Carequality Interoperability Framework
Principles of Trust is the policy foundation for connecting health data sharing networks throughout the U.S. The Carequality Interoperability Framework is a collection of documents that are used to operationalize data sharing and includes:
Legal and Governance Documents
Carequality Connected Agreement
(Effective 08/01/2022)
This document contains the standard legal terms agreed by all implementers of the Carequality Framework. It provides the foundation for trusted exchange among implementers, by establishing the “rules of the road” and defining an implementer’s rights and obligations. (Note – the document linked here is the CCA itself, without any exhibits or schedules. Prospective implementers should contact Carequality at admin@carequality.org to obtain a complete legal package for execution.)
Carequality Connection (CC) Terms
(Effective 08/01/2022)
This document contains the standard terms that implementers are required to make legally binding on their members, customers, or participants who engage in exchange activities through the Carequality Framework and are listed in the Carequality Directory.
Dispute Resolution Process
This document outlines the steps involved in addressing any formal disputes that may arise between implementers, or between implementers and Carequality.
Technical Trust Policy
(Effective 07/31/2023)
This document outlines requirements that constitute technically enforceable evidence that the organization has met the associated criteria for being a Carequality Participating System, to ensure technical trust among any system that hosts an end point listed in the Carequality Directory, or directly originates a request to such an end point. Individual use case Implementation Guides may specify different requirements from those outlined in this policy and in such a case the Implementation Guide will take precedence.
Carequality Framework Policies
(Effective 05/12/2025)
The purpose of this document is to establish overarching policies that exist within the Carequality Framework, but outside of specific Use Case Implementation Guides, the Carequality Connected Agreement (CCA), or other Carequality Elements. The policy requirements in this document apply broadly across the entire Carequality Framework. More specific policies defined for an individual Use Case take precedent over the general policies contained in this document to the extent it is not possible to comply with both.
Concise Consolidated CDA: Deploying Encounter Summary and Patient Summary Documents with Clinical Notes
This document contains the consolidated work of the Carequality and CommonWell Joint Document Content Workgroup. Version 2.0, now called “Concise Consolidated CDA: Deploying Encounter Summary and Patient Summary Documents with Clinical Notes”, includes guidance on new topics. While we suggest that you review the whole document, highlights of this update include further refinements to the content recommendations featured in version 1.0, guidance for laboratory orders and results, and the dynamic generation of documents (aka On Demand). Please note that while this document reflects best practices, it is not binding to the Carequality Implementer community at this time.
Issue Resolution Process
This document outlines the steps involved in addressing any Issue that an Implementers may bring forward relating to its own processes or Connections.
Implementation Guides
Use Case Implementation Guides:
Implementation Guides provide both technical specifications and requirements, as well as additional business and policy requirements, for a particular Carequality Use Case.
Query-Based Document Exchange Implementation Guide
(Updated 2021) (PDF)
The initial Carequality Use Case is Query-Based Document Exchange.
Imaging Data Exchange Supplemental Implementation Guide
(Updated 2019) (PDF)
This IG is an extension of the QBDE IG for Imaging Data Exchange purposes only. It is not its own Carequality element.
Electronic Case Reporting (eCR) Implementation Guide
(Updated 2020) (PDF)
The second Carequality Use Case is Electronic Case Reporting.
FHIR-Based Exchange Implementation Guide
(Updated 2020) (PDF)
The third Carequality Use Case is FHIR-Based Exchange
Push Notifications Use Case
(Updated August 2022)
Carequality’s Push Notification’s Use Case allows a patient’s care providers to subscribe to their specific patient at an infinite number of locations where that patient has an existing record. This IG is available for current and future Implementers as a standalone Use Case, or in conjunction with any of our other Use Cases.
Directory Implementation Guides:
FHIR R4-Directory IG
(Updated July 2023)
Draft IG 1.6.2
(Updated June 2025)