Standards and Exchange

If interoperability is the problem, standards and exchange networks are the solution the field has built. Understanding the main ones, the FHIR data standard, health information exchanges, and the nationwide TEFCA framework, is essential for anyone building value-based analytics, because they determine how data can actually be moved and used.

FHIR: the modern standard

FHIR (Fast Healthcare Interoperability Resources) is the prevailing modern exchange standard.

Worth remembering: FHIR’s key idea is exposing health data as discrete, queryable resources through APIs. Instead of shipping an entire document and hoping the receiving system can parse it, a system can request exactly the pieces it needs, a specific lab result, a medication list, a problem, through a standardized interface. This is a fundamental improvement over document-based exchange, and it is why federal rules increasingly require FHIR APIs. For an analytics builder, FHIR is becoming the default way to pull clinical data programmatically.

Since 2023, certified electronic health records have been required to offer standardized FHIR APIs for patient and population access, which has made programmatic data access far more feasible than it once was.

Health information exchanges

A health information exchange (HIE) is both an activity, moving clinical data across organizational boundaries, and the name for the regional organizations that broker it. HIEs connect providers in a geography so that a hospital, a clinic, and a specialist can share records for a shared patient. They have long been the workhorse of regional data sharing and remain important, though the national frameworks are increasingly connecting them.

TEFCA: the nationwide floor

The Trusted Exchange Framework and Common Agreement (TEFCA) is the federal effort to set one nationwide floor for data exchange in place of a patchwork of regional deals. It operates through QHINs (Qualified Health Information Networks), designated hubs that exchange data between networks that would otherwise not connect.

TEFCA has grown quickly: as of late 2025 there were 11 designated QHINs and more than 10,600 organizations live on the framework, having exchanged over 115 million documents since it launched at the end of 2023. For the first time, a genuinely national exchange backbone is taking shape, though it is still maturing.

What this means for building analytics

For an analytics function, these standards and networks are the pipes. FHIR APIs are increasingly how you pull clinical data; HIEs and TEFCA are how you reach data beyond your own walls. Designing your data architecture around these standards, rather than one-off custom feeds, is what makes it scalable as the national infrastructure matures. The next lesson covers the federal rules that increasingly require all of this.

Key takeaways

• FHIR exposes health data as discrete, queryable resources via APIs, a major improvement over document-based exchange, and is now required of certified EHRs.
• Health information exchanges move clinical data regionally and are the long-standing workhorse of data sharing.
• TEFCA, operating through QHINs, is building a nationwide exchange floor, with 11 QHINs and 10,600-plus organizations live as of late 2025.

Sources

• ONC/ASTP, Trusted Exchange Framework and Common Agreement (TEFCA) (opens in a new tab)