HIE Integration Services

A health information exchange (HIE) is a network and process that enables the electronic sharing of clinical data between healthcare organizations. HIEs operate at three levels: community HIEs serve local markets like metropolitan areas or health system networks, state HIEs aggregate data across an entire state and are often legislatively mandated, and national networks like eHealth Exchange and CommonWell connect participants across the country. The goal of an HIE is to ensure that clinicians, payers, and public health agencies can access the right patient data at the right time, regardless of which EHR system generated the original record.

TEFCA (Trusted Exchange Framework and Common Agreement) is a national framework established by ONC to create a single, universal policy and technical floor for health data exchange across the United States. Under TEFCA, Qualified Health Information Networks (QHINs) serve as on-ramps to the national network — connecting to one QHIN gives your organization access to every other QHIN participant. TEFCA affects your organization by establishing mandatory technical standards (including FHIR, IHE profiles, and FAST/UDAP security), governance requirements, and permitted exchange purposes that you must implement to participate in the national health information network.

There are three pathways to QHIN connectivity. You can apply to become a QHIN yourself, though this requires significant infrastructure and governance investment and is typically pursued only by large networks. More commonly, organizations connect as a Participant — signing a participation agreement directly with a QHIN and meeting their technical onboarding requirements. The most accessible pathway is Sub-Participant status, where you connect through an existing Participant organization (such as your EHR vendor or a regional HIE). Saga IT helps organizations evaluate which pathway fits their size, use cases, and technical readiness, then manages the onboarding process from application through production connectivity.

eHealth Exchange is the largest operational health information network in the US, connecting over 300 million patient records through a federated query model based on IHE XCA profiles. CommonWell Health Alliance focuses on record linking and document retrieval, with over 187 million patient records and strong EHR vendor participation. Carequality is a framework rather than a network — it establishes technical and policy standards that enable networks to exchange data with each other, and a majority of US providers can be reached through Carequality-enabled connections. eHealth Exchange and CommonWell are designated QHINs under TEFCA; Carequality is not itself a QHIN — it remains a separate trust framework, with cross-traffic to TEFCA reached through QHINs that participate in both. Many organizations connect through multiple networks to maximize their exchange partner coverage.

HIE data exchange relies on several complementary standards. HL7 v2 handles real-time clinical messaging (ADT, orders, results) over MLLP connections. C-CDA (Consolidated Clinical Document Architecture) provides the XML document format for clinical summaries and transitions of care. IHE profiles define the transactions — XDS.b for document sharing, XCA for cross-community access, XCPD for patient discovery, and MHD for FHIR-based document exchange. FHIR R4 is increasingly used for individual access, payer exchange, and SMART on FHIR applications. TEFCA also mandates FAST/UDAP for OAuth 2.0 security and identity proofing across QHIN connections.

A typical HIE implementation takes 6-12 months from readiness assessment through production go-live. Simpler implementations — such as connecting a single facility to an existing QHIN through a Sub-Participant pathway — can be completed in as few as 4-6 months. More complex projects, such as building a new community HIE, connecting multiple organizations simultaneously, or implementing custom patient matching and consent management, may require 9-12 months or longer. The primary variables that affect timeline are the number of participating organizations, the complexity of your EHR environment, and the specific QHIN's onboarding requirements and testing queue.

Carequality and CommonWell Health Alliance are the two largest pre-TEFCA health information exchange frameworks in the United States, and they serve complementary but distinct roles. Carequality is a trust framework that establishes technical and governance rules for query-based clinical document exchange — enabling organizations to find and retrieve patient records across participating networks using IHE XCA and XCPD profiles. Epic's Care Everywhere, Surescripts, and eHealth Exchange all participate in Carequality. CommonWell Health Alliance focuses on patient identity matching, record location, and document retrieval across member EHR platforms including Oracle Health (Cerner), MEDITECH, athenahealth, and others. Since 2020, Carequality and CommonWell have been interoperable, meaning providers connected to either network can exchange data across both. Under TEFCA, CommonWell is itself a designated QHIN, while Carequality remains a separate trust framework — cross-traffic to TEFCA flows through QHINs that participate in both. TEFCA is designed to subsume and extend both networks through a unified national framework of designated QHINs.

FAST (FHIR at Scale Taskforce) and UDAP (Unified Data Access Profiles) define the security and identity framework for TEFCA-based health data exchange. UDAP extends OAuth 2.0 with healthcare-specific requirements for dynamic client registration, certificate-based authentication, and organization identity verification. As of January 2026, FAST/UDAP is a required component of TEFCA connectivity — all QHINs, Participants, and Sub-Participants must implement UDAP-compliant security for their TEFCA-facing interfaces. This means organizations planning QHIN connectivity need to implement UDAP client credentials, configure certificate trust chains, and pass UDAP conformance testing as part of their onboarding process.