Interoperability Initiatives Environmental Scan

This Environmental Scan was created to provide an image of the current landscape in which interoperable, nationwide health information exchange occurs. The following entities were included given their work to address interoperability needs via a variety of methods and collaborations. This Scan offers a wide range of details on each entity, including overview information, their method of exchange, and details on the stakeholders and processes involved. Please use the filters to review all information gathered for each entity. A full version of the scan is available for download, and further details on each entity is available by clicking on their organization link.

The information gathered from this scan was leveraged in the creation of the HIMSS Interoperability Call to Action, which provides principles to drive interoperability forward.

The Environmental Scan will be updated regularly as new interoperability approaches gain traction or new efforts evolve from these existing entities. If you have suggestions on updates, new organizations, or additional considerations, please email

View a list of Interoperability Environmental Scan Acronyms & Definitions.

Want to understand the full value of this resource? Review how to make the most of the Interoperability Initiatives Environmental Scan.

Use the scrollbar to view additional criteria. Select an organization to view the full description.
Organization Leadership Date Formed Ownership Governance Geographic Reach Website Mission Primary Goals/Objectives Type How does this approach facilitate exchange? Access Method (use cases) Number of live connections and/or participants Members Primary Participants Costs (Amount and/or Party Incurring Cost) Directory/MPI Details Standards Leveraged Onboarding Process (Requirements to connect) Data Persistance Certification Requirements for Participation Testing Future Plans Current Collaboration across Efforts
Care Everywhere Epic Community, led by Governing Council

2008 (source)


Governed by a peer-elected Governing Council and associated Rules of the Road agreements.


Expand the access to health data to create a more comprehensive health record and improve the speed of care.

• Be easy to use

• Use open and inclusive standards  

• Expand the amount of content and variety of... More

Provider-centric network

Care Everywhere is an HIE platform that is primarily a federated model that is controlled by the patient and can be used... More

Push and pull exchanges are embedded within Epic applications used by providers and consumers:

  ▪  Advanced record... More

100% of Epic’s U.S. customers using clinical applications, or over 1,700 hospitals and 34,000 clinics are live on Care... More

Not applicable

Patients, Hospitals, Clinics, CINs, ACOs, Payers, Pharmacies, and Retail Clinics

Care Everywhere is free to use for treatment and care coordination, regardless of the exchange partners technology platform... More

Care Everywhere facilitates automatic distribution of exchange-ready providers and healthcare organizations regardlesss of... More

Care Everywhere exchanges information using industry standard transport protocols. Query Approach: Transactions from the... More

Care Everywhere is natively integrated into the Epic EHR and does not require a separate implementation process.  

... More

Federated Model: There is no centralized hub or data storage. No data flows through Epic servers involved in the exchange... More

There are no certification requirements.

Standard connectivity testing is conducted during the initial implementation. New sites are connected with no additional... More

Extend the content of documents exchanged to match the needs of specialists. Each provider should find information relevant... More

Care Everywhere is an implementer of the Carequality Framework. (... More

Carequality Dave Cassel, VP of Carequality


Non-profit, public-private collaborative that is independently governed but supported by The Sequoia Project, a 501c3.

Governed by Carequality Steering Committee, with Carequality Connected Agreement as legal framework


Carequality has brought together the entire healthcare industry to facilitate consensus and develop a national-level, trust... More

Allow diverse data types to move freely to where and when it is needed, regardless of technology or geography, by... More

Network-to-network trust framework to support use cases

Carequality provides a trust framework that can be leveraged by existing networks (HIE, Vendor, Payer, PHR, etc.) and... More

Initial use case: Peer-to-peer query-based document exchange

Other use cases: Data element access via HL7 FHIR, and a... More

More than 260,000 physicians are enabled to share across 23,000+ clinics and ~900 hospitals.

(As of July 2017)... More

Carequality is an open, transparent and inclusive framework that does not require membership to participate in its... More

Implementers are health data-sharing networks and service providers. Healthcare providers and physicians generally wouldn’t... More

Implementer fees are dependent on an organization's annual revenue.

Organizations participating in exchange through... More

Centralized healthcare directory that currently provides organization-level information on technical end-points for... More

Carequality’s governance framework, at a general level, is independent of any particular architecture, technology, or... More

Health data sharing networks (e.g. national networks, vendor networks, HIEs, PHRs, payers) and service providers (e.g.... More

Federated Model: The Carequality Framework supports exchange between unaffiliated data sharing networks and services. No... More

See “Onboarding Process (requirements to connect)” above, and “Testing” below.

