In the past, technology was often used as a wedge against local hospital independence. Big systems would offer subsidized EHRs, and in exchange, small hospitals would give up control—over workflows, over data, over their futures. “Community Connect” models promised integration but too often delivered dependency.
That doesn’t have to be the future.
Thanks to the emergence of Qualified Health Information Networks (QHINs) under TEFCA, the national interoperability infrastructure is finally real. And for community and safety-net hospitals, this moment is a chance to flip the script—to choose EHR partners that are wired into national exchange standards and still treat them like the primary customer, not a downstream user.
It’s a chance to stay connected without being absorbed.
QHINs Change the Game
QHINs are the backbone of the Trusted Exchange Framework and Common Agreement (TEFCA), a federal initiative designed to ensure seamless, secure health data sharing across the U.S. For hospitals—especially those in rural or underserved areas—the promise of QHIN participation is enormous: patients no longer need to be tethered to one system for their data to follow them. The burden of manual record requests, faxed histories, and clunky portal logins finally starts to lift.
More importantly, QHIN-connected EHRs level the playing field. A 25-bed critical access hospital can now exchange clinical data with a major academic medical center, a multispecialty group, or a nationwide pharmacy chain—without having to be owned by or technically dependent on any of them.
But here’s the catch: you only benefit from TEFCA if your EHR is built to take advantage of it. Not every vendor is ready. And not every host system is incentivized to make your data as portable as theirs.
Independence Through Infrastructure
For decades, smaller hospitals have had to choose between capability and control. Either go it alone on aging software, or accept a hosted model with strings attached. QHIN participation changes that. It creates a new middle ground—where hospitals can:
- Own their own instance of a modern EHR
- Connect nationally without needing a large health system to broker access
- Build their own networks with FQHCs, post-acute providers, and local clinics
- Compete on quality, not scale
This isn’t just about data exchange—it’s about redefining what partnership looks like. In a post-TEFCA world, community hospitals should demand EHR vendors who help them plug in to QHINs, not just get absorbed into someone else’s platform.
Better CDI. Smarter Charge Capture. Real Revenue Integrity.
While the benefits of interoperability are often framed around care coordination and patient access, the financial and operational implications are just as important—especially for under-resourced hospitals.
A QHIN-connected EHR can significantly improve clinical documentation integrity (CDI) by automatically retrieving relevant external histories, diagnoses, and procedures. This means:
- Physicians document with more complete context
- Clarification queries are reduced
- Coders and CDI teams get better inputs up front
- Risk adjustment and case mix accuracy improve
And on the revenue side, this enables smarter, more complete charge capture. When documentation is timely, accurate, and enriched by external clinical context, charges don’t fall through the cracks—and claims don’t get held up in rework.
Take a patient who shows up in your ED with CHF exacerbation but was recently hospitalized elsewhere.
With a QHIN-connected EHR, your team can automatically pull the prior discharge summary, medication list, and echo results. That means the attending physician can fully document acuity, the coder can assign the correct DRG, and your CDI team isn’t chasing documentation three days later. You’ve captured higher severity, prevented duplication, and submitted a clean claim—without a single phone call or fax.
Hospitals lose an estimated 1% of net revenue due to charge capture and coding gaps [1]. For smaller facilities, this can total millions. In fact, 90–95% of recoverable missed revenue in rural hospitals is tied to outpatient charge leakage alone [2]. When CDI, coding, and billing workflows are optimized and supported by structured external data, hospitals can recapture that revenue without adding staff or complexity.
Health systems that prioritize accurate documentation and charge integrity have seen annual revenue gains of $3–8 million—just by closing the loop on missed encounters, clinical context, and DRG precision [3].
That’s not a theoretical benefit. That’s real revenue integrity—and it starts with the right kind of EHR, built for interoperability.
Safety-Net Hospitals Deserve Better Options
For safety-net providers, the stakes are even higher. They serve the most complex patients with the fewest resources. Every delay matters. Every documentation gap compounds financial risk.
But with a QHIN-connected EHR, these hospitals can:
- Access external patient data automatically at the point of care
- Improve continuity and reduce duplicative testing
- Boost documentation and coding accuracy
- Stay eligible for interoperability-driven funding and value-based care models
And they can do all this without ceding governance or autonomy—a major shift from legacy models that used technology as leverage to consolidate market share.
What to Look for in an EHR Partner
If you’re a hospital leader evaluating options right now, here’s a simple framework:
- Is the EHR natively integrated with a designated QHIN?
- Does your hospital own the license—or just rent access from another organization?
- Will you retain the ability to customize, integrate, and evolve independently?
- Does the system support revenue-critical workflows like real-time charge capture and CDI optimization?
The best vendors are building with TEFCA, not just reacting to it. They see QHINs not as checkboxes, but as strategic infrastructure for independent providers.
Final Thought
For too long, the message to small and safety-net hospitals was: “You can’t afford to stand alone. Let us take over your technology, and we’ll keep you afloat.”
QHINs change that.
A modern EHR connected to a national health data backbone can give local hospitals what they’ve always needed: the tools to thrive without giving up who they are—clinically, financially, or strategically.
It’s time to stop asking whether community hospitals can survive—and start building the infrastructure that helps them lead.
About Jay Adams
Jay Adams is Executive Vice President of Altera Sunrise. A U.S. Navy veteran, he brings over two decades of leadership experience in healthcare IT, managed services, and enterprise software. Jay is passionate about restoring autonomy and clarity to community health systems through smarter, more sustainable technology strategy.
References
- Health Catalyst. Charge Capture Accuracy: A Case Study in Revenue Recovery. https://www.healthcatalyst.com/learn/success-stories/charge-capture-accuracy
- National Rural Health Association. Outpatient Revenue Leakage in Critical Access Hospitals. https://www.ruralhealth.us/blogs/2025/06/rural-hospitals-unlock-hidden-revenue-with-charge-capture
- Streamline Health. Five Gaps in Charge Reconciliation That Are Costing Health Systems Revenue.https://streamlinehealth.net/5-gaps-in-charge-reconciliation-that-are-costing-health-systems-revenue-and-how-to-fix-them/
