ONC moves to formalize how TEFCA hears from its exchange networks
ONC moves to formalize how TEFCA hears from its exchange networks — Monday, August 17, 2026
TEFCA may be getting a more official listening post. The Office of the National Coordinator for Health IT has published a request for OMB approval of a three-year feedback and monitoring collection for the national health-information-exchange framework, with comments due September 16.
This is not a new data-sharing mandate, an enforcement action, or a rule that quietly rearranges everyone’s Tuesday. It is a Paperwork Reduction Act notice, but it offers a useful clue about what comes next as TEFCA’s exchange architecture becomes something agencies must monitor as well as admire.
### What It Is
TEFCA—the Trusted Exchange Framework and Common Agreement—is intended to let qualified health information networks exchange electronic health information under shared technical and legal terms. ONC oversees the Recognized Coordinating Entity that administers the Common Agreement and its baseline requirements for participating networks.
The notice seeks a new generic clearance for qualitative feedback about TEFCA-related service delivery and program performance. In plain English: ONC wants a standing, OMB-approved way to ask whether the networks at the center of the framework are finding the machinery timely, accurate, usable, and capable of resolving problems before they acquire the usual federal patina of permanence.
### What’s Changing
If OMB approves the collection, ONC would have a three-year vehicle for standardized monitoring and performance reports from Qualified Health Information Networks, or QHINs. The agency estimates 15 QHIN respondents each year, about seven qualitative feedback activities annually, and 1,420 burden hours per year. The proposed work includes applications, monthly and quarterly reports, attestations, directory submissions, usability testing, and other feedback activities.
ONC says the information would be qualitative rather than statistically generalizable. It would cover participant perceptions, communication, training, operations, early warnings of service issues, and matters such as timeliness, appropriateness, accuracy, efficiency, and issue resolution. An earlier 60-day notice drew no comments, and ONC reports no changes to the proposed content or burden estimate in this 30-day OMB-review notice.
### Why It Matters
The direct reporting burden here is on QHINs, not physicians or individual practices. That distinction matters: this notice does not create a new clinical reporting duty or alter what information may be exchanged. Still, physicians and health systems experience TEFCA downstream, where successful exchange can make a patient record more available—and a failed exchange can turn an elegant national framework into a very expensive scavenger hunt.
The practical question is whether QHIN-centered feedback will reliably expose the friction that patients, clinicians, and health systems encounter. ONC is not claiming it has solved that problem. It is asking for permission to measure it more systematically.
As TEFCA shifts from blueprint to routine infrastructure, the feedback loop is becoming part of the infrastructure too. That is less dramatic than a new mandate, but often more revealing. Read the published Federal Register notice (https://www.federalregister.gov/documents/2026/08/17/2026-16766/agency-information-collection-request-30-day-public-comment-request-submission-for-office-of).