TEFCA is operational, information-blocking rules have teeth, and hundreds of billions in savings are sitting on the table anyway.
The infrastructure to fix healthcare's data fragmentation problem now technically exists. The savings it's supposed to unlock mostly haven't shown up yet, and that gap is where the next wave of interoperability startups is placing its bets.
The technology is live, the savings are still theoretical
The Trusted Exchange Framework and Common Agreement, TEFCA, has exchanged nearly 500 million records as of early 2026, according to Keragon's interoperability vendor analysis. Full interoperability could save the US healthcare system $77.8B annually by reducing administrative costs, duplicate testing, and medical errors, per the same analysis, while a JAMA study found administrative complexity already accounts for $265.6B in annual waste, much of it from manual data re-entry, faxed records, and phone-based referrals that interoperable systems are specifically built to eliminate.
Physicians currently spend an average of 16 minutes per patient encounter searching for external health records, time that better interoperability could cut to just 3-4 minutes, according to the same research, freeing meaningfully more time for actual patient care rather than data hunting.
35% of Canadian physicians using EMRs report spending two or more extra hours a day searching for patient information, a data point from an adjacent healthcare system showing the problem TEFCA and its US-based peers are trying to solve isn't unique to any one country's infrastructure.
Live infrastructure and realized savings are two different milestones
TEFCA being operational is a genuine milestone, but it's an infrastructure milestone, not an outcomes one. The $77.8B in potential annual savings depends on health systems, EHR vendors, and point-solution startups actually building on top of that infrastructure and changing clinical workflows accordingly, not just on the network existing. That gap between infrastructure being live and savings being realized is exactly the space companies like Metriport, Redox, and Datavant are trying to occupy, translating raw interoperability into an actual workflow change a clinician or care team notices.
Whether realized savings start showing up in health system financials
Watch for the first health systems to publicly report measurable reductions in administrative cost or duplicate testing directly attributable to TEFCA-based data exchange, rather than interoperability adoption metrics alone. The startups that can point to a real health system's before-and-after cost data, not just network participation numbers, are the ones most likely to convert this infrastructure milestone into an actual enterprise sales advantage over the next funding cycle.
