Connecting fragmented healthcare for better outcomes

A quest for continuity in healthcare: Primary vs. retail vs. virtual options

Primary care practices are no longer the only places where patients receive care. But they do remain responsible for coordinating and contextualizing that care over time. Over the past decade, urgent care, retail clinics, and telehealth services have become a routine part of how patients receive healthcare.

These options offer convenience and speed but have created a challenge for practices in sustaining longitudinal, coordinated care in long-term patient relationships, even with widespread adoption of electronic health records. Patient data can often arrive late, in the wrong format, or not at all, leaving clinicians to piece together a patient's story while making real-time decisions.

This tension between episodic convenience and longitudinal care isn't going away. The question for practices is no longer whether retail and virtual care will exist, but how patient data can move with the patient—securely, consistently, and at scale.

Addressing competing goals between episodic vs. longitudinal care

When interoperability of EHRs was first mentioned in the Health Information Technology for Economic and Clinical Health (HITECH) Act,¹ many of the care opportunities we have today didn't exist. Patients went to doctors' offices or hospitals. Today, however, there are multiple telehealth options on the market, and many of them aren't even in the same city or state. At the same time, urgent cares or pop-in retail clinics are on every corner and patients are showing up. According to the Urgent Care Association (UCA), there are nearly 15,300 urgent care centers in the U.S. More than a quarter of Americans (about 27%) have visited an urgent care over the past year.

Many of these care centers that live outside of a physician's traditional office do not have an automated way to share patient data to ensure continuity of care. When a physician or clinician is looking at a patient's chart they may not see, for instance, that they were prescribed a new medication. From a care perspective, the physician could prescribe something that will interact with the new drugs or miss a diagnosis that could have been obvious had they been in possession of the patient's complete set of data and records.

This type of disconnected care can create myriad issues that include:

• Fragmented medical records across multiple unconnected systems
• Medication conflicts when PCPs can't see prescriptions from retail care visits
• Duplicate testing that wastes time and money
• Delayed diagnoses due to incomplete patient histories

So, can continuity of care improve patient outcomes? Most definitely, yes, and here's how technology can help.

Bridging the divides caused by healthcare's fragmentation

A robust data exchange and interoperability can bridge the gaps that urgent care and emergency clinics create in the continuum of care, supporting both retail convenience and continuous patient relationships.

This is where TEFCA comes in. Known as the Trusted Exchange Framework and Common Agreement, it's a government initiative designed to create a nationwide, standardized, secure way for disparate health data networks to share electronic health information. Having a framework like TEFCA in place can simplify how patient data is shared across healthcare systems, allowing consistent, secure data sharing without the need for manual work or multiple logins.

TEFCA provides a framework that allows existing exchanges to work together. This opens up opportunities for care providers to better protect patient data and provide more complete care.

Consider how things get done even today for those healthcare organizations that don't use a TEFCA-aligned infrastructure.

How data interoperability can speed up care

Patient data resides in silos since each provider has their own workflows, contracts, and data storage rules. If you're lucky, the patient lets your office know that they visited an urgent care or clinic elsewhere. Then your staff needs to get permission from the patient to have their records sent, call the other office, fax or email over the record requests, and potentially need to log into the other office's portal to download the information. If the records come over as a fax they must be scanned and uploaded as a PDF, which can mean the data they contain may not be searchable. The entire process could take a few hours or a few weeks, depending on how busy both offices are. Even when the data comes over, care gaps may persist.

A TEFCA-aligned infrastructure automates and, in some cases, even eliminates this manual and often tedious task. According to HealthIT.gov, TEFCA is essentially a nationwide network-of-networks for health information exchange.² Today, we can send money to and from different banks or call people on other cell phone carriers. TEFCA is designed to help create that same interoperability and connectivity for healthcare data.

As of August, 2025 more than 9,200 separate organizations were signed up to participate in TEFCA Exchange, representing 41,000-plus unique connections between clinicians, hospitals, clinics, post-acute and long term care facilities, and public health authorities, among others, according to to the Office of the National Coordinator for Health IT's blog.³

A path to creating the perfect bridge

Similar to how we don't need to explicitly connect our bank with a friend's bank to send them cash, TEFCA doesn't require every healthcare organization to connect directly to each other. Instead, it establishes a way to let healthcare providers join cloud-based Qualified Health Information Networks (QHINs) that live inside the existing exchange structure. They serve as a key component to TEFCA.

QHINs are like hubs, enabling nationwide information sharing between tiny, one-person pediatricians, giant healthcare systems, and small pop-up clinics and urgent care facilities. They are invisible and always on, augmenting rather than replacing the national interoperability networks that many organizations already use, such as Carequality, Epic's TEFCA-enabled exchange infrastructure, and CommonWell, among others. Virtually any practice of any size can take advantage of the framework to the benefit of its care providers and patients.

The U.S. Department of Health and Human Services has designated TEFCA for the following purposes⁴:

• Treatment
• Payment
• Healthcare operations
• Public health
• Government benefits determination
• Individual Access Services (IAS) 

TEFCA in the real world

Although it was only finalized in January 2022, TEFCA is already making a huge difference for patients and their providers. Today, a parent can take a child to an urgent care at midnight and, if both the clinic and the pediatrician's office are connected to a QHIN, the doctor there can pull up all the child's relevant information. In the morning when the pediatrician gets into the office, the patient's previous night's care will be available. The office records, including test results, any diagnostic imaging, and diagnoses will be more readily available for review.

This kind of connectivity and quality healthcare is already happening across the country. Thanks to years of policy work designed to break down technical and logistical barriers that kept patient data in silos, TEFCA is making cross-organization data exchange a given. The result is connected care that works for the patient and all of their healthcare providers. He or she gets to choose how they want to access care. Meanwhile clinicians can make better decisions thanks to clinical integration.

Using software for care coordination

For many practices, enabling access to TEFCA might seem difficult and overwhelming. However, by working with a partner like athenahealth, one of the first healthcare IT companies to implement TEFCA at scale, healthcare providers can accelerate their own jump into data sharing without the need for in-house technical expertise. Clinicians and their teams get to focus on taking care of patients, enabling coordination of care and boosting patient satisfaction. It also creates an environment where walk-in clinics and urgent cares become another destination for 21st century patient care. Episodic care could become a thing of the past since every patient encounter may be part of their longitudinal records.

Indeed, fragmentation doesn't have to be the cost of convenience. Learn how national interoperability frameworks like TEFCA are shaping the future of connected care — and how healthcare organizations are beginning to participate in these networks to support both episodic access and longitudinal relationships and continuous care.