Do ABDM and TEFCA both use FHIR?

ABDM exchanges FHIR R4 documents defined in the NRCeS implementation guide. TEFCA exchange follows the Common Agreement's technical framework, which covers document exchange and FHIR. A product serving both should map its own data model to each, rather than assume one FHIR profile set fits both.

Can one codebase serve hospitals in India and providers in the US?

Yes, if identity, consent and profile mapping sit in separate adapters around a shared clinical core. What should not be shared is the patient index, the consent records and the data stores, because each market has its own rules for them.

Who joins the network: our company or our customers?

In ABDM, the facility is the HIP or HIU and your software carries out the flows for it. In TEFCA, organizations join as Participants or Subparticipants under a QHIN, and a technology company may connect on behalf of its customers under those agreements. Settle who signs what before you build.

Which is harder to integrate with, ABDM or TEFCA?

They are hard in different places. ABDM work concentrates on ABHA linking, consent flows and passing ABDM's integration checks. TEFCA work concentrates on the QHIN agreement, patient matching and handling Exchange Purposes. Doing both adds the mapping layer and separate stores.

How long does it take to add ABDM or TEFCA to an existing product?

It depends on scope: which roles you take in each network, how your current data model maps to the FHIR profiles, and how consent is captured today. We agree a fixed first release on the scoping call.

Earth at night seen from orbit, with city lights spread across a continent

ABDM vs TEFCA

India ABDM vs US TEFCA: a digital health comparison for products sold in both markets

ABDM is India's national digital health mission, run by the National Health Authority. TEFCA is the US framework for network-to-network exchange through Qualified Health Information Networks. Both move records between organizations, but they disagree on patient identity, consent, network shape, FHIR profiles and the law behind them.

15-Minute Scoping Call All Comparisons

What is the difference between ABDM and TEFCA?

Quick answer

ABDM and TEFCA differ at the foundations. ABDM gives each patient a national health ID and releases records only after the patient approves a consent request, while TEFCA has no national patient ID and exchanges records for defined Exchange Purposes between networks. Agnotic Technologies builds products for both markets with separate identity and consent adapters over one clinical core.

Criterion	ABDM	TEFCA
Patient identity	National ABHA number and ABHA address, linked to each facility's local patient record	No national patient identifier; each network matches patients on demographics and the identifiers it holds
Consent	The patient approves a consent request before an HIU can view records	HIPAA permits disclosures for treatment, payment and operations; express consent is required before a QHIN provides Individual Access Services
Network shape	A national gateway routes requests between HIPs, HIUs and consent managers	QHIN to QHIN, with Participants and Subparticipants connected under a QHIN
Data profiles	FHIR Implementation Guide for ABDM (NRCeS), based on FHIR R4	Standards set by the Common Agreement and its technical framework; US Core where FHIR is used
Governing law	Digital Personal Data Protection Act, 2023, plus ABDM policies	HIPAA Privacy and Security Rules, plus Common Agreement terms
Who runs the network	The National Health Authority, as public infrastructure	Designated QHINs, which must be US entities not under foreign control
How a product joins	Build against the ABDM sandbox, then pass ABDM's integration checks before production	Sign a Participant or Subparticipant agreement with a QHIN and follow its onboarding
Patient-facing access	Patients view and share records through ABHA apps	Individual Access Services through a QHIN, Participant or Subparticipant

What they are

What is ABDM

The Ayushman Bharat Digital Mission is India's national digital health ecosystem. Patients hold an ABHA number and ABHA address, and records move from a Health Information Provider (HIP) to a Health Information User (HIU) only with the patient's informed consent, using FHIR R4 profiles published by NRCeS.

What is TEFCA

The Trusted Exchange Framework and Common Agreement is the US framework for network-to-network health information exchange, codified in 45 CFR Part 172. Qualified Health Information Networks (QHINs) connect to each other, and Participants and Subparticipants connect through a QHIN to exchange for authorized Exchange Purposes.