For the Query-Based Document Exchange Use Case, candidate Implementers are expected to conduct peer-to-peer testing with... More

Carequality has stated a goal of enabling health data exchange among 80% of the nation's hospitals and more than 70% of the... More

Ongoing pilot program will give eHealth Exchange participants access to Carequality.
CommonWell Health Alliance have... More

CARIN Alliance Conveners: Mike Leavitt, Aneesh Chopra, David Blumenthal, David Brailer Management Team: Leavitt Partners


Public/Private Partnership

Governed by leadership and Board.


CARIN’s vision is to rapidly advance the ability for consumers and their... More

In 2017, CARIN focused on overcoming barriers to consumer-directed exchange in four areas: 

1) Develop a trust... More

Consumer Directed Network

The CARIN Alliance allows for the consumer or their authorized caregiver to electronically request access to their health... More

Consumer-controlled third-party applications or third-party data stores

49 published FHIR endpoints (as of October 2018)

Providers, Payers, Vendors, Patient Groups, Hospital Systems, Health IT companies, EHR vendors, Purchasers, etc.

Healthcare organizations, EHR companies,  Application Developers, Consumers and Caregivers

The CARIN Alliance is a coalition of the willing based on meaningful contributions from each participating organization.

The CARIN Alliance is working with standards development organizations (SDOs) to develop a process for remotely ID proofing... More

Multiple: Argonaut DSTU2, Open ID Connect / Oauth 2.0, SMART on FHIR®, and others.

This process is currently in development.

Federated Model: The CARIN trust framework supports exchange between covered entities and non-covered entities including... More



CARIN as an alliance will only continue to exist if there is continued interest from its board members and there are... More

Surescripts and a number of Community HIEs serve as an Alliance Members of CARIN (... More

CommonWell Health Alliance Jitin Asnaani, Executive Director


Not-for-profit trade association funded by members

Governed by Board of Directors with an Independent General Counsel

Publicly available... More


CommonWell Health Alliance is devoted to the simple vision that health data should be available to individuals and... More

Execute a vendor-neutral platform that breaks down the technological and process barriers that currently inhibit effective... More

Network to network

CommonWell enables exchange across vendors through the implementation of its services with participating vendors, which... More

Federated query-based exchange based on centralized record location and patient ID management

 More than 13,000 provider sites live in all 50 states, D.C. and... More

80 members, who represent more than 20 care settings, more than 15 public and proprietary networks, and market leaders and... More

Mainly acute and ambulatory care settings
- Health Information Technology (Health IT) suppliers and digital Health... More

Cost of Services to the Provider/End User: Each member determines the cost for deploying to its providers/end users... More

CommonWell does not maintain a central copy of clinical records. Data remain within the provider HIT system where it was... More

Leverages existing standards that members use to enable scalable, secure and reliable interoperability.

CommonWell... More

See Certification Requirements for Participation. 

Federated Model: The data remains within the provider health IT system where it was collected. CommonWell services will... More

The CommonWell Service Provider onboards Member products onto the network prior to deploying. The onboarding process... More

Testing is one step in the process of being onboarded onto the network.  

Highly scalable network: no point-to-point... More

Extend services across new settings of care and providers via new and current members.
Build new application... More

CommonWell Health Alliance have established a connection with the Carequality framework, allowing CommonWell members the... More

Community HIE N/A (Varies by entity)

Varies (KeyHIE is one of the oldest and was founded in 2005)

Varied. Several HIEs are run/managed/funded by the state; others are non-profit organizations in the private sector; a few... More

Governed by Participant Agreements, usually in turn governed by a Board of stakeholders. In some cases governed by State or... More


Varies by HIE.  Mission statement dependent on structure of organization and needs of member organizations.

Dependent on the original focus/objectives of the HIE and the community/region they serve.  These may include but are not... More


Community-based HIE organizations serve states or specific regions to provide services to enable the sharing of information... More

Various use cases include: ADT alerts, results delivery, electronic order delivery, order entry, query, public health... More

Varies, depending upon the capabilities of the HIE.  While some HIEs place focus on a particular type of member (hospital,... More

Members may range from providers, provider organizations, post-acute care organizations, private labs and other ancillary... More

Systems may include nearly any EHR, lab, pharmacy, or other HIT system, payer systems

Varies greatly depending on funding mechanisms, grant funding, capabilities of the HIE and size of HIE staff.

Various levels of centralized resources necessary to meet participant needs though most maintain a master-patient index... More

Varied use of IHE standards, HL7 standards, C-CDA standards, and/or a combination of these and other standards.

Varies, depending upon the capabilities of the HIE and the needs of the members/customers.

