Frequently Asked Questions

1. Overview

What is Carequality?

Carequality, a 501c3 non-profit, is a national-level, consensus-built, interoperability framework to enable exchange between and among health information networks and service platforms. Carequality supports secure access to health information across diverse networks, including those operated by electronic health record vendors, record locator service providers, health information exchanges, and others. The connectivity is governed by technical and policy agreements developed and maintained by a broad group of industry and government stakeholders.

What does Carequality do?

Carequality provides programmatic and operational support for the Carequality Interoperability Framework, which enables health information sharing among and between all types of health data networks.

How does Carequality actually work?

Health information network and service platform operators – “Implementers” – agree contractually to abide by the terms of the Carequality Interoperability Framework, which includes flow-down terms for their customers and members who participate as “Carequality Connections”. This approach enables communication between and among networks, and is conceptually similar to how cell phones work today. If you use a cell phone on AT&T’s network, you can still call your friend who uses the Verizon Wireless network.

Who belongs to Carequality?

The Carequality community includes health information networks, electronic health record vendors, personal health record vendors, consumer groups, record locator service providers and other types of service providers. Carequality’s workgroups and committees are open to all.

Is Carequality a non-profit?

Yes, Carequality is a 501c3 non-profit with a public mission to enhance and operationalize health IT interoperability for the public good.

Does The Sequoia Project own Carequality?

Carequality was founded as an initiative of The Sequoia Project in 2014. The non-profit launched and fostered Carequality’s growth to ensure it was a self-sustaining organization. In 2018, Carequality became an independent, 501c3 organization with its own governance and board of directors.

What is shared on Carequality? // What data would I receive if I joined?

The Carequality Interoperability Framework can support a variety of different types of information. That said, the large majority of the information shared via Carequality today is in the form of C-CDA documents. Carequality also supports the submission of electronic initial case reports to public health agencies, and is working with early adopters to support exchange of DICOM images. Support for FHIR-based exchange is coming soon.

How does Carequality fit into the marketplace?

The healthcare information technology landscape is made up of many different technologies. Carequality strives to unite these technologies and power interoperability among them with a common set of rules of the road and technical standards. Carequality is not a network or a standards body. We work with the entire healthcare and healthcare IT communities to build consensus for real-world health information exchange regardless of technology or geography or network.

Is Carequality aligned with the Office of the National Coordinator for Health IT’s (ONC’s) Trusted Exchange Framework and Common Agreement (TEFCA)?

Carequality is a supporting partner of ONC’s Recognized Coordinating Entity (RCE), and in particular leading the development of the Qualified Health Information Network (QHIN) Technical Framework (QTF).

When was Carequality founded?

Carequality was founded in 2014 by healthcare information technology industry leaders with support of the broader healthcare community and federal government stakeholders.

Is Carequality a network?

No, Carequality is a contractual and operational framework that health information networks may choose to implement to empower their customers and members to share information with members of other networks.

2. Participating in Carequality

Can I join Carequality?

There are lots of ways to participate in Carequality’s work. Anyone may volunteer in the Carequality work groups and committees, to help with the development and maintenance of the Carequality Interoperability Framework. We have found that most who ask about joining Carequality, however, are seeking to participate in exchange activities via Carequality. HIEs, technology vendors, service providers, and others seeking to provide connectivity for their customers/members can reach out to us at, to learn more about becoming an Implementer and whether that role is a good fit for their organization.

How long does it take to become an Implementer?

The Carequality Interoperability Framework is designed to leverage existing IT infrastructure and lower legal costs by reducing the number of exchange partner contracts. How long it takes to onboard depends on your own IT priorities and technical abilities. Some traits that quicker Implementers have in common include: choosing to make onboarding a priority; leveraging a dedicated technical team in house; and familiarity with the technical standards used. Carequality has no timeline requirements for Implementer onboarding; you can take as long as you need, but conversely we will also support the efforts of those who wish to move as quickly as possible.

How long does it take for a provider organization to connect through an Implementer?

The details may vary significantly from Implementer to Implementer. Variables such as your current product version and supported modules may play a role in determining your timeline. More specific information, however, can only be obtained from the relevant Implementer.

As an implementer, how much does Carequality participation cost me?

Carequality’s Implementer fees depend on a number of factors including your organization’s size, as indicated by annual revenue, and the types of exchange in which you participate (e.g. document exchange vs. case reporting vs. FHIR-based exchange). Please contact us at to obtain the fee schedule information that applies to your expected participation type.

As a provider, how much does Carequality participation cost me?

Provider organizations, and any other non-Implementer participants, do not pay anything to Carequality. Your Implementer may charge you specifically for Carequality participation, or may include Carequality participation in a larger product/service bundle. Please contact your Implementer for specific pricing details.

3. Definitions

What is a Carequality Implementer?

A Carequality implementer is a health data sharing network or service platform that has adopted and implemented the Carequality Interoperability Framework, connecting its customers and members to those of other networks that also have implemented the framework.

What is a Carequality Connection?

A Carequality Connection is an organization that participates in exchange activities via Carequality through a Carequality Implementer. One example would be a health system that participates via its EHR vendor, who is an implementer.