News Archives

Advisory Council Now Accepting Applications

National-level health data exchange is here. Won’t you join us?

The Carequality Advisory Council is now accepting applications for new members.

The Advisory Council, like Carequality itself, seeks to embody the entire healthcare continuum. The diverse Council includes not only provider organizations, networks, and vendors, but also patient safety organizations, behavioral health organizations, government agencies, standards development organizations, and other health care settings such as labs, pharmacies, and long term care.


Carequality Members Invited to Attend Annual Meeting

Carequality is pleased to announce The Sequoia Project’s first annual member meeting which will be held from December 5-6, 2017 at the Gaylord National Harbor, located just minutes outside of Washington, DC.  Carequality brings together a diverse group of representatives, including electronic health record (EHR) vendors, health information exchanges (HIEs), and other types of networks and service providers from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks, platforms, and geographies. Attendees from provider organizations, national and regional data sharing networks, consumer application providers, payers, vendors, and more are expected at this exciting event.

In addition to Carequality members, attendees will consist of members and participants of The Sequoia Project, eHealth Exchange, and RSNA Image Share Validation. The annual meeting agenda will include product roadmaps, government representatives, data sharing case studies, technical tips and tricks, networking events, and much more. Experts from all areas of the health IT data field will present including Mariann Yeager, CEO of The Sequoia Project, and Dave Cassel, Vice President, Carequality.

As the inaugural live member meeting, this event promises to be a must-attend gathering of health IT interoperability experts. With nearly 200 attendees expected, The Sequoia Project Annual Member Meeting 2017 will be a valuable opportunity to network with executive, IT, and operations professionals across the health IT field. Make sure to take advantage of this unique opportunity. For more information,

Apply Now for the Carequality Steering Committee

Be a Carequality Leader

Carequality is a consensus-based initiative to connect networks under a shared interoperability framework. We’re looking for leaders to take a stand in accelerating health data sharing by joining the Carequality Steering Committee! We’re accepting applications to join the Steering Committee until July 24th.Carequality Steering Committee Application

The Steering Committee is responsible for Carequality’s strategic direction, and for the development and oversight of the Carequality Interoperability Framework. The Carequality Interoperability Framework was published in December 2015 and has since been adopted by a more then a dozen leading healthcare information networks. Our implementing networks have enabled more than 260,000 physicians across 850+ hospitals and 23,000 clinics.

With input from the Carequality Advisory Council and other stakeholders, the Committee manages the work of Carequality, including adoption of new use cases and settling key decisions regarding our consensus-built Framework. The Committee of 14 members balances continuity with fresh perspective by rotating terms so that 50% of the seats have terms expire each year. When this year’s seven open seats are filled, the committee will elect this session’s leadership. The Committee is currently led by Chair Dr. Michael Hodgkins, of the American Medical Association, and Vice Chair Dr. Steven Lane, of Sutter Health.

Learn more about the Steering Committee commitment and submit your application today.

The long and winding road to patient data interoperability

Most of the time when Dr. James Tcheng gets a new patient from outside of Duke Health, he starts with a bundle of paper. After his secretary receives a patient’s records—either directly from another doctor’s office or after a request is faxed—and opens them, Tcheng goes through the information, with a sheet of 8½ x 11 paper at his side for taking notes. He starts, usually, with the summary notes. Sometimes, almost all of what he reads is irrelevant. But he must go through everything nevertheless, making sure he misses nothing.

Carequality & Sequoia Project Support HHS Secretary Tom Price

Health and Human Services Secretary Tom Price spoke yesterday at Health Datapalooza 2017, touting the promise of health IT and his belief in the innovations of the private sector to increase health interoperability and improve usability for patients and physicians. Price added that HHS would be engaging and “encouraging health interoperability from the 60,000 foot level.”

Carequality, and its parent non-profit The Sequoia Project, are excited to hear Price mention that true interoperability has always been the goal, although the path to achieving it hasn’t always been a smooth and steady ride. No organization knows this better than us. This month, The Sequoia Project celebrated its five-year anniversary and during this timeframe, we have witnessed significant growth across the health IT industry in moving toward health data sharing. Although we have not arrived at our final destination, we are certainly well into the journey and miles from where we started.

