Adding clinical records to a product?
Plan retrieval, matching and presentation of outside records, including source attribution and a review path for incomplete or ambiguous results.
For US healthcare product teams
TEFCA integration
services.
Connect your healthcare product to nationwide exchange with a scoped QHIN pathway and the engineering to support it.
Your route into TEFCA
Your healthcare productWorkflow, patient identity and data handling
Participant routeConnect directly to a QHIN
Subparticipant routeConnect through a Participant
Designated QHINExchange with other QHINs and their networks
Turn network access into a usable workflow.
Nirmitee helps healthcare software vendors, digital health companies and provider technology teams scope and build TEFCA connectivity. Start with the records your product needs, who will use them and the exchange purpose that supports that use.
Already selected a network provider?
Bring the API documentation and sandbox. We can assess the connector, application changes and validation needed to move your integration forward.
The Trusted Exchange Framework and Common Agreement (TEFCA) supports exchange through a network of networks. Organizations can participate through a QHIN, Participant or Subparticipant. See the RCE participation guidance.
Choose the TEFCA support you need.
Start with one workstream or combine them into an implementation. Each offering is scoped around your approved use case, chosen provider and available access.
TEFCA readiness assessment
When you need this: You need to establish the scope before choosing a connection.
Review your intended use, systems, existing connectivity and technical gaps.
What you receive: Readiness findings, dependency map and phased implementation scope.
QHIN selection & onboarding support
When you need this: You are evaluating a network provider or preparing to onboard.
Compare interfaces and sandbox requirements; coordinate the technical onboarding work with your selected provider.
What you receive: Provider evaluation checklist, architecture and onboarding work plan.
Clinical document exchange integration
When you need this: Your product needs to request and use outside clinical records.
Implement the provider-supported discovery and retrieval workflow, document parsing, provenance and exception handling.
What you receive: Connector, data mappings and workflow validation evidence.
Facilitated FHIR integration
When you need this: Your approved exchange workflow calls for FHIR API access.
Assess endpoint discovery, registration, authentication and authorization against the applicable specifications and provider capabilities.
What you receive: A scoped FHIR integration with agreed access and failure scenarios tested.
Patient identity & consent workflows
When you need this: You need to resolve identities and enforce approved access rules.
Implement matching inputs, ambiguous-result review and the consent or authorization controls required for your use case.
What you receive: Identity mappings, access-control rules and audit events.
EHR & application workflow integration
When you need this: You can retrieve records but need them inside a usable product workflow.
Map and present returned information in your application, preserving source context and agreed review steps.
What you receive: Application integration, reconciliation rules and user acceptance criteria.
Testing & production readiness
When you need this: You have a connector and need evidence to support a launch decision.
Exercise successful queries, no-match responses, unavailable data, authorization failures and recovery behavior in agreed environments.
What you receive: Test evidence, unresolved-issue register and cutover checklist.
Monitoring & integration support
When you need this: You need operational ownership after the connection launches.
Scope monitoring, incident triage, provider escalation, interface changes and maintenance responsibilities.
What you receive: Operational runbook and an agreed support scope with coverage and response targets.
Your intended use also matters. TEFCA has defined exchange purposes; eligibility and applicable requirements need to be confirmed for your workflow. We assess provider support before committing to implementation.
What your team receives.
Choose a readiness assessment, a defined implementation or support for an existing connection. The statement of work ties each workstream to reviewable outputs.
Connection strategy
Assess direct Participant and Subparticipant routes, provider interfaces, supported workflows and technical dependencies.
Deliverable
Decision brief, architecture and responsibility map
Product integration
Build the agreed connector, request orchestration, response handling and mappings into your EHR or application workflow.
Deliverable
Source code, interface contracts and configuration guide
Identity and data handling
Implement patient matching workflows, ambiguous-result handling, provenance and access controls against the approved design.
Deliverable
Mapping specifications and exception-handling rules
Production readiness
Exercise agreed positive and failure scenarios; add monitoring, retries, audit events and operational handover.
Deliverable
Test evidence, cutover checklist and support runbook
Choose the connection before building the connector.
Evaluate the route against your product’s actual requirements. Nirmitee can support technical evaluation and integration planning; your selected network manages its participation process.
| Decision | What to establish before committing |
|---|---|
| Participation & use | Your entity’s eligibility, Participant or Subparticipant route, intended exchange purpose and required agreements. |
| Interfaces & data | Available APIs, document formats, facilitated FHIR support and data coverage for the workflow you need. |
| Identity & controls | Patient discovery inputs, ambiguous matches, authorization, consent requirements and audit responsibilities. |
| Operations & fees | Sandbox availability, acceptance criteria, support ownership, usage limits and recurring network charges. |
Use the RCE’s designated QHIN directory to confirm current designation. No QHIN partnership or endorsement is implied by this service.
Make the returned data useful.
Receiving a response is only part of the implementation. Your product still needs to reconcile identities, preserve provenance and handle unavailable or duplicate data.
Explore FHIR integration →Document exchange and facilitated FHIR
We scope parsing and mappings for the content your provider exposes, including C-CDA documents or FHIR resources where supported. We validate the interface contract instead of assuming that every network offers the same API.
Security and operational ownership
Build the agreed access controls, audit trail, retry policies and escalation paths into the integration. Your security and compliance stakeholders approve intended use and applicable obligations.
