Strengthening Interoperability for Rural Hospitals: The Role of TEFCA

The digital divide between rural and urban hospitals (a gap in adoption and use of robust IT tools to support care delivery) has narrowed considerably in recent years. And yet, hospitals in rural communities – especially those not part of a larger health system – are still struggling with access to and routine use of interoperable health information exchange (HIE) capabilities.

The Trusted Exchange Framework and Common Agreement (TEFCA) is the federal policy solution to offering all health care organizations an on-ramp to interoperable HIE, particularly entities that lack other vendor-specific alternatives. Beginning in late 2023, organizations could start connecting to a qualified health information network (QHIN) that would then gain participants access to a “network of networks” for national information exchange. It is unclear to what extent rural hospitals are actively participating in TEFCA and whether TEFCA participation has been equally helpful in both rural and urban communities with helping to mitigate persistent barriers to interoperability.

This project seeks to describe rates of TEFCA participation among critical access hospitals (CAHs) and other rurally-located hospitals, and characterize whether and how reported barriers to interoperability vary based on TEFCA participation.