ONC Tightens Oversight as TEFCA Surpasses One Billion Records

Overview

• ONC announced on Friday that the federal TEFCA network has exchanged more than 1 billion health records and that the agency will increase oversight of network activity.
• The agency awarded a new contract to strengthen monitoring and to verify that participating organizations follow TEFCA’s policies, though the press release did not name the contractor.
• ONC has launched expanded compliance reviews of Qualified Health Information Networks (QHINs) and their participants to check adherence to TEFCA rules and operating requirements.
• Thomas Keane said ONC will refer potentially civil or criminal conduct, including information blocking and fraud, to the HHS Office for Civil Rights, the HHS Office of Inspector General, and the Department of Justice for investigation.
• The shift raises enforcement stakes for coordinating entities such as The Sequoia Project and could change how networks onboard and operate while giving patients a clearer route to file privacy or access complaints with OCR; TEFCA grew from roughly 10 million exchanged records at the start of 2025 to over 1 billion by June 26, 2026.