What's the Difference Between the eHealth Exchange and Carequality?

The Sequoia Project team at HIMSS16 was 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 interoperability initiatives managed by The Sequoia Project. They complement each other in our pursuit of seamless and accurate health data sharing nationwide.
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.

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 health IT interoperability are complex and multifaceted, and so The Sequoia Project is home to several initiatives that are managed and staffed independently.

Let’s start with the eHealth Exchange, The Sequoia Project’s longest lasting interoperability initiative.

Sequoia assumed stewardship of the nationwide health information network exchange (or NwHIN Exchange) from ONC in 2012. The eHealth Exchange is a health data sharing network, and it happens to be the largest in the country. It connects participants across all 50 states and supports more than 100 million patients.

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. The eHealth Exchange is unique in that it has a federated architecture, which means the network does not have a central hub through which all data passes.

Rather, 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.

Now that you understand that the eHealth Exchange is a network, it’s much easier to differentiate Carequality. Carequality is not a network.

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 approach 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.

Carequality is a network-to-network trust framework 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 that 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?

Recognize many physicians today 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.

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

Health data sharing opportunities are dramatically expanded to include additional providers, payers, 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.

If you still have questions about the difference between the eHealth Exchange and Carequality, or if you want more information about either, please contact us at


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