ONC marks universal EHR adoption and one billion TEFCA health records exchanged in inaugural Coordinator's Quarterly

The Office of the National Coordinator for Health IT declared universal EHR adoption across the U.S. healthcare ecosystem in June 2026, marking the milestone in the first issue of a new publication called the Coordinator's Quarterly. The same edition announced that the TEFCA network has exchanged one billion health records, a figure ONC characterized as a defining moment for nationwide health data infrastructure.

The quarterly is positioned as ONC's primary channel for consolidating policy updates, research findings, and adoption data into a single, regular read for the health IT community. National Coordinator Tom Keane framed the publication's purpose plainly in his opening message, describing it as a way to show how health data policies show up in exam rooms, pharmacies, hospitals, and kitchen tables, according to the ONC site.

Sixteen years of adoption data, now in one place

Four new ONC data briefs anchor the quarterly's research section, each drawing on nationally representative survey sources to document where the health IT ecosystem stands after more than a decade and a half of HITECH-driven investment.

The first brief covers non-federal acute care hospital EHR adoption from 2008 through 2024, using American Hospital Association IT Supplement data to examine trends by hospital characteristics, developer market share, and use across inpatient and outpatient settings. The second covers office-based physician EHR adoption across the same period, drawing on the 2024 National EHR Survey and offering what ONC describes as its deepest analysis yet of how HITECH investment translated into physician practice adoption.

For health system CIOs and procurement directors, the market share data in the hospital brief is particularly actionable. It offers a current-cycle benchmark of which certified EHR developers hold what share of the acute care market, a practical input for contract negotiations and vendor evaluation cycles.

The third brief tracks health information organizations' experiences of perceived information blocking between 2019 and 2025, surveying state, local, and regional HIOs on whether hospitals, health systems, or certified health IT developers may have engaged in behaviors that restricted electronic health information exchange. The fourth examines HIO capabilities to support public health data exchange, drawing on the 2025 National Survey of Health Information Organizations, which covered 76 HIOs and assessed their connectivity to public health agencies and the services they offer to support public health reporting.

TEFCA at one billion and the interoperability work ahead

The announcement that TEFCA has crossed one billion health records exchanged comes from HHS directly and represents a significant scale marker for the Trusted Exchange Framework and Common Agreement. TEFCA was designed to enable different health information networks to share patient data under a common set of rules, and the billion-record figure reflects that the framework is operating well beyond early pilot conditions.

For health system operations and IT teams, the milestone has a direct procurement implication: organizations that have not yet connected to a TEFCA-qualified health information network are increasingly outliers. The scale of exchange activity also raises the stakes for data governance, as records flowing through TEFCA must conform to structured data standards if they are to be clinically usable on the receiving end.

Principal Deputy National Coordinator Steven Posnack noted in his message for the quarterly that reaching current EHR adoption levels required presidential leadership, congressional action, federal rulemaking, private-sector investment, standards development, state and local implementation, and the daily resilience of clinicians, according to the ONC publication. That attribution of credit across multiple actors is a useful frame for understanding why interoperability, the next phase, is proving more complex: it requires all of those same layers to coordinate simultaneously.

Standards pipeline: USCDI+ comment windows now open

ONC also used the quarterly to surface two active comment opportunities that have near-term implications for clinical informatics and IT teams. Two new USCDI+ data element sets, one for Sickle Cell Disease and one for Quality measurement, are currently out for public feedback. USCDI+ extends the United States Core Data for Interoperability standard for specific programmatic or policy use cases, and elements that are finalized typically flow into certification requirements for EHR developers.

Health systems with sickle cell disease programs or those deeply engaged in quality reporting workflows have a narrow window to influence which specific data elements are included before they become a certification baseline. Once finalized, USCDI+ elements become part of what certified systems must support, which affects both upgrade timelines and implementation costs.

On the standards side more broadly, ONC released its 2026 Interoperability Standards Advisory in the first quarter, incorporating the Federal FHIR Action Plan. The ISA is the authoritative reference for which interoperability standards and implementation specifications ONC considers for federal health IT programs, and the 2026 update is now available via the agency's Interoperability Standards Portal.

What this means for your team

• Review the hospital and physician EHR adoption data briefs for market share benchmarks before your next vendor contract renewal or EHR re-evaluation cycle.
• If your organization is not yet connected to a TEFCA-qualified network, assess the operational case now: one billion records exchanged signals production-scale infrastructure, and late connection increasingly means clinical and administrative data gaps.
• Submit comments on USCDI+ Sickle Cell Disease and USCDI+ Quality data element sets before the windows close; finalized elements will become EHR certification requirements, affecting your upgrade roadmap and budget.
• Review the 2026 Interoperability Standards Advisory to confirm your current certified systems align with ONC's updated Federal FHIR Action Plan references, particularly if you are planning any integration or data-exchange projects this year.