Technical Implementation of TEFCA with FHIR and USCDI

This technical report outlines the implementation roadmap for the Trusted Exchange Framework and Common Agreement (TEFCA) with a focus on the integration of Fast Healthcare Interoperability Resources (FHIR) and the United States Core Data for Interoperability (USCDI). It is designed for technical leaders seeking to understand the Qualified Health Information Network (QHIN) Technical Framework (QTF) and the requirements for implementing it. The document details the three modalities of data exchange under TEFCA—QHIN Query, QHIN Message Delivery, and Facilitated FHIR Exchange—highlighting their operational mechanisms. Additionally, it discusses the essential technical architecture required for secure and reliable health information exchange, including trust infrastructure, identity resolution, and directory services. The report emphasizes the importance of compliance with QTF standards, connectivity requirements, and robust security policies to ensure effective interoperability across the U.S. healthcare system, ultimately aiming to enhance patient safety and care coordination.