25 TEFCA & HIE Coverage Statistics Every Legal Professional Should Know in 2026

Comprehensive data on health information exchange networks and their impact on medical record retrieval for litigation

Key Takeaways

• TEFCA adoption is accelerating rapidly — Over 11,419 organizations are live on TEFCA, representing more than 60,000 unique connections to healthcare facilities, creating unprecedented access pathways for medical record retrieval.
• The HIE market is experiencing substantial growth — The global health information exchange market, valued at $2.27 billion in 2025, is projected to reach $5.25 billion by 2034, reflecting the critical role of interoperability in modern healthcare.
• Document exchange volumes demonstrate real-world impact — More than 205 million documents have been shared through TEFCA since its December 2023 launch, proving the framework's capacity for large-scale health data exchange.
• Significant interoperability gaps persist despite progress — While 70% of hospitals engage in all four interoperability domains, only 43% do so routinely, creating inconsistent access that complicates medical record retrieval for legal cases.
• Cross-vendor challenges remain a primary barrier — 72% of hospitals report difficulties exchanging data across different vendor platforms, explaining why traditional retrieval methods often face delays and rejections.
• Rural and independent hospitals lag behind — Approximately 40% of rural hospitals lack full interoperability, requiring retrieval partners with multiple access pathways to ensure comprehensive record collection.
• EHR adoption has reached near-universal levels — With 96% of hospitals using certified EHR systems, the digital infrastructure for health information exchange is largely in place, though connectivity challenges persist.

Understanding Health Information Exchanges and Their Impact

1. Global HIE market valued at $2.27 billion in 2025

The global health information exchange market has reached $2.27 billion in 2025, reflecting the healthcare industry's commitment to interoperability. This valuation encompasses the software, services, and infrastructure required to share patient health information across organizational boundaries. For personal injury law firms, this market growth translates to expanded digital pathways for accessing patient records without traditional fax-based delays.

2. HIE market projected to reach $5.25 billion by 2034

Market projections indicate the global HIE market will grow to $5.25 billion by 2034, representing a 9.75% compound annual growth rate. This expansion signals continued investment in the technical infrastructure that enables rapid medical record retrieval. Organizations like Codes Health that integrate with these expanding networks position themselves to deliver faster turnaround times as connectivity improves.

3. U.S. HIE market valued at $439.2 million with strong growth trajectory

The United States HIE market specifically is valued at $439.2 million in 2025 and is expected to reach $986.5 million by 2034. This 9.41% CAGR reflects regulatory mandates, provider adoption, and the demonstrated value of electronic health information sharing. For legal practices handling medical-related litigation, this growth means more providers will become accessible through digital channels rather than requiring manual retrieval processes.

4. 75% of hospitals participate in state, regional, or local HIEs

Three-quarters of U.S. hospitals now participate in HIE networks, creating established pathways for electronic record exchange. This participation rate means the majority of hospital records can potentially be accessed through HIE integrations rather than traditional fax requests. However, the remaining 25% still require alternative retrieval methods, making multi-channel retrieval capabilities essential.

5. 64% of hospitals participate in both national and local networks

Beyond local participation, 64% of hospitals engage in both national and regional networks simultaneously. This dual participation creates redundant access pathways and increases the likelihood of successful electronic retrieval. Medical record retrieval platforms that connect to multiple network types can leverage these overlapping connections to maximize retrieval success rates.

TEFCA: A Framework for National Health Data Interoperability

6. Over 11,419 organizations now live on TEFCA

The Trusted Exchange Framework and Common Agreement has achieved significant adoption, with 11,419 organizations live including Qualified Health Information Networks (QHINs), Participants, and Subparticipants. This represents a substantial network of healthcare providers, payers, and health information organizations committed to standardized data exchange. For legal practices, TEFCA participation signals which providers can be accessed through streamlined digital channels.

7. TEFCA represents over 60,000 unique healthcare facility connections

Beyond organizational participation, TEFCA now encompasses over 60,000 connections to healthcare facilities nationwide. This connection density means patient records from thousands of individual care settings can potentially be retrieved through TEFCA-enabled pathways. The practical impact for medical record retrieval is reduced reliance on manual provider outreach and faster access to treatment documentation.

8. More than 205 million documents shared through TEFCA since launch

Since its December 2023 go-live, TEFCA has facilitated the exchange of more than 205 million documents. This volume demonstrates the framework's operational capacity and real-world utility for health information sharing. Document types include clinical summaries, discharge records, laboratory results, and imaging reports—all critical elements for building comprehensive case chronologies in personal injury litigation.

9. 10 Qualified Health Information Networks designated as of 2025

The TEFCA ecosystem now includes 10 designated QHINs, up from the initial five designated in December 2023. These QHINs serve as the primary gateways for TEFCA exchange, each connecting their own networks of participants and subparticipants. Multiple QHIN designations create competitive options and redundant pathways for accessing patient health information through the framework.

