertainty surrounding TEFCA participation is a key indicator of the challenges ahead,” one analyst noted. “Successfully achieving nationwide interoperability requires broad adoption, and a significant portion of HIOs are still evaluating their options.”
HIO Services Expand Beyond Basic Exchange
Despite the TEFCA adoption rate, most HIOs are actively supporting a range of crucial services.These include alerting systems, community record building, and data normalization efforts. Increasingly, HIOs are also focusing on incorporating social determinants of health data and supporting value-based care initiatives.
This expansion of services demonstrates the evolving role of HIOs in the healthcare ecosystem.They are no longer simply conduits for data exchange but are becoming active participants in improving care coordination and population health management.
Financial Sustainability: A mixed Bag
The financial health of HIOs varies considerably.Approximately one-third are able to fully cover their operating expenses through fees paid by participants. this suggests a viable business model for some organizations, particularly those offering high-value services.However,the remaining two-thirds likely rely on a combination of grants,philanthropic funding,or other revenue streams to remain operational.
“The ability to achieve financial sustainability is critical for the long-term viability of HIOs,” a senior official stated. “Organizations that can demonstrate value to their participants and generate sufficient revenue will be best positioned to thrive in the evolving healthcare landscape.”
The survey underscores the ongoing need for support and investment in HIOs as they navigate the transition to a more interoperable and data-driven healthcare system. Continued monitoring of TEFCA adoption and financial trends will be essential to ensure the success of national health information exchange efforts.
