A New Era of Clinical Information Exchange: What Practice Leaders Need to Know About TEFCA and QHINs

In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams speaks with Justin McMartin, Director of Product Innovation at Surescripts, about one of the most important developments in U.S. healthcare interoperability: TEFCA and Qualified Health Information Networks (QHINs). They dig into what TEFCA is (and isn’t), how QHINs operate, what Surescripts is doing as a newly approved QHIN, and — most importantly — how practice leaders can use these tools to improve clinical decision-making, streamline workflows, reduce prior authorization pain, and support value-based care.

Justin’s insights translate a deeply technical topic into clear, practice-oriented guidance that helps healthcare administrators understand what’s changing, how it impacts their clinicians, and what steps they should take now.

Key Takeaways

• Justin’s background & the evolution of Surescripts beyond e-prescribing
  00:58 — From EHR implementation during Meaningful Use to building national data exchange networks.
• What Surescripts offers medical practices today
  02:45 — Eligibility, medication history, real-time benefit tools, clinical messaging, record locator/exchange.
• TEFCA explained: Why it exists and what it solves
  04:59 — Preventing fragmented, state-by-state frameworks by establishing a single national standard.
• QHINs & the Sequoia Project’s role as RCE
  06:08 — How QHINs govern secure, standardized data exchange nationwide.
• How Surescripts participates: InterConnect & QHIN approval
  07:33 — Surescripts’ new QHIN subsidiary and what it means for practice connectivity.
• Scope of data available: Billions of clinical documents exchanged
  08:39 — How Carequality volume and TEFCA adoption are converging.
• What TEFCA adds to existing practice workflows
  10:33 — Access to CCDAs across care settings, improving completeness at the point of care.
• Practical use cases for clinicians and practice managers
  12:33 — ED episodes, chronic disease management, and value-based care coordination.
• Why practices hesitate: Awareness, education, and workflow clarity
  14:54 — Adoption barriers and how vendors can support practices.
• Action steps for practice leaders
  17:44 — Review InterConnect resources, understand state exchanges, and incorporate patient feedback on data access.

Resources Mentioned in the Episode

• Surescripts
• The Sequoia Project (TEFCA RCE)