Here is a sampling of what The Sequoia Project and its initiatives, Carequality, eHealth Exchange and RSNA Image Share Validation have accomplished:

  • More than 19,000 clinics, 800 hospitals, and 250,000 providers now implement the Carequality Interoperability Framework, a drastic increase from one year ago when the framework was first published and 10 pioneering organizations signed up to implement.
  • The eHealth Exchange is now the largest health data sharing network of its kind in the United States, connecting participants in all 50 states, including four federal agencies, 65 percent of all U.S. hospitals, 46 regional and state HIEs, 50,000 medical groups, and more than 3,400 dialysis centers and 8,300 pharmacies. Combined, the eHealth Exchange supports more than 109 million patients across private, military, veteran, and public care settings.
  • This winter, seven companies received RSNA Image Share Validation, which uses rigorous technical testing to ensure accurate and efficient exchange of medical images. Other companies are in the process of getting validated as the program transitions from pilot to production mode.

The unprecedented growth of Carequailty, and Sequoia’s other initiatives, illustrates the promise of health IT and innovation. To the points that Secretary Price made yesterday at Health Datapalooza, interoperability improves health outcomes. This is a win-win for everyone.

Sequoia Project, DirectTrust tout Interoperability Surge

Two major interoperability groups, Sequoia Project and DirectTrust, are exchanging more health records and connecting more provider sites than ever, the companies announced this week.

The Sequoia Project – whose members include Carequality, eHealth Exchange, and RSNA Image Share Validation – marked its fifth anniversary by touting across-the-board growth: The number of health organizations participating in its in initiatives, the size of geographic reach and the volume of data exchanged are all on the rise.

Document Content Workgroup Forming Now

We hope you’ve recovered from HIMSS17 and are ready to roll-up your sleeves to join us in refining the Carequality Framework.

While standard clinical document templates exist, there remains a great deal of variation in how information is actually expressed within these templates. The content of clinical documents (i.e. the fields and terminology values within these standard templates) can vary widely between organizations, even within the same network or across different implementations of the same vendor’s software.

Within a query exchange environment, this leads to challenges where requested documents might not contain the vital information expected by the requester based on the type of documents requested, or might not contain the information in an expected or recognized way.

Carequality is seeking volunteers for a new workgroup that will address this need.

The Document Content Workgroup will focus on determining what critical content values are essential to various stakeholders to exchange. The Workgroup will make detailed recommendations regarding document content and how it relates to Carequality’s specific needs.

To support future adoption of the Workgroup’s final recommendations, the group will be encouraged to build on and incorporate the efforts of others in the industry. As a starting point, the Workgroup will evaluate content requirements of existing network(s) to determine if they will meet Carequality’s needs. The Workgroup is also strongly encouraged to consider incorporating ideas from the C-CDA R2.1 Companion Guide, and to consider the findings of the HL7 Pertinent and Relevant project.

How to Volunteer for Carequality’s Patient Document Content Workgroup

If you or someone from your organization is interested in participating, please send an email to with subject “Document Content Workgroup Volunteer” and briefly describe your qualifications. We’re soliciting volunteers until 5:00pm PDT on March 31, 2017.

To learn more about the work of some of our past workgroups, visit the Carequality Wiki (free registration required).

Carequality and CommonWell Connectivity FAQs

Have Questions about the Carequality & CommonWell Announcement?
We’ve got Answers.


  Jump to:

The belief that collaboration is a key part of success is not a new one, especially when it comes to achieving nationwide interoperability in healthcare. We have always been dedicated to working together across the industry to break down the barriers to interoperability, which is why we are excited to share CommonWell Health Alliance and Carequality are increasing nationwide health IT connectivity by providing additional health data sharing options to the more than 15,000 hospitals, clinics, and other healthcare organizations actively deployed under the Carequality framework or CommonWell network. The agreement outlines three objectives:

  • CommonWell will become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequality participant.
  • Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.
  • CommonWell and The Sequoia Project, the non-profit parent under which Carequality operates, will also explore collaboration on other interoperability projects in the future.

This is a big moment in healthcare, and we understand there are likely questions about the collaboration. Details regarding the agreement can be found in the press release [hyperlink] as well as answers to more specific questions in the FAQ below.
If you have any additional questions about the announcement or its impact on your health data sharing capabilities, please email or contact your Carequality implementer.

                           Quick Facts:

  • Carequality is a platform-neutral, vendor-neutral framework to connect health data networks under a common set of nationwide legal, technical, and policy rules with the goal of promoting trusted exchange. The Carequality Framework is enabling exchange today for patients, providers, and others across vendor networks, as well as Health Information Exchange networks (HIEs), record locator services, clinical information networks, and personal health record (PHR) networks.
  • CommonWell Health Alliance offers operational cross-vendor interoperability services that health, health IT, and health data exchange organizations across the care continuum embed into their technology to enable caregivers to exchange data within existing workflows. Today, services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve records for a patient from multiple member systems. CommonWell members span the continuum of care including hospitals, ambulatory practices, post-acute and long-term care, pharmacies and PHRs.

