The Sequoia Project, Carequality, and eHealth Exchange

What’s the Difference?

Interoperability Is a Multifaceted Challenge. So are the Solutions. 

Defining the

eHealth Exchange and Carequality

The Sequoia Project team is regularly asked, “What’s the difference between the eHealth Exchange and Carequality?” We want to answer the question clearly to assist with any lingering confusion. Both the eHealth Exchange and Carequality are independent of The Sequoia Project. They complement each other in our pursuit of seamless and accurate health data sharing nationwide.

A simple explanation of the differences is that the eHealth Exchange is a network while Carequality is not a network. But the differences run a little deeper than that.

eHealth Exchange

The eHealth Exhange was The Sequoia Project’s first interoperability initiative. Sequoia assumed stewardship of the nationwide health information network exchange (or NwHIN Exchange) from ONC in 2012. The eHealth Exchange is a public-private, health information network, and it happens to be the largest of its kind in the country. While an initiative incubated by The Sequoia Project, the network more than quadrupled in size to connect participants across all 50 states and support more than 120 million patients. Recognizing the maturity and sustainability of the network, the eHealth Exchange became independent of The Sequoia Project in 2018.

Network Architecture

There are nearly a dozen data sharing use cases supported by the eHealth Exchange to date, but one of the most unique and popular is connecting the private sector providers and state and regional HIEs to federal agencies.  eHealth Exchange provides its participants a single API to connect with the nation to reduce information sharing expense and complexity. Network participants are able to securely connect and share data over the Internet in a standardized and seamless manner.

In addition to providing the ability to connect members to each other, the eHealth Exchange network does provide some shared services, including a rigorous testing program to ensure connectivity and interoperability.


Based on the history of the health IT market, The Sequoia Project agreed with the rest of the industry that there will not be a single national network that meets the needs of the entire industry. That created a challenge: If there will not be one national network, how will providers who connect through different networks be able to share data with each other?

The Sequoia Project partnered with health IT leaders in the public and private sectors to create the answer: Carequality.

Trust Framework

Carequality is a network-to-network, trusted exchange framework and common agreement developed by a diverse group of representatives from across healthcare to connect existing and future data sharing networks to each other. This allows providers to securely share data with providers who are part of an entirely different network. Examples of disparate networks include vendor networks, payer networks, lab networks and others, such as the eHealth Exchange network.

Why is this important?

Why is this important? Consider that today, many physicians already have access to a network through a technology vendor or a health data sharing network. However, physicians are often restricted to share data only with other providers in their same network. This is the equivalent of having a cell phone plan that only allowed you to call other customers of your carrier. That’s the situation for most healthcare providers today when they join a data sharing network.

The physician cannot join Carequality directly (remember, Carequality isn’t a network), but when their existing network adopts and implements the Carequality Interoperability Framework, the physician will be able to share healthcare data with other providers who connect through entirely different networks, without additional special effort.

Carequality Video Overview

Health Data Sharing

Health data sharing opportunities are dramatically expanded to include additional providers, payers, and other care settings, and others as the Carequality community grows. This in turn helps patients receive better care, increases healthcare efficiency and decreases healthcare costs. In response to the success of Carequality initiative, it was re-launched as an independent non-profit in 2018.

The Sequoia Project

The Sequoia Project is a non-profit, public-private collaborative dedicated to advancing implementation of secure, interoperable nationwide health data sharing. We are not an association, which typically prioritizes benefits to its membership over benefits to the public, and we aren’t a think tank, because we are action-oriented thought leaders who implement interoperability in the real world.

Healthcare Challenges

We proactively address the multi-faceted and complex challenges of health IT interoperability, including testing for reliable health information exchange, ensuring content of the data exchanged is useful, improving patient identity management nationwide, and much more.

The challenges of healthcare IT interoperability are complex and multifaceted, and so The Sequoia Project incubates several initiatives that are managed and staffed independently. The eHealth Exchange and Carequality, now independent organizations, are examples of our track record of implementing health data sharing solutions.

Still Have Questions?

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The Sequoia Project is the independent, trusted advocate for nationwide health information exchange. In the public interest we steward current programs, incubate new initiatives and educate our community.