As interoperability requirements expand and patient-care complexity increases, medical group leaders need reliable, practical strategies to improve information exchange across the care continuum. In a recent episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams spoke with Justin McMartin, Director of Product Innovation at Surescripts, to break down the rapidly evolving world of TEFCA, Qualified Health Information Networks (QHINs), and national-scale clinical data exchange.

McMartin’s insights shed light on what these changes mean for medical practices, how they can reduce administrative friction, and the steps leaders should take now to improve workflows, support clinicians, and enhance patient care.

Understanding Surescripts’ Evolution Beyond Prescriptions

Many practice leaders still associate Surescripts primarily with e-prescribing, but the organization’s footprint is far broader. McMartin explained that while “Surescripts really grew up being the network for exchanging prescriptions,” the network has expanded dramatically to support modern, multi-directional data exchange.

Over the past decade, Surescripts built out eligibility tools, medication history services, real-time benefit capabilities, clinical direct messaging, and record exchange solutions integrated with national frameworks like Carequality. As McMartin described, these innovations are designed “to ensure that we're connecting healthcare from beginning to end with all the various information that needs to be exchanged.”

For practice leaders, this means that Surescripts is increasingly an interoperability partner — not merely a routing service for prescriptions, but a mechanism to bridge information gaps across disparate systems.

Why TEFCA Exists: Reducing Fragmentation and Building a Single National Standard

At the center of today’s interoperability conversation is TEFCA — the Trusted Exchange Framework and Common Agreement created to streamline and unify national data sharing. As practices face rising administrative burden and shrinking margins, TEFCA aims to provide one blueprint rather than 50 different state-level systems.

McMartin explained that TEFCA originated from a bipartisan 2016 bill designed to prevent fragmentation. He noted that lawmakers sought to avoid a future in which states or vendors would each develop their own approach, saying the goal was: “to say there's a lot of emerging opportunities to exchange data. If we don't try to consolidate or bring these things together, it's going to be very costly to adopt 50 different ways that states might want to do it.”

For MGMA members navigating interoperability demands, TEFCA’s mission is straightforward: reduce complexity, reduce cost, and increase consistency.

QHINs and the Role of the Sequoia Project

A core part of TEFCA’s structure is the introduction of Qualified Health Information Networks (QHINs)—organizations authorized to facilitate nationwide, interoperable data exchange.

According to McMartin, the federal government selected the Sequoia Project as the Recognized Coordinating Entity (RCE), responsible for setting the “rules of the road.” As he explained, Sequoia was chosen because they are “a group … who are really a public interest group being able to focus in and say, how do we exchange data better in the country?”

These rules define security requirements, exchange protocols, onboarding practices, and quality expectations. Practices do not connect to TEFCA directly; they connect through a QHIN, which serves as the gateway.

McMartin emphasized that the goal is to grow participation so that “we reach kind of all the edges of who should be able to get access to information safely, effectively and securely in our country.”

How Surescripts Is Participating as a QHIN

Surescripts is now one of the approved QHINs under TEFCA, operating through a subsidiary called the Surescripts Health Information Network. McMartin described this as “a logical next step for us to be a QHIN in some way,” given the organization’s long-standing role in national data exchange.

Surescripts’ QHIN offering — the InterConnect service — allows practices to tap into TEFCA directly through platforms they already use. This approach reduces the adoption burden on practice administrators and clinicians by limiting the need for new logins or additional systems.

The organization is now onboarding customers into the TEFCA framework and expects participation to grow rapidly.

Clinical Value: Improving Completeness at the Point of Care

One of the most consequential benefits for medical practices is the ability to access complete and up-to-date CCDAs (continuity of care documents) from other healthcare organizations. These documents contain:

• medication history
• allergies
• problem lists
• recent labs, diagnoses, and imaging
• encounter summaries

McMartin explained that TEFCA allows practices to “reliably get my fingers on everything that a patient has, or the most recent information … from all sorts of different healthcare organizations.”

This gives clinicians a more complete picture during acute episodes (such as emergency room visits) or chronic disease management, reducing the risk of incomplete information, duplicative testing, and preventable adverse events. For practice administrators, this could mean fewer manual record requests, fewer faxes, and a more efficient clinical workflow.

Reducing Friction in Value-Based Care and Prior Authorization

In addition to clinical improvement, TEFCA offers operational and financial benefits.

McMartin noted that interoperability is critical for care coordination in value-based care, explaining that practices need to ensure “that we're sharing that information across care teams to ensure that patient is getting the best and most comprehensive set of care that they can when they are working in those multiple settings.”

He also highlighted Surescripts’ work to streamline prior authorization, stating the company is “trying to take the friction out of that data exchange that doesn't occur as data exchange in today's world and is much more of a manual, let's get on the phone process.”

For MGMA members — who continually rank prior authorization delays as a top operational issue — this work has significant implications for reducing staff burden and improving revenue cycle performance.

What’s Holding Practices Back? Awareness and Education

Despite the benefits, McMartin noted that many practice leaders simply aren’t aware of TEFCA. He shared that while EHR vendors understand its importance, “it's not the top of mind for a lot of the providers we work [with].”

He emphasized the need for education and tangible examples to demonstrate value, especially for practice managers navigating chronic disease management, care coordination, and administrative challenges. “I think there's that awareness aspect … and then … an education aspect, to really give the tangible examples of how it can benefit my organization and why it is useful and important,” he said.

What Practice Leaders Should Do Next

McMartin offered three concrete steps for MGMA members:

1. Explore Surescripts’ InterConnect resources
   He directed practices to “head out to our [website] and find our Interconnect product,” which offers education and onboarding information.
2. Monitor state-level exchange developments
   He encouraged leaders to “make sure that you're well aware of things that are going on in your states,” as many states are developing complementary exchange strategies.
3. Listen to patient frustrations with fragmented data
   Patients increasingly expect seamless access and portability. McMartin noted that “patients are frustrated with their lack of ability to kind of exchange their information effectively.”

Resources

• Surescripts InterConnect (QHIN Readiness Hub)
• The Sequoia Project (TEFCA Recognized Coordinating Entity)