TEFCA, the Trusted Exchange Framework and Common Agreement, is the US attempt at a national on-ramp for health information exchange. For patient-mediated retrieval it matters because 'Individual Access Services' is a named exchange purpose: a patient, or someone acting for them, can query the network and connected providers are obliged to respond.
What it changes: for providers connected through a QHIN, we can query electronically with the patient's authorisation and expect a response, usually a C-CDA document. This is faster and more reliable than the pre-TEFCA world of bilateral agreements and hoping.
What it doesn't change: coverage. Connection is uneven, response quality varies wildly, and a C-CDA is a summary document, not the chart. Imaging reports, full lab histories, clinical notes and anything on paper are largely outside it. Small practices, imaging centres and retired physicians are not on any QHIN and will not be for years.
Our data from the first half of 2026: for a typical patient with seven providers, TEFCA-connected queries return usable data from about three. The rest still require a portal, a phone call, or a fax. That is why we built agents, and why we expect to be running them for a long time even as the network grows.
Our position is simple: use the network wherever it works, and don't pretend it's complete. A record that stops at the network boundary is a record with a hole in it, and the patient is the one who pays for the hole.