As TEFCA grows, connecting is the easy part

On November 5, 2026, ONC announced that the U.S. Department of Veterans Affairs and the Department of War have joined the Trusted Exchange Framework and Common Agreement (TEFCA). The announcement is a useful moment to ask what a bigger exchange network changes for a healthcare technology company.

What ONC reported

VA and the Department of War join the Indian Health Service, the Consumer Product Safety Commission, and the Social Security Administration as federal agencies on TEFCA, which launched in December 2023. Beyond those five agencies, ONC says nearly 25,000 organizations are live on the network, representing nearly 110,000 unique connections to clinicians, hospitals, clinics, post-acute and long-term care facilities, public health authorities, and others. It reports that more than 2 billion health records have been exchanged since December 2023.

The federal electronic health record modernization office's director said the aim is for beneficiaries' information to travel with them across military, VA, and local hospital settings.

What the figures do not show

These are counts of organizations, connections, and records exchanged. They do not describe data completeness, accuracy, or how often exchanged records are used in care. They are also ONC's own figures, announced alongside a policy milestone, and the press release does not break the totals down by use case. Nothing here says how any particular vendor's integration performs.

Our interpretation

This section is interpretation, not ONC's conclusion. As participation grows, being able to connect to the network becomes an expectation rather than a differentiator. Buyers will assume it, and most capable vendors will say yes.

The difference shows up after the record arrives. The same patient can appear differently across a federal system, a hospital, and a clinic. Fields are missing, medications are coded in different ways, and duplicates need to be reconciled. A product that receives more data without a plan for this can make the clinician's job harder rather than easier. The work of making exchanged data trustworthy sits with the engineers and implementers behind the product.

What this means for hiring

• Hire for production experience with exchanged data, not only knowledge of the standards and acronyms.
• Ask for the messiest incoming record the candidate had to make usable, and what changed in the product afterward.
• Name an owner for data quality in the product, and make sure it is a person, not a shared intention.
• Pair integration engineers with someone who understands the clinical workflow, so the question "what should the clinician see" gets asked early.

A larger network raises the number of places your product can get data from. It does not decide what the product does with it.

If you are planning an integration, interoperability, or data engineering hire, we are glad to compare notes on what the role should prove.

Keith Anderson, Founder

Sources

• ONC, HHS, HHS Welcomes the Department of Veterans Affairs and Department of War to the TEFCA Network, November 5, 2026.