Carequality is a national interoperability framework that allows different health information networks to exchange patient records with each other. Think of it as a set of shared rules that lets your doctor’s system pull your medical records from a hospital across the country, even if both organizations use completely different software. It operates under The Sequoia Project, a nonprofit public-private collaborative focused on nationwide health information exchange, and currently facilitates the exchange of more than 1 billion clinical documents every month across more than 100,000 connected endpoints.
The Problem Carequality Solves
Healthcare in the U.S. runs on dozens of different electronic health record (EHR) systems, each built by a different vendor. Hospitals, clinics, labs, and insurance companies often can’t share data with each other because their systems don’t speak the same language. Even when individual health information exchanges (HIEs) exist at the state or regional level, those networks historically couldn’t talk to each other either.
Carequality addresses this by creating a common framework: a package of legal terms, policy requirements, technical specifications, and governance processes that any network can adopt. Once two networks both follow the Carequality rules, they can exchange data without needing to negotiate separate agreements with each other. This turns what would be thousands of one-to-one contracts into a single shared trust framework.
How It Works in Practice
Individual doctors and hospitals don’t join Carequality directly. Instead, they connect through an “implementer,” which is typically their EHR vendor, a health information exchange, or a data network like CommonWell Health Alliance. When a clinician needs records from an outside organization, their system sends a query through the Carequality framework. If the patient’s records exist at another connected organization, the system retrieves and displays them, often within the same EHR workflow the clinician already uses.
The exchange is built around directed queries for treatment purposes. A provider at one hospital can look up a patient and pull clinical documents from a provider at a different hospital, even if they’re on opposite sides of the country and use different EHR platforms. CommonWell Health Alliance, for example, became a Carequality implementer in 2018, which means any CommonWell-enabled provider can exchange records with any Carequality-enabled provider without additional technical work or cost at the provider level.
Who Participates
The network is large. More than 50 networks and over 100,000 connections route data through Carequality. The list of implementers and candidate implementers includes major EHR vendors like Oracle (formerly Cerner), eClinicalWorks, Meditech, Greenway Health, Netsmart, and Veradigm, along with specialty-focused platforms like Modernizing Medicine, Office Practicum, and Homecare Homebase. Regional and state HIEs like CRISP also participate, as do payer organizations and data aggregators like Particle Health.
This breadth matters because it means Carequality isn’t limited to one corner of healthcare. It spans hospitals, physician practices, post-acute care facilities, oncology centers, home health agencies, and health plans.
Governance and Oversight
Carequality is governed by a Steering Committee made up of representatives from across the healthcare ecosystem. The committee includes members from EHR vendors (Epic, Oracle Health, Netsmart), health systems (Penn Medicine, Trinity Health), physician organizations (American Medical Association), payer organizations, consumer advocates, HIEs, networks like CommonWell, and federal agencies including the Social Security Administration.
The Steering Committee sets strategic direction, approves new use cases, manages the annual budget, and oversees policy development. It also coordinates with standards development organizations and federal initiatives to keep Carequality’s technical specifications aligned with broader industry efforts. Work groups handle specific policy or technical questions, and an Advisory Council provides additional stakeholder input.
Cost Structure
Individual healthcare providers typically don’t pay Carequality fees directly. Costs fall on implementers, the organizations that build and maintain the technical connections. Implementer fees are based on annual revenue and scale significantly. An organization with more than $10 billion in revenue pays $480,000 per year. The fee drops to $240,000 for organizations in the $2.5 to $10 billion range, and continues downward from there. For service providers that connect multiple smaller organizations, the fee is based on either the service provider’s own revenue or the combined revenue of the organizations it represents, whichever is greater.
If you’re a physician practice or small hospital, your costs are determined by whichever implementer you connect through, not by Carequality’s fee schedule directly. CommonWell, for instance, offers Carequality connectivity to its members at no additional cost.
Carequality and TEFCA
TEFCA, the Trusted Exchange Framework and Common Agreement, is a federal initiative designed to create a single, nationwide approach to health data exchange. Carequality predates TEFCA and operates independently, but the two frameworks are converging. Carequality has been actively involved in TEFCA’s development and is aligning its own policies with TEFCA’s requirements in several areas: how it defines treatment-related exchange, how it manages directory integrity, and how it handles queries between organizations.
Several organizations that participate in Carequality are also becoming Qualified Health Information Networks (QHINs) under TEFCA, and Carequality is supporting those transitions. The long-term vision is convergence between the two frameworks, though Carequality continues to operate and evolve its own policies in the meantime. For organizations already connected through Carequality, this means the framework they rely on today is being shaped to align with the federal standard that will increasingly define health data exchange going forward.
What Carequality Doesn’t Do
Carequality is a framework, not a network itself. It doesn’t store patient data, doesn’t operate servers that route messages, and doesn’t provide software to end users. It sets the rules that networks and vendors follow so their systems can interoperate. The actual data exchange happens between the participating organizations through their own infrastructure.
It also doesn’t cover every type of health data exchange. The framework was originally built around query-based document retrieval, meaning one system asks another for records about a specific patient. Other exchange patterns, like real-time event notifications or bulk data transfers, involve different technical approaches that may or may not be part of Carequality’s current scope depending on the use case.