Key differences

Why can't one patient ID serve both markets?

ABDM gives the product a national key: the ABHA number, linked to the facility's own record. TEFCA has none, so a US query depends on demographic matching and local identifiers. Store identity per market, never use an ABHA as the primary key for a US patient, and keep a separate patient index for each country so a matching rule tuned for one market cannot merge records in the other.

How do the consent models change the data flow?

In ABDM, the requesting HIU sends a consent request, the patient approves it, and only then do records flow. Under HIPAA, 45 CFR 164.506(c) lets a covered entity use or disclose PHI for its own treatment, payment or health care operations without that step. TEFCA adds its own rule for patient apps: 45 CFR 172.202(a) requires a QHIN to obtain express consent before providing Individual Access Services. One consent engine cannot serve both, so build two adapters behind one internal interface.

Can a company outside the US run a TEFCA network?

Not as a QHIN. 45 CFR 172.201(a) requires an entity designated as a QHIN to be a US entity and not under foreign control. A product team based in India can still reach TEFCA by connecting as a Participant or Subparticipant under a US QHIN, or through a US customer that already connects. Plan the contract path before the technical one.

Do ABDM and TEFCA use the same FHIR profiles?

They share a base but not the profiles. The FHIR Implementation Guide for ABDM, version 6.5.0 from NRCeS, is built on FHIR R4 and defines its own document bundles and resource profiles for India. US exchange uses US Core where FHIR is in play. Keep the clinical core in your own model and map to each profile set at the edge, so a profile update in one country touches one mapping layer.

Where should each market's data live?

Each market answers to its own law: the Digital Personal Data Protection Act, 2023 in India and HIPAA in the US. Keep records, logs and backups for each market in separate stores and cloud regions, with separate access policies. That keeps a residency or transfer question in one market from forcing a redesign in the other.

When to use each

When to use ABDM (India)

Your product serves hospitals, clinics, labs or pharmacies in India that link records to a patient's ABHA.
Your customers create records that patients may share with other providers, which makes them Health Information Providers.
Your product reads records from other facilities with the patient's consent, as a Health Information User.
Your product touches insurance claims in India, where the same FHIR guide also carries NHCX profiles.

When to use TEFCA (US)

Your US product needs records from providers outside the EHR networks it already reaches.
You offer patients an app that retrieves their own records nationally through Individual Access Services.
Your customers are US providers, health systems or payers that already connect through a QHIN.
You want one network connection instead of a growing list of point-to-point interfaces.

How do you build one product that connects to both ABDM and TEFCA?

1. One clinical core, two network edges. The core stores encounters, results and documents in your own model. An ABDM edge handles HIP and HIU flows; a TEFCA edge handles queries through your QHIN or partner.

2. Identity per market. ABHA linking lives in the ABDM edge; demographic matching lives in the US edge. Neither writes to the other's patient index.

3. Consent adapters, not one consent table. The ABDM adapter tracks approved consent requests and their expiry; the US adapter records the permitted purpose for each disclosure and IAS consent where it applies.

4. A profile mapping layer. Map the core to NRCeS profiles for India and to US Core for the US, with tests for each mapping.

5. Separate stores per market, in regions that fit each country's rules, with their own keys and audit logs.

Failure points we design around: an ABHA reused as a global key; a consent flag copied from one market to the other; a shared index that merges an Indian and a US patient; one FHIR profile forced on both markets; and logs from both markets landing in one store.

Which sources does this comparison rely on?

ABDM integration services TEFCA integration services FHIR integration services HIPAA compliance engineering Software development for digital health startups NHCX integration services

Frequently Asked Questions

Only in purpose. Both move health records between organizations, but ABDM is national infrastructure with a national health ID and patient-approved consent requests, while TEFCA is a framework of private networks with no national patient ID. The engineering work differs at identity, consent and onboarding.