10. Over 9,200 organizations have signed up for TEFCA participation

The Office of the National Coordinator reports that over 9,200 organizations have signed up to participate in TEFCA exchange. This figure includes organizations in various stages of onboarding, indicating continued expansion of the network. The gap between sign-ups and live connections reflects the technical integration work required, but signals strong momentum toward broader participation.

Hospital Interoperability Performance and Participation

11. 70% of hospitals engage in all four interoperability domains

ONC data indicates that 70% of hospitals engage in all four interoperability domains: sending, receiving, finding, and integrating external health information. This capability assessment demonstrates that the technical foundation for comprehensive data exchange exists in the majority of hospital settings. However, capability does not equal consistent practice, as the next statistic reveals.

12. Only 43% of hospitals routinely engage in all four domains

Despite 70% capability, only 43% routinely engage in all four interoperability domains. This 27-percentage-point gap between capability and routine practice explains why electronic retrieval attempts sometimes fail even when technical pathways exist. Medical record retrieval services must maintain multiple access channels to compensate for this inconsistency in provider engagement.

13. Hospital interoperability engagement increased 52% from 2018 to 2023

The five-year trend shows a 52% increase in hospital interoperability engagement between 2018 and 2023. This trajectory indicates continued improvement in the healthcare industry's data sharing practices. For legal practices relying on external record retrieval, this trend means progressively easier access to patient information over time as more hospitals participate actively in data exchange.

14. 84% of hospitals often send health information electronically

Sending capability represents the strongest interoperability function, with 84% of hospitals often sending health information to external parties. This high rate of outbound information sharing creates opportunities for electronic retrieval when requests reach providers through appropriate channels. The challenge lies in ensuring requests reach the right systems and personnel to trigger these sending capabilities.

General-purpose AI tools (like ChatGPT and similar assistants) aren’t designed to reliably interpret medical charts end-to-end and can miss context, provenance, and document gaps. Codes Health’s purpose-built AI is trained for medical-record workflows and can analyze records with high precision inside a controlled retrieval and review process.

15. 73% of hospitals often receive health information from external sources

Receiving external data occurs at a 73% rate among hospitals, lower than sending rates but still representing majority adoption. This receiving capability is essential for care coordination but also indicates hospital familiarity with external data exchange workflows. Providers accustomed to receiving external data may respond more efficiently to retrieval requests that follow standardized electronic formats.

EHR Adoption and Digital Infrastructure

16. 96% of hospitals have adopted certified EHR systems

Near-universal EHR adoption has been achieved, with 96% of hospitals using certified EHR systems by 2021. This adoption rate means patient records exist in digital formats at nearly all hospital settings, creating the foundation for electronic retrieval. The remaining question is not whether records are digital, but whether the connectivity exists to access them efficiently.

17. 88% of office-based physicians use EHR systems

Beyond hospitals, 88% of physicians have adopted EHR systems, with 78% using certified systems. This high adoption rate across ambulatory settings means most physician office records also exist digitally. However, smaller practices often connect to fewer HIE networks than hospitals, requiring retrieval partners with diverse integration capabilities.

18. 1,000+ hospitals connected to TEFCA through Epic Nexus

Epic Systems reports that over 1,000 hospitals have connected to TEFCA through its Epic Nexus QHIN as of June 2025. Given Epic's substantial market share among large health systems, this single QHIN connection creates access to a significant portion of U.S. hospital records. Additionally, 22,000 clinics using Epic are now live on TEFCA through the same pathway.

Barriers and Challenges in Health Information Exchange

19. 72% of hospitals report cross-vendor platform exchange challenges

Despite progress, 72% of hospitals report challenges exchanging data across different vendor platforms. This technical friction explains why records from certain providers take longer to retrieve than others. Platforms like Codes Health address this challenge by maintaining integrations across multiple vendor ecosystems rather than depending on single-vendor connectivity.

20. 70% of hospitals struggle to find providers' Direct addresses

Locating appropriate recipients for electronic exchange remains difficult, with 70% of hospitals struggling to find providers' Direct addresses for secure messaging. This challenge affects both care coordination and record retrieval efforts. Proprietary databases that maintain current provider contact information and electronic endpoints become essential for overcoming this barrier.

21. 57% of hospitals face patient matching difficulties between systems

Patient matching—connecting records for the same individual across different systems—presents challenges for 57% of hospitals. Without accurate patient matching, retrieval attempts may return incomplete results or miss relevant records entirely. AI-powered error checking that validates patient identifiers before submission can reduce matching failures and improve retrieval completeness.

22. Approximately 40% of rural hospitals lack full interoperability

Geographic disparities persist, with approximately 40% of rural and critical access hospitals lacking full interoperability capabilities. For legal cases involving patients treated at rural facilities, electronic retrieval may be unavailable, requiring traditional fax-based methods. Comprehensive retrieval services must maintain both digital and traditional capabilities to ensure complete record collection regardless of provider location.

