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ONC Releases Common Agreement Version 2.0, Paving the Way for TEFCA Exchange via FHIR

The U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC) and its Recognized Coordinating Entity (RCE), The Sequoia Project, Inc., announced that Common Agreement Version 2.0 (CA v2.0) has been released. The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road. The seven designated Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA) can now adopt and begin implementing the new version. Also published today is the Participant and Subparticipant Terms of Participation, which sets forth the requirements that each Participant and Subparticipant must agree to and comply with to participate in TEFCA.

Notably, CA v2.0 includes enhancements and updates to require support for Fast Healthcare Interoperability Resources® (FHIR®) Application Programming Interface (API) exchange, which will allow TEFCA Participants and Subparticipants to more easily exchange information directly between themselves and will enable individuals to more easily access their own health care information using apps of their choice via TEFCA. These enhancements and updates mark a huge step forward for TEFCA as it meets the promise of seamless nationwide exchange at scale. Visit to view a list of key concepts that have evolved from Common Agreement v1.1 to v2.0.

The Terms of Participation will also greatly enhance the TEFCA framework by providing a standalone document that Participants and Subparticipants can incorporate into existing data use agreements, thus reducing legal costs and burden for organizations seeking to connect to TEFCA.

“We have long intended for TEFCA to have the capacity to enable FHIR API exchange. This is in direct response to the health IT industry’s move toward standardized APIs with modern privacy and security safeguards, and allows TEFCA to keep pace with the advanced, secure data services approaches used by the tech industry,” said Micky Tripathi, Ph.D., national coordinator for health information technology. “I want to commend the effort put forth by the TEFCA and FHIR communities to help get us there with the release of CA v2.0.”

“The initial exchange of clinical data began within 24 hours of the nation’s first Qualified Health Information Networks achieving designation in December 2023,” said Mariann Yeager, The Sequoia Project CEO and RCE lead. “Today’s release includes framework enhancements, including greater use of FHIR, better support for use cases beyond treatment, and simplified onboarding for Participants like clinicians, digital health apps, public health agencies and other end users of health data.”

For more information about TEFCA, visit or visit the RCE’s website,