                            Are terms like member, participant, connection, and implementer interchangeable? No. Below are definitions:

  • CommonWell Member A CommonWell member is a health care organization that believes in the vision and mission of CommonWell and can participate in CommonWell committees to drive forward key initiatives.
  • CommonWell Subscriber A CommonWell member who has subscribed to using and deploying CommonWell services, such as patient ID management, advanced record location, and query/retrieve broker services.
  • CommonWell-enabled Providers CommonWell-enabled providers are those providers who are enabled with CommonWell services via their vendor member or providers who subscribe directly to the CommonWell services.
  • Carequality Member A Carequality member is a health organization with an interest in a national-level common trusted exchange agreement and interoperability framework. Members are engaged in developing and expanding the framework.
  • Carequality Implementer A Carequality implementer is a health data sharing network that has adopted and implemented the Carequality Interoperability Framework, connecting their network (and their members) to other networks that have implemented the framework.
  • Carequality Connection A Carequality Connection is enabled to share health data under the Carequality framework via an existing Carequality implementer. An example would be a health system that is enabled to share health data via their vendor, who is an implementer.
  • Carequality-enabled Providers Carequality-enabled providers are those providers who are enabled to exchange health data under the Carequality Framework via their Carequality Implementer.
  • Directed Query. A user- or system-initiated query that is sent to a specific organization to determine whether a specific patient has a record at that location.  An organization is defined as any entry in the Carequality directory.  The query may be sent directly to the organization or through an intermediary gateway such as the CommonWell gateway.

                            Questions about Carequality and CommonWell Collaboration and Membership

  1. How did this agreement come about? CommonWell is a health data sharing network and Carequality is a framework to enable health data sharing between and among networks. Though each initiative approaches the challenge differently and has different intermediate goals, the ultimate goal of both initiatives is to ensure that vital clinical information is available to those who need it, including patients and other relevant players but particularly focused on providers at the point of care. It became increasingly clear as the initiatives matured that their distinct architectures and approaches could be bridged in order to further that shared common goal. The current agreement is the culmination of discussions for over year to address the practical details involved in making the connectivity and future collaboration a reality.


  1. Why is this important? What are the benefits to patients and providers? Ultimately both providers and their patients will benefit. By expanding the number of interconnected networks across the country, patients will benefit because they will have more assurance that their providers are able to diagnose and treat them with more and easier to find available information at hand. 

CommonWell Health Alliance and Carequality through their members represent the overwhelming majority of providers across the country who can exchange health information today.  Connecting the participants with this arrangement will expand exchange opportunities nationwide, including for Carequality participating networks that are not vendor-based. While this doesn’t solve interoperability for every provider in the country, it does reduce the complexity of data sharing between providers. 


  1. What is the connectivity that will happen between these two organizations? There are many types of interoperability required to support care delivery.  Some of these information exchange capabilities are already widely adopted, such as electronic prescribing, electronic lab results delivery and electronic public health reporting.  Up until now, however, the industry has not had a consistent nationwide approach for a provider to electronically request and retrieve a medical record from another provider. This agreement changes that.  

CommonWell and Carequality will work together in the following ways:

• CommonWell will become a Carequality implementer on behalf of its members and the provider organizations they serve. This gives CommonWell subscribers the option to engage in health information exchange through directed queries with other Carequality participants, and vice versa.

• Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality. This enables non-CommonWell-enabled providers to utilize such a service from CommonWell.

• CommonWell and The Sequoia Project, the non-profit parent under which Carequality operates, will collaborate on this endeavor and expect to collaborate on other interoperability projects in the future.

Specifically, the two organizations are enabling query and retrieve of CCDAs and the option for a record locator service that can help improve the likelihood of finding a patients’ record via a distributed process. This type of exchange is important in many critical health care situations, such as when a patient shows up in the emergency room or in any other situation where a provider is making a diagnostic or treatment decision but needs to know key medical information to avoid adverse events such as allergic reactions.


  1. Which organizations are covered by this arrangement? This new connectivity agreement impacts the health IT organizations, and their clients, who already share health data via either Carequality or CommonWell. Known as Carequality implementers and CommonWell subscribing members, these organizations come from across the healthcare eco-system. The members of CommonWell Health Alliance can be found at the CommonWell website:  The participants in the Carequality framework can be found at the Carequality website: 


  1. Does this mean that any CommonWell-enabled provider will be able to talk with any Carequality-enabled provider? With this new agreement, any CommonWell-enabled providers that agree to the Carequality Connection Terms via their participating CommonWell subscriber will be able to exchange information for treatment purposes with any Carequality-enabled provider.


