A year after Draft 2 of TEFCA, what has happened and where are we now? The ONC awarded a cooperative agreement to The Sequoia Project to serve as the Recognized Coordinating Entity (RCE) to develop, update, implement, and maintain the Common Agreement and the QTF. On today’s episode, Shahid Shah joins your host, Don Lee to talk with the CEO of The Sequoia Project, Mariann Yeager. If you are an HIE and you want to become a QHIN (or sell to one), this episode is for you.


TEFCA, Trusted Exchange Framework and Common Agreement, are the rules of the road and the specific technical requirements to enable health information networks to interconnect.

  • Sequoia has an HIE portfolio and is helping the ONC to implement TEFCA
  • What is a Qualified Health Information Network (QHIN)?
  • Minimum requirements for legal and privacy vs. technical implementation details for interoperability
  • What do product managers, developers, and customers need to know about TEFCA? Read the QTF!
  • The technology used for treatment based exchange is the easy part. TEFCA provides the trusted community to get over the privacy concerns.
  • Ms. Yeager breaks down the TEFCA Value Proposition.
  • What parts of TEFCA are descriptive vs. prescriptive?
  • Does the government or industry get to decide what it means to be “TEFCA compliant”?

Mariann Yeager

Mariann Yeager, CEO has more than 20 years of experience in the health information technology field. She currently serves as CEO for The Sequoia Project, a non-profit solely focused on advancing secure, interoperable nationwide health data sharing in the US.  She also leads the Recognized Coordinating Entity (RCE) effort, in close collaboration with the Office of the National Coordinator for Health IT to develop, implement, and maintain the Common Agreement component of the Trusted Exchange Framework and Common Agreement (TEFCA) and to operationalize the Qualified Health Information Network (QHIN) designation and monitoring process. The Sequoia Project also serves as a steward of independently governed health IT interoperability initiatives including the Patient Unified Lookup System for Emergencies (PULSE) and the RSNA Image Share Validation Program.  Under her leadership, The Sequoia Project supported, the startup, growth and maturation of two highly successfully interoperability initiatives, the eHealth Exchange and Carequality, which now operate as independent non-profit organizations.  Prior to her tenure at The Sequoia Project, she worked with the HHS Office of National Coordinator (ONC) for five years on nationwide health information network initiatives.  She also led the launch and operation of the first ambulatory and inpatient EHR certification program in the US. 

The Sequoia Project

The Sequoia Project is a non-profit, 501c3, public-private collaborative chartered to advance implementation of secure, interoperable nationwide health information exchange. The Sequoia Project focuses on solving real-world interoperability challenges and brings together public and private stakeholders in forums like the Interoperability Matters cooperative to overcome barriers. Sequoia also supports multiple, independently governed interoperability initiatives, such as the Patient Unified Lookup Service for Emergencies (PULSE), a system used by disaster healthcare volunteers to treat individuals injured or displaced by disasters.

Links and Resources

@sequoiaproject on Twitter

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Music by StudioEtar