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 EpisodeSurescriptsThe Sequoia Project (TEFCA RCE)