  1. Why did CommonWell and Carequality enter this agreement? Both organizations saw an opportunity to work together following demand from Carequality and CommonWell end-user providers for additional data sharing options. Ultimately, the two organizations entered this agreement to expand nationwide interoperability, giving their end-user providers easier access to more health information so they can make better informed care decisions.


  1. Does this mean that CommonWell and Carequality are merging? No.  While Carequality and CommonWell have a shared interest in expanding connectivity, they will continue to have distinct missions and approaches, and will continue to provide different value to their respective communities.


  1. I’m connected through Carequality, through my vendor or another implementer. What does this mean to me? You will be able to find and exchange with any CommonWell participants who choose to participate in exchange via Carequality. These CommonWell participants will be available in the Carequality Directory and will be query-able like any other participant. In addition, current Carequality participants can choose to use the CommonWell record locator service, just as they would any other record locator service that supports the Carequality Framework.


  1. My vendor is a subscriber of CommonWell services. What does this mean to me?  CommonWell-enabled providers will continue to have access to their existing CommonWell services, such as record locator brokered queries that automatically fetch data from multiple locations. Now, additionally provider organizations served by CommonWell Subscribers will have the option to engage in directed query with all organizations that are enabled by Carequality Implementers. CommonWell Subscribers can incorporate directed query functionality into the existing specifications and infrastructure. Of course, CommonWell will continue to innovate on the set of services that it offers to its members across the care continuum, including those that are not covered by the Carequality implementer model. (For a more detailed explanation of how the connectivity will work, see question 14.)


  1.  My vendor is both a Carequality implementer and a CommonWell subscriber. What does this mean to me? Providers with vendors in this situation will continue to have access to all existing connectivity that their vendors have enabled.  Vendors that subscribe to the CommonWell services and that are a Carequality implementers will choose whether to enable all connectivity via CommonWell (for record-locator brokered queries and directed queries for organizations that are enabled by Carequality implementers) or whether to continue to use CommonWell for record-locater brokered queries and to use the Carequality framework to engage in directed queries with organizations that are enabled by Carequality implementers.


  1. I’m not connected to either group today. How can I participate? Together, Carequality and CommonWell represent a significant majority of the electronic health record marketplace, and connectivity through your EHR vendor may be a possibility. Regional or state health information organizations (HIOs) may be an option as well.  If you don’t have a clear option from your vendor or an HIO, you can encourage your vendor or your HIO to pursue connectivity through these interoperability initiatives, or contact the initiatives to explore other possibilities. 


  1. Will this change the roles of CommonWell or Carequality in the future?   These and other interoperability networks and initiatives will continue to grow and evolve the services that they offer to their respective participants.  Connecting the two organizations with this arrangement allows them to connect their participants regardless of platform, which will provide value to all providers and patients.


  1. Is this the only way that participating vendors will connect to other vendors and other networks in the future? It isn’t the exclusive way EHRs and other networks connect today, and will not be the only way in the future. EHR systems, networks, and other health IT systems and devices are using a variety of standards, interfaces and tools to exchange data. The market continues to evolve and will continue to provide a variety of interoperability options to meet the needs of all customers.    


  1. What actually needs to happen in order for this connectivity to work? Once the technical implementation is complete, each CommonWell subscriber will determine if they will utilize CommonWell to enable their Carequality connectivity. Provider organizations will need to specifically agree to the Carequality Connected Agreement (CCA) to enable connectivity through their CommonWell subscriber. 


  1. What does this mean for state health information exchange organization? Regional and state health information exchange organizations (HIOs) are health data sharing networks serving particular geographies or markets. Often these networks provide additional value to local communities, such as public health reporting, that is not offered by nationwide initiatives such as Carequality and CommonWell. These national initiatives do provide opportunities to expand the reach of these regional networks for some use cases, and thus provide additional value to their members.  A number of HIEs and HIOs currently participate in the Carequality and CommonWell organizations, and others are welcome to do so.


  1. Is this aligned with the ONC Roadmap? Yes, the work of CommonWell and Carequality independent from each other are aligned with the ONC RoadMap, as demonstrated by their pledges of support last year. The new arrangement furthers our respective commitments to supporting collaborative governance, implementing nationally-recognized interoperability standards, addressing data blocking, and easing consumer access.


                            Questions about Carequality and CommonWell Technology and Services

  1. How technically will CommonWell become a Carequality implementer on behalf of its members and their clients work to enable directed queries?  CommonWell will provide a gateway between CommonWell subscribers and Carequality implementers. The gateway enables support for directed queries. This will allow a Carequality participant to request and retrieve medical records from any CommonWell subscriber listed in the Carequality directory using the same technology that they already use to talk to other Carequality participant. Each CommonWell subscriber who chooses to participate will be listed in the Carequality directory just like any other Carequality participant.


