# Nationwide exchanges (TEFCA IAS)

> One identity verification finds a person’s records across facilities on the TEFCA network. Flexpa is an Individual Access Services provider through two QHINs, Kno2 and CommonWell.

Web page: https://www.flexpa.com/networks/nationwide-exchanges

## For people and teams

People rarely remember every place that holds their records. Through TEFCA, they verify who they are once, and Flexpa searches participating facilities for them. Flexpa has matched patients at more than 88,000 distinct facilities in live production.

### What comes back

- Clinical documents from each matching facility, such as care summaries, discharge summaries, and clinical notes.
- Lab and imaging results, and unstructured notes.
- Conditions, medications, allergies, immunizations, and procedures, converted from those documents into structured FHIR.

### How people connect

1. Review and accept the TEFCA consent.
2. Verify identity with CLEAR, ID.me, or Persona, using a government-issued photo ID. This takes under a minute with an existing account, or 3 to 7 minutes to create one.
3. Flexpa searches the network and retrieves records from matching facilities. A facility that answers over a FHIR API asks for its own sign-in.

### Good to know

- Flexpa starts retrieving records within minutes of the patient finishing consent. Separately, a new record can take about 24 to 72 hours to become available at the source facility or network, so a very recent visit may not appear until the source makes it available.
- A connection can finish with no records found. It keeps refreshing, so records from future visits appear without signing in again.
- When the search finds an Epic organization, a patient who signs in there with their Epic ID may also share the other Epic organizations linked to their MyChart Central account.
- The patient verifies their own identity. There is no guardian or proxy path through TEFCA.
- TEFCA is enabled per application. Contact partnerships@flexpa.com to turn it on.

## For agents

- **Source:** TEFCA Individual Access Services, through the Kno2 and CommonWell QHINs
- **Patient sign-in:** IAL2 identity verification with CLEAR, ID.me, or Persona
- **Launch:** Flexpa Consent authorization URL with `flexpa_ial2_mode=true`. It cannot be combined with `flexpa_endpoint_id`. In the Node SDK, `flow: { type: 'ial2' }`.
- **FHIR R4:** `DocumentReference` wrapping each C-CDA (base64 in `content[0].attachment.data`, facility in `custodian`), plus converted `Condition`, `MedicationRequest`, `Observation`, and more, each linked to its source by `Provenance`
- **Standards:** XCPD (ITI-55) patient discovery; XCA (ITI-18, ITI-43) document query and retrieve
- **Timing:** Retrieval starts within minutes of consent. The 24 to 72 hours is source-side: a new record can take that long to become available at the facility or network, so a recent visit may be missing until the source has it. It is not Flexpa processing time.

### Records tools

After the patient authorizes through Flexpa Consent, read their records with these tools at `https://api.flexpa.com/mcp/consent`. They need a patient access token.

- `get_documents`: The C-CDA documents found for the patient
- `get_document_content`: The narrative text of one C-CDA
- `get_problems`: Conditions converted from the documents
- `get_medications`: Medications converted from the documents

### Notes for agents

- With `offline_access` in scope, authorizations verified with CLEAR or ID.me refresh automatically.
- `GET /rest/consent/:consentId?include=tefcaOutcomes` summarizes the latest sync: patients found, facilities queried, and documents retrieved.
- An empty result means no matching facility was found, not an error.

## Scale and context

### How a TEFCA request reaches a facility

TEFCA is a network of networks. Flexpa sends Individual Access Services requests through two QHINs, which reach the participants and subparticipants connected across all QHINs.

- **Recognized Coordinating Entity:** The Sequoia Project. Selected by ONC to maintain the Common Agreement and oversee the QHINs.
- **Designated QHINs:** 11. Qualified Health Information Networks that connect directly to each other, as of August 17, 2026.
- **Organizations live on TEFCA:** 24,500+. QHINs, participants, and subparticipants, representing 107,000+ unique connections to clinicians, hospitals, clinics, and more, as of October 20, 2026.
- **Flexpa:** IAS Provider. Connected through two QHINs, Kno2 and CommonWell. Flexpa has matched patients at 88,000+ distinct facilities in live production (88,897 as of August 25, 2026).

Scope:

- The RCE counts cover every TEFCA exchange purpose, not Individual Access Services alone.
- Flexpa’s facility count is facilities where it has matched at least one patient. It is a different unit from the RCE’s organizations and connections, not a share of them.

Sources:

- RCE informational call, “TEFCA by the Numbers” (2026-10-20): https://rce.sequoiaproject.org/wp-content/uploads/2026/09/10.20.26-RCE-Info-Call_FINAL-2.pdf
- RCE announcement, “ONC Increases Funding for TEFCA RCE in New Contract Year” (2026-08-17): https://rce.sequoiaproject.org/onc-increases-funding-for-tefca-rce-in-new-contract-year/
- Flexpa network docs (2026-08-25): https://www.flexpa.com/docs/network#nationwide-exchanges

## Docs

- [Nationwide exchanges](https://www.flexpa.com/docs/network#nationwide-exchanges)
- [IAL2 identity for record access](https://www.flexpa.com/docs/network/cms#capability-2-ial2-digital-identity-for-record-access)
- [C-CDA to FHIR transforms](https://www.flexpa.com/docs/network/cms#c-cda-to-fhir-transforms)
- [Steps to connect](https://www.flexpa.com/docs/guides/patient/steps-to-connect)
- [Document tools for agents](https://www.flexpa.com/docs/guides/agents#get_documents)

## Other networks

- [Health insurers (CMS-9115)](https://www.flexpa.com/networks/health-insurers.md)
- [Medical record systems (ONC (g)(10))](https://www.flexpa.com/networks/medical-record-systems.md)
- [The Flexpa network](https://www.flexpa.com/network.md)