Many may have overlooked two apparently-related announcements from Carequality and Epic on Friday. They were quite understated, given the potential tectonic shift that they represented. Carequality’s announcement came first, publicizing a blog post about “Framework Enhancements”, with a subheading indicating that Carequality would “thoughtfully align with TEFCA”. You can read Carequality’s blog here.
Epic’s announcement came out shortly afterwards, and was even more understated. It consisted of a few simple paragraphs posted in an obscure location on the fhir.epic.com website. I would never have found it if it hadn’t been publicized on LinkedIn. Its content seems quite dull - no offense meant to its authors - at first glance, with the title and opening paragraph commending Carequality’s announced plans to align its policies with those of TEFCA.
Its second paragraph, however, notes that Epic’s customers will be transitioning to live TEFCA participation by the end of 2025. Crucially, it also states that (emphasis added) “Epic will continue to support our customers’ connectivity through Carequality during the transition….”
Those who enjoyed Hulu’s recent reboot of James Clavell’s Shogun might be forgiven for thinking that Epic’s seemingly mundane announcement was penned by Yoshi Toranaga. My reading of it is that Epic’s customers will be transitioning to TEFCA between now and the end of 2025, and that Epic’s support for Carequality will not continue into 2026.
Obviously, caveats apply here. This is my interpretation, and far be it from me to speak for Epic. Second, while January 2026 is not far away, it still leaves time for pivoting and adjusting (and a presidential election) to occur. It seems, however, that Carequality ceding the stage to TEFCA is likely just a matter of time.
From a personal standpoint, this saddens me. I can’t recall any literal bloodshed, but my sweat and tears absolutely were poured into the founding and operation of Carequality. We realized that Carequality being eclipsed by TEFCA was a distinct possibility from the moment drafts of the 21st Century Cures Act emerged that directed ONC to “develop or support” a national exchange framework. Eight years later, what was a possibility now seems highly likely.
For now, however, the two frameworks must continue to operate. As both Carequality and Epic stated, it is absolutely a good thing for the two to be aligned, and for migrations to be as smooth as possible. At Health Gorilla, we look forward to supporting and contributing to this alignment, and continuing to provide our customers with complexity-free access to both frameworks.