  1. How technically will Carequality members be able to access a Carequality-compliant version of the CommonWell record locator services? CommonWell will provide a record locator service that conforms to agreed-upon standards for record location through the Carequality Framework, and this will enable those who choose to subscribe to the CommonWell record locator service to use their platform’s Carequality implementation to access CommonWell’s record locator data.


  1. Is this based on standards? What standards are being used? Yes, document query and document retrieve transactions will continue to follow the ITI-38 and ITI-39 standards already in use by both CommonWell and Carequality. CommonWell will also support ITI-55 and ITI-56 transactions as part of the communication layer between CommonWell and Carequality members.


  1. Why isn’t this based on FHIR and OAuth? Today, CommonWell already utilizes FHIR in order to enable some of its APIs, while Carequality is already working on using FHIR to enable provider directory management. However, note that FHIR is still a draft standard.  As these standards mature, each organization will incorporate them more broadly.


  1. As a provider, how much will this cost me? Neither Carequality nor CommonWell can determine pricing charged by vendors/service providers, please contact your CommonWell subscriber or Carequality implementer for specific pricing details.


  1. What is the timing for this connectivity? When will it go live? Completion of the technical aspects of the Carequality specifications and CommonWell gateway are expected in the first half of 2017.  Connections will be enabled between participants of the two initiatives as members agree to deploy the services and as CommonWell-enabled providers accept the additional connection terms required under the Carequality framework.



Carequality Accelerates Health Data Sharing

Nationwide Patient Data Exchange Across Networks Triples in 60 Days

We are thrilled to announce that Carequality is rapidly expanding and the rate at which new providers are enabled to share health data is accelerating. In fact, since we announced live exchange in August, our Carequality implementers have brought more than 11,000 clinics and 500 hospitals online. This means that more than 150,000 clinicians nationwide are now capable of sharing patient health data across technology and networks.

This impressive scale of connectivity is possible because the Carequality Interoperability Framework was developed by volunteers from across all of healthcare who understand the value of leveraging existing technologies and investments. The Framework is dynamic and flexible to work with all types of networks, including payers and vendors, as well as welcoming service providers such as patient portals, record locator services, and others.

We also need to thank our pioneering implementers. The leading healthcare IT organizations were the earliest to adopt the framework and encourage their clients and members to connect with others under the Carequality Framework. Their leadership is paving the way for others. Since our last announcement, we’ve welcomed three more implementers: Inovalon, Mana Health, and Medicity.

ONC Coordinator Dr. Washington Visits Carequality Participants in St. Louis  

Dr. Washington visited SSM Health St. Louis

Dr. Washington (center) visits with Dr. Dr. Richard Vaughn, CMIO, (left) and Dr. Peter Schoch, Vice President of Value-Based Care & Payment (right) of SSM Health (photo credit: SSM Health)

On Tuesday, Dr. Vindell Washington, National Coordinator for Health Information Technology, visited St. Louis-area healthcare clinics and a long-term care nursing facility to see real-world health data sharing via the Carequality Interoperability Framework. The site visit allowed participants to observe patient health records being shared across different electronic health record systems and record locator services. For example, SSM Health, including the St. Louis-area SSM Health Outpatient Center that Dr. Washington visited, uses Epic to receive patient files with multiple community partners who use NextGen, athenahealth®, MatrixCare with Kno2 interoperability services, and eClinicalWorks with Surescripts’ National Record Locator Service (NRLS).


Read the complete Carequality news release.


Carequality Needs You!

Now Hiring a Program Coordinator or Program Manager

The Carequality Interoperability Framework has attracted national attention and is growing quickly. In addition to new implementers and members, we are experiencing the dynamic scale of growth in Carequality Connections for which the framework was designed. This means we’re now hiring a Program Coordinator or Program Manager to support our diverse membership of providers, vendors, payers, and other stakeholder from across the healthcare ecosystem.tsp-icons-cq-executives

This individual will assist Carequality Director Dave Cassel in all areas of Carequality’s operations, including support for health information exchange activities, planning and running committee and working group meetings, and executing on strategic priorities identified by the Carequality Steering Committee. The position is full time and is based either in the Washington, DC or Madison, WI metropolitan areas.

If you are qualified and looking to join a great group of passionate folks, please consider applying. Know someone who would be perfect? Please share the word with your friend or colleague – we can’t wait to meet them.

Learn more about the vacancy on our Carequality careers page.