23. System-affiliated hospitals outperform independent facilities

Interoperability disparities exist between hospital types: 53% of system-affiliated hospitals routinely engage in full data exchange compared to only 22% of independent hospitals. Similarly, 53% of large hospitals engage routinely versus 38% of small hospitals. These disparities mean retrieval complexity varies significantly based on where patients received treatment.

FHIR Standards and Patient Access Trends

24. FHIR app adoption reached 64% in outpatient settings

Fast Healthcare Interoperability Resources (FHIR) adoption has grown substantially, with 64% adoption in outpatient settings in 2024, up from 49% in 2021. FHIR provides standardized APIs for accessing health data, creating additional pathways for retrieving patient information. This standards-based approach reduces the custom integration work required to connect to individual provider systems.

25. 99% of hospitals offer patients electronic record viewing

Patient access capabilities have reached near-universal levels, with 99% of hospitals offering electronic record viewing. Additionally, 81% enabled access via apps in 2024, with 70% using FHIR-based applications. These patient-facing portals represent additional channels through which authorized record retrieval can occur when provider-to-provider pathways face barriers.

How Codes Health Maximizes HIE and TEFCA Access

The statistics above paint a picture of expanding opportunity tempered by persistent challenges. While TEFCA participation grows and HIE networks mature, significant gaps remain in routine engagement, cross-vendor compatibility, and geographic coverage.

Codes Health addresses these realities through a multi-channel retrieval approach that combines HIE integrations, TEFCA network access, EHR system connections, and traditional fax retrieval. This diversified strategy ensures that record retrieval succeeds regardless of individual provider connectivity status.

Incomplete authorizations are the #1 cause of denied requests. Missing patient signatures, unclear expiration dates, or unchecked boxes for sensitive records will restart your 15-day clock. Codes Health's AI review catches these errors before submission.

While some competitors advertise same-day retrieval, these services often deliver incomplete records and require ongoing client involvement to fill gaps, leading to frustration and churn. Codes Health's approach prioritizes completeness over speed, ensuring legal teams receive comprehensive records in 10-12 days without requiring follow-up or client coordination.

Codes Health's MIT-educated engineering team continuously builds out additional workflows and products, ensuring the platform constantly evolves and improves to meet the changing demands of legal professionals. For high-volume customers, Codes Health can build custom integrations with CRM platforms, case-management systems, and medical software/EHR-related tools, streamlining intake and reducing manual data entry.

The platform operates on a flat fee structure, providing predictable costs for record retrieval regardless of record volume or complexity.

Frequently Asked Questions

What is the primary difference between an HIE and TEFCA?

Health Information Exchanges (HIEs) are regional, state, or enterprise-level networks that enable health data sharing among participating providers within their geographic or organizational scope. TEFCA (Trusted Exchange Framework and Common Agreement) is a national framework that connects these disparate networks through designated Qualified Health Information Networks (QHINs), enabling cross-network exchange under standardized rules. HIEs existed before TEFCA; TEFCA creates the interoperability layer that links them together nationally.

How does nationwide HIE and TEFCA coverage impact the speed of medical record retrieval?

Expanded HIE and TEFCA coverage creates digital pathways for accessing records that would otherwise require manual fax-based requests and follow-up calls. When providers participate in these networks, records can often be retrieved electronically within days rather than weeks or months. However, with only 43% routinely engaging in full data exchange, retrieval services must maintain multiple access channels to achieve consistent speed across all provider types.

Can any healthcare provider connect to TEFCA, or are there specific requirements?

Providers connect to TEFCA through designated QHINs, each of which has its own participation requirements and onboarding processes. Currently, 10 QHINs are designated to facilitate TEFCA exchange. Providers typically join as Participants or Subparticipants under a QHIN, agreeing to the Common Agreement's terms regarding data exchange, privacy, and security. The technical requirements vary by QHIN but generally require EHR connectivity and compliance with TEFCA's standardized exchange protocols.

What are the main security measures protecting patient data shared through HIEs and TEFCA?

Both HIEs and TEFCA operate under HIPAA requirements for protected health information. TEFCA's Common Agreement establishes additional baseline security and privacy requirements that all participants must meet, including standards for authentication, authorization, and audit logging. Individual QHINs may implement additional security controls beyond these baselines. The framework includes mechanisms for patient consent management and individual access services that give patients visibility into how their data is being exchanged.

How does Codes Health ensure data completeness when using HIEs and TEFCA as data sources?

Codes Health employs a Missing Record Review process that cross-references patient medical history to identify gaps in record collection. Because only 43% routinely engage in full interoperability, relying solely on electronic networks would leave significant gaps. By combining HIE and TEFCA access with traditional fax retrieval and proprietary provider databases, Codes Health creates redundant pathways that maximize completeness before trial or care decisions.