News Archives

Carequality Implementation Guide Updates Now In Effect

Carequality strives to address the evolving needs of our community. With this in mind, our governing document, the Query-Based Documentation Exchange Implementation Guide is treated as a living document that is updated based on the collaborative work of our members, subject matter experts, and staff. Building on this inclusive process, we are thrilled to announce an updated version of the Implementation Guide, known as Version 1.1. or IG v1.1., is now available.

What’s new?

Policy Assertions

Carequality has responded to community feedback that all queries are not the same. Implementers may now give context to their queries. For example, an Implementer responding to a query may have access policies related to medical emergencies that differ from routine responses. Carequality’s new policy assertions allow the requester to give the responding Implementer that vital context.

Additional Permitted Purposes of Use

As the Carequality Implementer community evolves, additional use cases must be added. To this end, IG v1.1 adds Patient Request and Coverage Determination to our list of Permitted Purposes of Use. We have also included a handy crosswalk of our Carequality Permitted Purposes of Use with the NHIN Purpose of Use Codes.

Implementer Non-Discrimination

Our non-discrimination policies (those that regulate Implementer to Implementer bias treatment) are essential to frictionless exchange between community members. We have further enhanced these policies in IG v1.1 to account for new purposes of use and policy assertions.

Where can you download the new guide?

These are just some of the highlights of IG v1.1. We encourage everyone to download and review the document. You can find the updated Carequality Implementation Guide on the Resources page.

Finally, thank you to all of the members, subject matter experts, and staff that have worked tirelessly over the past year to make this update happen. Your concerted effort has been invaluable to this process. The work is never done though! As we grow and adapt to new community needs, we hope to have your continued support.

Nationwide Connectivity Accelerating via Carequality

Carequality is thrilled to share that in January 2018, more than 2.4 million clinical documents were shared under its trusted exchange framework. This occurred across nine organizations in production today, including athenahealth®, eClinicalWorks, Epic, GE Healthcare, Netsmart, NextGen Healthcare, OneRecord, Santa Cruz HIE, and Surescripts.

Chart of clinical document exchange volumes

The rate of health data exchanged is accelerating monthly under the Carequality framework.


The continued increase of exchange via Carequality’s interoperability framework is do to the continued dedication of all Carequality implementers, who continue to on-board their network members and clients. To date, more than 1,250 hospitals, 35,000 clinics, and 600,000 health care providers are connected through the Carequality interoperability framework.

In a February 28, 2018 news release, live implementers athenahealth, GE Healthcare, Netsmart, and Surescripts shared more about their experience with Carequality.

Visit The Sequoia Project booth (#3374) at HIMSS 2018 to meet Carequailty staff, hear from Carequality Implementers and Carequality Connections, and learn more about how you can get involved.

New Members to the Advisory Council

Carequality welcomed 13 new members to the Advisory Council:


Gretchen Bebb, TheraTech Pathways

David Berkowicz, PatientPing

Ryan Bramble, CRISP

Robert Cothren, CAHIE (California Association of HIEs)

Doc DeVore, MatrixCare

Morgan Knochel, OneRecord – Co-Chair

Shannah Koss , Koss on Care

David Mendelson, IHE

AJ Peterson, Netsmart

Terri Ripley, OrthoVirginia

Niko Skievaski, Redox

Alan Swenson, Kno2 – Co-Chair

Brian Yeaman, Coordinated Care Health Network


The purpose of the Advisory Council is to inform the work of the Carequality Steering Committee and the final Carequality Interoperability Framework policies through its representation of broad constituent groups and a diverse array of perspectives.


The Council serves a valuable role in assuring the broadest set of interests are reflected in Carequality’s work. We strive to include representatives from across the entire healthcare industry and care continuum, and our new members fit that bill. They join an already diverse council, and we look forward to the varied perspectives they will bring to its work.


The Advisory Council Members do not have to be members of Carequality itself. We include all stakeholder voices regardless of membership to ensure a transparent and inclusive process for developing this national framework for health data exchange regardless of technology or geography.


Carequality shares updates, including on the Advisory Committee’s activities, monthly with the membership and the interested public.  Visit The Sequoia Project events calendar to find all our upcoming Carequality meetings.


Learn more about the Advisory Committee Responsibilities.

Apply Now!

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).