A Network of Networks: The New Internet of Healthcare Data

Beth Plumptre
September 1, 2023

As healthcare’s redesign into a digitized, patient-centric system continues to take shape, advances in information technology (IT) are promoting the collaboration needed to achieve this goal.

Since 2013, organizations like CommonWell have connected electronic health records (EHRs) across hospitals, clinics, health information exchanges (HIEs), and other health systems to streamline data exchange for more efficient care delivery. As of 2019, more than 13,000 provider sites across the United States are connected to this Alliance. Complemented by networks like Carequality and eHealth Exchange, these frameworks adopt common data-sharing standards like HL7 FHIR, Continuity of Care Documents (CCD), and Consolidated Clinical Data Architecture (C-CDA), to co-operate and safely access information from their respective databases.

As individual organizations, each initiative serves as a network where member participants can access health information securely. However, joint efforts like the CommonWell-Carequality connection broaden information exchange, as providers and other players can access and retrieve data from a broader pool.

Metriport is helping to build the inevitable future of healthcare: a network of networks based on modern, internet-based architecture via an open-source and universal approach.

National Information Exchange Networks

The evolution of health data exchange has always reflected the needs of the times. When paper-based systems were replaced by EHRs, their initial use by research and large-scale institutions was democratized to accommodate hospitals, clinics, and other health-centered electronic storage of valuable health information.

HIEs became the next innovation to connect disparate EHR systems whose differences in IT technology, data standards, and other proprietary interfaces often complicated seamless data exchange between providers and health players. Following these developments, national frameworks further developed the data-exchange ecosystem by fine tuning the efforts of EHRs and HIEs when vendor specifications, geographic locations, plus data standards kept important patient information in silos.

These national frameworks include trusted names like:

CommonWell Health Alliance

CommonWell establishes a trusted framework where health data, which was typically confined to EHRs within hospital systems, becomes readily accessible for care-coordination. Hospitals only need to be participating members of the Alliance to retrieve and transfer patient records between facilities.

A health IT company focused on care-coordination can leverage CommonWell services to access and update electronic patient records between organizations. This trusted network is represented by more than 20 care settings spread across health care providers, government agencies, profit and non-profit organizations, digital health companies, and more.

CommonWell provides a consolidated record database, helping to promote nationwide interoperability.


The Carequality framework was a needed intervention for trust in health data exchange. Established in 2014, the landscape was more deeply fragmented, as custom interfaces, region-specific HIEs, plus data-sharing agreements slowed what could have been instant access to health information.

The Sequoia Project established Carequality as a trust framework. Through its library of technical and policy agreements, this network empowers CommonWell participants to collaborate with providers covered under other systems like Epic CareEverywhere and the eHealth Exchange.

By streamlining data sharing standards to formats like HL7 FHIR, and introducing expansionary policies like the 2022 Carequality Connected Agreement which permits data access to federal agencies — the framework continues to bring diverse groups together to promote health information networks.

eHealth Exchange

Operating in 75% of hospitals in the United States and connecting 61 state HIEs, the eHealth Exchange is considered the largest public healthcare program in the US.

This exchange provides the structure for data exchange between federal and non-federal agencies like HIEs and providers for national data exchange. Under the exchange, participants have a single set of APIs to connect to other members of the framework. These frameworks are laying the groundwork for a network-of-networks under the Trusted Exchange Framework and Common Agreement (TEFCA).

But while the Office of the National Coordinator (ONC) established TEFCA as a nationwide network linking members for widespread information exchange, there remains a way to go. The challenge is, health IT is a distance away from reaching the state necessary to achieve this goal, which is where organizations like Metriport come in.

The New Internet of Healthcare Data

Healthcare’s shift away from a fee-for-service to a patient-centered model means health organizations are more than ever incentivized by improved patient outcomes. This need forged the creation of networks that push the envelope for data sharing, but are many steps shy of achieving seamless, efficient data exchange. Providers, payers, HIEs, and other health players will need to adopt stricter standards for data to become readily accessible to diverse health and IT systems.

Application Programming Interfaces (API) like Metriport’s open-source API already function as a bridge between disparate systems, networks, and organizations. These interfaces are essentially a network-of-networks, pushing interoperability and the future of data exchange in healthcare.

Because APIs are largely vendor-agnostic, a provider can access a patient’s lab result from one laboratory EHR system, or their past admissions history from another using one API interface. APIs are also secure structures, playing a key role in managing the data breaches observed across health networks. In 2022, around 1.94 data breaches on 500 health records occurred per day.

Already pushing the fringes of healthcare innovation, APIs are in the forefront of advancements in care delivery. APIs foster innovation by permitting developers to integrate applications like a medication management app with a hospital EHR system to keep track of treatment adherence.


APIs hold unique attributes that ground them as a core piece of present-day interoperability, and the future of collaboration between healthcare systems. As a cost-effective means of introducing standardization into exchange systems, API protocols and data formats encourage compatibility between diverse health systems.

APIs are the link between information networks, bridging the gaps between CommonWell, Carequality, eHealth Exchange, and other data systems. As the foundation of easy interactions between these data systems, this unifying feature secures APIs as the future of health data communication.

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