Varies, depending upon the capabilities of the HIE. Some are based upon query/retrieve models, while others persist data in... More

Depending upon the services provided by the HIE, many have received certification for portion of their solutions in order... More

Generally, standard test scripts based upon transaction type and required minimum content.

Varies by HIE
Growing focus on providing data cubes for analytics, expanding available clinical and claims data along... More

Numerous community HIEs are DirectTrust members, with some even serving as accredited HISPs for the implementation of... More

DirectTrust Scott Stuewe, President and CEO


Not-for-Profit Trade association (501c6)

Governed by a Board of Directors, which is elected by the members at large. Two advisory committees operate beneath the... More


The mission of DirectTrust is to support health information exchange that is secure, interoperable, affordable, ubiquitous... More

Establish and maintain a national, transparent Security and Trust Framework upon which trust relationships for exchange... More

Secure messaging network

DirectTrust develops and maintains the policies, standards, and practices that support the trusted and effective use of... More

Direct Secure Messaging (Push messaging)
Transitions of Care
Release of information

According to end of first quarter 2019 metrics:

  • DirectTrust organizations served: 167,000 health care... More

Members include the 41 accredited operators of the DirectTrust network, including:

  • Health Information Service... More

A number of participants from the health IT ecosystem have the opportunity to obtain a Direct address, including but not... More

DirectTrust does not have control over pricing nor access to member information on what they charge for Direct secure... More

The DirectTrust Provider Directory Data Aggregation Service encourages the sharing of Direct Address information among... More

The Direct Standard™

X.509 public key infrastructure (PKI) standard

Provision of a Direct address requires involvement of a Registration Authority (RA) to conduct identify proofing of the end... More

Federated Model: Direct Trust does not store any data exchanged in Direct transactions. Receiving end-point systems may... More

All participating HISPs, CAs, RAs must complete an accreditation process to participate. End users with Direct accounts do... More

Testing is required to be accepted into a Trust Bundle, and must be conducted with at least 10 other entities. Ongoing... More

Plans include extending use cases leveraging current capabilities to create new value and leveraging the trust framework to... More

In 2019, DirectTrust and CommonWell created a reciprocal membership relationship. DirectTrust leadership and members... More

eHealth Exchange Jennifer Rosas, Director

2006 (Sequoia Project assumed support in 2012)

Non-profit, public-private collaborative

Governed by the DURSA (Data Use and Reciprocal Support Agreement), in turn managed by committee of participants, known as... More


The eHealth Exchange is a group of federal agencies and non-federal organizations that came together under a common mission... More

Enables de-centralized, federated exchange between signees of the DURSA, through a common legal agreement, shared... More

Provider-centric network

eHealth Exchange provides a legal framework and support services including comprehensive testing, security validation,... More

Supports push, query/response, publish/subscribe, directory services, security services, and any other transaction/standard... More

Participants include four federal agencies (DoD, VA, HHS including CMS, and SSA), 65% of U.S. hospitals, 50,000 medical... More

Participants represent a diverse group and include: federal agencies... More

Participants make up eHealth Exchange membership. See above “Members” for participants.

Participant fees: Based on annual revenue of organization. Government agencies and non-profits have fees based on annual... More

Centralized healthcare directory that currently provides organization-level information on technical end-points for... More

Query/Exchange: Web Services Registry Web Service Interface Specification v 3.1; Messaging Platform v3.0;... More

Key Eligibility Criteria:  
 • Be an organization or agency that oversees and conducts, on its own behalf and/or on... More

Federated Model: The network does not have a central hub through which all data passes. Rather, participants are able to... More

Participation requires an onboarding process, which includes testing and validation activities. Operational monitoring and... More

Participant Testing: Designed for applicants seeking to onboard to the eHealth Exchange or for existing participants... More

The eHealth Exchange continues to expand use cases and services to meet the needs of its members and the market, as well as... More

Ongoing pilot program will give eHealth Exchange participants access to Carequality.

There are nearly a dozen data... More

National Association for Trusted Exchange (NATE) Aaron Seib, CEO


Not-for-profit association of organizations, Governed by a Board of Directors

Non-for-profit association of organizations, Governed by a Board of Directors


The National Association for Trusted Exchange (NATE) is a not-for-profit membership association focused on facilitating... More

Participate in ongoing and emerging project in consumer centered data sharing of health information consistent with their... More

Person-centric network

NATE leads and participates in a number of ongoing and emerging projects focused on exchange via multiple modes of... More

Consumer-Mediated Exchange, Consumer-Directed Exchange

10 active vendor participants in the NBB4C

Members are classified into one of the following types:... More

States, U.S. Department of Veterans Affairs, various consumer controlled apps, health IT and health information exchange... More

Membership fees range from $125 for an individual membership to $500 for small associations and startups, up to $10,000 for... More

A directory of organizations participating in the various NATE... More

Blue Button, FHIR®, Direct, various common APIs

Submit an onboarding application and work with NATE. 

