Ever since EHRs began replacing paper records as the industry standard, the healthcare sector has been working toward data interoperability. Many years and billions of EHR investment dollars later, significant progress has been made, but there is still room to improve. At this juncture, two complementary federal initiatives, the CMS Health Tech Ecosystem and TEFCA, are working in tandem to bridge the remaining interoperability gap.
The CMS Health Tech Ecosystem was launched in July 2025 and consists of two main goals: promoting a CMS interoperability framework to enable information sharing between patients and providers and increasing the availability of personalized tools so patients can make informed health decisions. More than 700 organizations have signed onto or pledged support for the initiative.
Meanwhile, TEFCA was mandated by the 21st Century Cures Act in 2016, went live in December 2023 and was further embedded into the healthcare ecosystem when the Health Data, Technology, and Interoperability (HTI-2) rule took effect in January 2025. As of February 2026, more than 500 million records have been exchanged through TEFCA.
"Both of them aim to reduce the friction in healthcare data and bring additional burden reduction and ease of consumer and patient experience throughout the process," said Eric Musser, vice president of federal affairs at the National Committee for Quality Assurance.
Musser suggested the alignment between the two initiatives is promising, but achieving true interoperability will also require consistent data standards and harmonized quality-reporting expectations.
Assessing CMS, TEFCA program alignment
Under the CMS Health Tech Ecosystem initiative, 21 networks and companies, including athenahealth, Carequality, Innovaccer and Surescripts, voluntarily pledged to meet the CMS interoperability framework criteria to become CMS Aligned Networks. The framework requires participating entities to provide or facilitate access to data using FHIR APIs, chart notes and clinical documents as FHIR attachments, as well as provide appointment and encounter notifications using FHIR subscriptions.
"We commit to empowering patients, providers, and their apps -- and, where appropriate, payers -- with real-time access to complete and secure health information, in ways that protect patient privacy and follow applicable standards and regulations, without friction or delay," the pledge stated.
In December 2025, Steven Posnack, principal deputy national coordinator for health IT at the Office of the National Coordinator for Health IT, published a piece on the ONC blog exploring the relationship between TEFCA and the CMS Aligned Networks.
Essentially, TEFCA and CMS Aligned Networks share the same objective of enabling the secure exchange of health data, though they go about it differently.
"Where TEFCA looks to be a rising tide that lifts all boats, networks that have pledged to be a CMS-Aligned Network are more like speedboats shooting out ahead to achieve specific milestones," Posnack wrote.
Unlike TEFCA, the CMS Aligned Network pledge does not establish a centralized network governance structure. What's more, any organization that identifies as a network can sign the CMS pledge, whereas TEFCA participants must connect through a designated QHIN.
"TEFCA implements the 21st Century Cures Act’s requirement to establish a Common Agreement for participating parties involved in network-to-network exchange, whereas CMS has given networks the opportunity to publicly step up and 'do more, faster.'" Posnack noted.
The key difference between the two initiatives is their pace and structure, Posnack said. Where TEFCA prioritizes careful, formal governance, CMS Aligned Networks encourage rapid testing and refinement. Rather than working at odds, the two approaches complement one another.
"I think the alignment is there," Musser shared.
Musser further noted that the CMS Health Tech Ecosystem's "sandbox approach," in which entities can accelerate innovation and quickly refine, has significant potential to address complex infrastructure requirements and accelerate progress in interoperability and other areas, like prior authorizations.
Prior authorizations have been a pain point in healthcare for years, driving cost inefficiencies and care delays. Streamlining the prior authorization process has been a focus of the Health Tech Ecosystem initiative from the start, with organizations pledging to standardize prior authorization submissions, expand real-time responses and enhance transparency.
In May 2026, CMS added a new pledge to the Health Tech Ecosystem that aimed to bring payers, providers and EHR vendors together to implement electronic prior authorizations. Pledgees committed to align on CMS Interoperability and Prior Authorization Final Rule deadlines, address workflow gaps and refine technical handoffs between stakeholders.
As exemplified by the prior authorization pledge, the fast-moving pace and structure of innovation within the CMS Health Tech Ecosystem are promising for the industry and could help refine TEFCA in the long run, Musser said.
All current QHINs have also signed up to become CMS Aligned Networks, further demonstrating the alignment. ONC and CMS officials have been vocal about the two initiatives' collaboration. Innovations developed within the ecosystem could ultimately be added to TEFCA, and advancements in data exchange will benefit the industry as a whole, Musser added.
The next step for interoperability: Data standardization, quality reporting improvements
The cohesion between TEFCA and the CMS Health Tech Ecosystem initiative has generated significant momentum for interoperability. But the future success of both initiatives, and interoperability as a whole, hinges on consistent data standards and quality reporting expectations, Musser asserted
Misalignment could cause healthcare organizations to miss valuable insights from data, leading to systems that are interoperable in theory but operationally disjointed.
"The access we all have to our own medical records, and what providers and others have now in access to clinical data are great, but that data continues to be messy," Musser said, pointing to the frequency of inconsistent formats, incomplete records and duplicate entries.
"When all the billions of dollars were invested in EMRs, the standardization of that data wasn't necessarily the fundamental component of that investment. And so, we are playing a little bit of catch-up to say, 'Okay, well, there's a million ways in which this data could be represented and how do we find the opportunity to standardize that data?'"
Data standardization efforts are already in place, including the USCDI data set, the standardized set of health data elements and classes required for EHR systems maintained by ONC. Musser said NCQA supports using the USCDI data set and wants to see additional data elements captured in a standardized way within EHRs.
"We need to ensure that that data is accurate and trusted if we're going to make policy and payment decisions off of it," Musser noted.
Once high-quality data can flow freely, the next challenge is ensuring it is accurate and actionable for quality reporting.
Musser suggested that digital quality measurement could be the answer to this problem. Digital quality measures are standardized metrics that leverage systems such as FHIR APIs to extract data directly from medical records and claims, reducing administrative burden and automating data capture.
Musser noted, however, that to reach the full potential of digital quality measures, initiatives like the CMS Aligned Networks and TEFCA must share common standards.
"It's been great that we have had this huge investment and proliferation of clinical data, but now making use of it is what much of TEFCA and the CMS Aligned Network work is about," he said.
"With this healthcare data becoming more interoperable, we feel that there's an opportunity to reduce burden while not sacrificing the intent of quality measurement and tracking national population health outcomes."
Essentially, standardization efforts today will determine whether providers, payers and patients can reap the full benefits of the healthcare data that is eventually shared.
"I think interoperable healthcare data and getting it right -- while there could be a short-term investment that folks have to make -- the long-term payout to get to improve clinical outcomes in real time, put data in people's hands to make decisions on in a way that truly moves the needle on population health and on individual care has one of the greatest impacts that we can have in leveraging this huge investment in electronic health records," Musser said.
Jill Hughes has covered health tech news since 2021. Her coverage areas include cybersecurity, HIPAA compliance, interoperability, AI and EHRs.