Architecture references: RCE technical requirements and the Common Agreement.
Budget the full connection
What affects TEFCA integration cost?
Get an engineering estimate based on your systems and connection path. The biggest scope differences usually come from the integration work your product needs and the dependencies outside the development team.
Engineering scope
- Number of applications, tenants and source systems
- Connector maturity and supported exchange patterns
- Patient matching, normalization and exception handling
- Security validation, deployment and support requirements
External dependencies
- QHIN or connectivity-provider onboarding and fees
- Agreements and organizational approvals
- Sandbox access, credentials and test coordination
- Identity services, infrastructure and ongoing usage
Start with a scoped assessment when the path is uncertain. Agree architecture and acceptance criteria, build and validate the connector, then schedule launch around network readiness and customer sign-off. We establish a delivery timeline after discovery.
Discuss your scopeInspect the engineering behind the proposal.
Review Nirmitee’s public healthcare repositories before a technical conversation. You can inspect the code, documentation and implementation choices directly.
Headless EHR and FHIR APIs
Explore our FHIR R4 platform, architecture documentation and published test instructions. Use them to discuss resource modeling, application access and the data layer your integration needs.
Review the FHIR repository →Mirth Connect integration examples
Examine channel recipes, transformers and scripts in our integration cookbook. Bring a mapping or operational problem and ask how we would approach it in your environment.
Review the integration cookbook →These repositories show broader healthcare engineering work. TEFCA delivery experience and compatibility with your chosen provider should be evaluated separately during the proposal discussion.
Start with a decision you can review.
A scoped readiness assessment can define your connection options, application changes, external dependencies and acceptance criteria before a larger implementation commitment. Ask the proposal to identify the technical lead, milestone deliverables, estimate assumptions and handover responsibilities.
For implementation, agree how success will be demonstrated: the authorized workflow completes in the agreed environment, exceptions are handled, audit evidence is available and your team can operate the delivered components.
TEFCA implementation questions.
Should we buy a connector or build a custom integration?
First check whether your EHR or connectivity provider already supports the intended workflow. An existing connector may reduce implementation work. Custom engineering can address application-specific orchestration, mappings, exception handling and operational controls. We assess the remaining gaps before proposing a build.
What should we confirm before choosing an implementation partner?
Ask for relevant integration evidence, a walkthrough of the proposed architecture, named delivery responsibilities and acceptance criteria. For a Nirmitee proposal, discuss the experience applicable to your selected provider and workflow, the team assigned and any work that requires a specialist or network provider. Confirm those details before contracting.
Will our team receive the source code and operating documentation?
Source code, interface contracts, configuration guidance and an operational runbook are included in the proposed engineering deliverables. Agree repository access, intellectual-property terms, third-party licenses and handover acceptance in the statement of work. Provider-owned software and services have separate terms.
Can you support the integration after launch?
Ongoing monitoring and maintenance can be scoped separately. Define supported components, coverage hours, incident severity, response targets, upgrade responsibilities and escalation to the connectivity provider in the support agreement. A development engagement does not automatically include around-the-clock support.
Do we need to become a QHIN to connect to TEFCA?
Most healthcare organizations evaluate joining through a designated QHIN or an existing Participant. Becoming a QHIN is a separate network designation process. We help assess the technical connection path for your organization and the work needed inside your product.
Can you work with our existing QHIN or connectivity provider?
We can scope engineering around your selected provider’s documented interfaces, sandbox access and onboarding requirements. Share the provider, intended workflow and available documentation so we can assess compatibility and implementation dependencies.
Is TEFCA integration the same as FHIR API integration?
No. FHIR defines a data and API standard; TEFCA provides a framework for exchange across participating networks. A FHIR endpoint alone does not establish TEFCA participation. The implementation may involve document exchange or facilitated FHIR, depending on the selected path and supported capabilities.
How much does TEFCA integration cost?
We scope engineering after reviewing your connection path, source systems, exchange workflow, data quality and operational requirements. Ask for a proposal that identifies discovery, connector development, validation and support separately. Network fees, identity services and cloud usage need their own budget; no universal project price applies.
How long does a TEFCA implementation take?
The schedule depends on provider onboarding, agreements, environment access, interface maturity and acceptance testing. Discovery establishes the milestones and dependencies. A working sandbox connector is one milestone; production exchange also depends on the selected network’s readiness process and your organization’s approvals.
Does connecting give us every patient record nationwide?
No. Availability depends on participating organizations, matching, supported workflows, authorized exchange purposes and applicable requirements. Design for no-match, incomplete records and unavailable responses, and validate coverage for your intended use case with the connectivity provider.
Can TEFCA connectivity replace our CMS-0057-F API work?
Do not assume the scopes are interchangeable. Assess your specific payer API obligations and proposed exchange workflows separately with your compliance stakeholders. We can map shared engineering components and the remaining API work before you commit to a combined project.
Plan your next step
Bring your workflow.
Leave with a clearer scope.
Tell us what you want to exchange, the product you are building and whether you have selected a QHIN or connectivity provider. We’ll discuss the engineering scope and dependencies for a proposal.
- Your organization type and intended use
- Existing EHR, APIs and network relationships
- Available access and target launch window
Nirmitee provides integration engineering. Participation agreements, eligibility decisions and network approvals stay with the relevant organizations.
Thank you. Your enquiry has been received. Our team will review your requirements.