Delaware just bet that the health-data hub is public infrastructure, not a product to sell. The national version of that bet already has a name: TEFCA — a "connect once, reach everyone" road for health data. So who's actually on the road, and who's still drawing their own dirt track?
TEFCA — the Trusted Exchange Framework and Common Agreement — is the federal answer to nine billion faxes: one nationwide agreement so a hospital connects once and reaches everyone, instead of building a private line to every payer and peer. In the 2024 ONC/AHA hospital survey (2,249 non-federal acute-care hospitals), here's where that stood:
Horizontal: how many hospitals the state had in the survey (its sample size). Vertical: the share already live on TEFCA. Dot size is the same hospital count. It's tempting to crown the states highest on the axis as interoperability leaders — so drag the minimum-hospitals floor and watch the tidy front-runners turn out to be tiny states with a handful of hospitals.
If "connect once, reach everyone" becomes true in even a handful of states, half of every eligibility / prior-auth / data-exchange product — the point-to-point plumbing — quietly becomes free infrastructure you didn't have to build. What's left is the half worth building.
mimi_ws_1.healthit.hospital_tefca_participation (derived from the ONC/ASTP Hospital Health Information Network Participation dataset, itself the AHA Annual Survey IT Supplement); source vintage mimi_src_file_date=2025-08-01; 2024 extract. MimiLabs report + SQL (query 6a58823653c953cfacc6047e). The chart intentionally plots 50 states (2,249 hospitals), excluding DC; the report includes 51 jurisdictions and 2,253 hospitals. "On TEFCA now / planning" and network participation are self-reported survey indicators — awareness and intent, not a measured live-exchange volume. TEFCA launched in late 2023, so these are early-adoption figures. Not Medicare Advantage, not commercial claims.