The flagship NATE Blue Button for Consumers (NBB4C) Trust... More

Focus on exchange and data liquidity (mobilizing data to consumers).  Some NBB4C apps store consumer data, others do not.... More

NBB4C Participants must attest to the completion of specific testing requirements as... More

To accommodate rapid growth in trust bundle participation, NATE designed and developed a new trust bundle administration... More

NATE Blue Button for Consumers (NBB4C) Trust Bundle version 2.0

NATE Blue Button Directory (NBBD)

NATE Trust... More

NATE and CommonWell Health Alliance are both members of their respective organizations with goals of collaboration to... More

SHIEC Patient Centered Data Home™ (PCDH) Kelly Hoover Thompson, CEO

2015 (PCDH concept); 2014 (SHIEC)


Allows for the independent community HIEs in the Strategic Health Information Exchange Collaborative (SHIEC) to maintain... More


The Strategic Health Information Exchange Collaborative (SHIEC) is a nonprofit national consortium of statewide, regional... More

Improving care coordination and care management across disparate health care systems and the health care... More

Patient-centric network

PCDH enables the exchange of patient information across HIE organizations. Patients are assigned a "home HIE" based on zip... More

Peer-to-peer push and/or query-based exchange triggered by automated notification of care event

PCDH currently has 26 HIEs connected in regional settings; however the member HIEs represent many data source connections... More

SHIEC member HIE entities/organizations

As of October 2018, 26 HIEs from the Western, Central, Midwest and Heartland regions of the US. 

SHIEC Membership for HIE organizations and Associate Members are $6,000 for a one-year membership and $11,000 for a two-... More

PCDH does not maintain a central record locator service, the member HIEs transmit clinical based upon the zip codes that... More

Technical Standards: ADT Push, CCD Push, CCD Query (XCA)

Zip Code Surveillance standards: Synchronized MPI’s ... More

PCDH is an initiative solely with SHIEC members, and is currently structured as regional efforts (three to-date) where... More

 All clinical data becomes part of the comprehensive longitudinal patient record in the patients’ data home, which is the... More

SHIEC has a set of specifications that participants must use to exchange data over the network.  With approval of the PCDH... More

Interested HIEs must complete the necessary testing before going live within PCDH.

Continue to service the local/regional/state communities in support of the current and changing healthcare landscape

Community/Regional HIEs make up SHIEC membership and PCDH Regions. (... More

Surescripts Tom Skelton, CEO


Privately owned by the National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA... More

Record Locator & Exchange (formerly National Record Locator Service): Governed by the Carequality Connected Agreement... More


Surescripts’s purpose is to serve the nation with the single most trusted and capable health information network, built to... More

Establish the most comprehensive access and exchange of patient information at a national scale.

Give providers and... More

Record Locator Service & query based exchange; Direct messaging; ADT notifications

Through the Surescripts Network Alliance and these solutions that support interoperability, Surescripts allows healthcare... More

Peer-to-peer query-based exchange

Admit, Discharge, Transfer (ADT) notifications for patients

Transitions of... More

Record Locator & Exchange provides clinical history and patient record information for 233 million patients (71% of the... More

Participants are EHR/EMR vendors and their health system customers who are part of the Surescripts Network Alliance, as... More

Providers, care managers, pharmacists, and other healthcare professionals involved in care delivery are the primary... More

Record Locator & Exchange: Beginning in 2019, health systems will incur a nominal fee based on the size of their... More

Provider directory & Master Patient Index (MPI) populated by Surescripts Network Alliance members, representing 233... More

Record Locator & Exchange: Industry standard IHE profiles for XCA and XCPD as well as FHIR® document and patient... More

These solutions integrate directly into Electronic Health Record/Electronic Medical Record software. The customer receives... More

Hybrid Model: Surescripts stores basic demographic information, provided by healthcare providers, for purposes of patient... More

Record Locator & Exchange: There is no certification process. Customers will perform message validation.

Clinical... More

Customers will pass message validation prior to transitioning to production.

Surescripts message validation focuses... More

Innovations in 2018 bring proactive patient notifications to providers and care managers in Record Locator & Exchange... More

Surescripts is accredited by and a member of DirectTrust. DirectTrust accredited organizations can exchange clinical... More