What is Carequality?

Beth Plumptre
August 3, 2023

Modern care delivery relies on connections between electronic health record vendors, record locator service providers, health information networks, and other data-sharing structures to provide patient-centered care. These links are especially important in an increasingly digitized landscape, where 96% of hospitals have transitioned from paper to electronic health record systems.

Enter the Carequality interoperability framework — which operates as a master connector, closing the gap between these information systems for seamless record exchange. Carequality bypasses the common geographical, IT, and other barriers that have historically stood in the way of data sharing, making real-time access to patient information a regular feature of care settings. 

Every month, this network supports the transfer of 350,000,000 health documents across the United States. This guide will explore the framework’s impact, and how its policies have developed a consensus, trust-based system to enable interoperable exchange.

What is Carequality? 

Carequality is a Sequoia Project Initiative, whose focus is to create a framework that supports nationwide health information exchange. Prior to this framework, healthcare organizations looking to access patient information did so through largely inefficient measures like fax and mail, or point-to-point connections, where health players had to establish direct communication links with every care organization it planned to exchange data with. And while Health Information Exchanges (HIE) improved value-based care, these systems often operated in silos, with individual protocols and exchange standards limiting easy data exchange between health systems

Carequality simplifies the data sharing process by ensuring health data is safely and readily accessible, without the hassle of first joining multiple information networks. This intervention in health data exchange is similar to a system where phone users can only reach contacts on the same carrier, requiring that they join several carriers to interact with multiple interests. Carequality's role is like a broad carrier, single-handedly permitting connections, regardless of the service provider used. 

Implementers of Carequality — such as Metriport — agree to be bound contractually to the terms of the framework, which by extension flows down to customers and members who will participate in Carequality as “Carequality Connections”. By providing the tools for seamless data exchange, Carequality implementers ensure that providers and other stakeholders can share patient information easily for coordinated care.

How Does Carequality Work?

To understand how Carequality works, let’s take a quick look at what this sharing structure is, and is not:

Carequality is a network-to-network framework, meaning it facilitates data exchange between different health information networks — such as HIEs and EHR vendors — using similar technical and policy agreements. This arrangement standardizes data sharing, reducing roadblocks for easy accessing health records. 

Carequality is not, however, a separate information network that clinicians, laboratories, pharmacies, or other stakeholders can join. Instead, it is a framework that sets rules of collaboration for implementers from different networks. 

For instance, a provider curious about his diabetic patient's status can easily query a lab's EHR system for test results on blood glucose levels using this framework. But before reaching this level of interoperability, both organizations must have completed a few requirements, with provider and laboratory first adopting APIs compatible with the Carequality framework. After registering with the framework as participants, this provider would then initiate a query to the local health information exchange housing the laboratory's health records. The HIE queries the organization, which processes the request before retrieving the information from its Electronic Health Records (EHRs). This information is returned to the HIE which updates the provider's EHR system with it. 

What are the Elements of Carequality?

Carequality is a major player in interoperable operations across healthcare. This framework not only supports the secure exchange of clinical documents, but ensures this information can be transferred in different forms. For instance, while C-CDA documents are the most widely exchanged format under this structure, in 2019, Carequality took its services a step further by providing for the exchange of medical images (DICOM), shortly after adopting FHIR standards to simplify change a little after in 2020.

As a unifier across different healthcare settings, Carequality continues to push the envelope of interoperability, updating its data structures to reflect the growing needs of care delivery. The question is how this network manages to achieve this.

There are three core elements that make up the Carequality operating system. These are:

Common rules of the road

Under Carequality, implementers have to play by the same rules to promote the safe and trusted exchange of patient information. Carequality has legal and governance documents, removing the need for participants to enter into individual agreements with each other, instead limiting their interactions to the nationwide framework.

For example, while an information exchange network may be bound to comply with HIPAA, a Social Security Administration (SSA), which is not a covered entity or business associate under HIPAA, will be subject to Federal Information Security Management Act (FISMA) as a Carequality implementer. All implementers will also observe the mandatory aspects of a Carequality implementation guide to promote standardization in data exchange.

Well-defined technical specifications

All implementers will also observe the mandatory aspects of a Carequality implementation guide to promote standardization in data exchange. Carequality implementers can also follow local rules that do not stand in the way of interoperability, and are limited to using Carequality services for the greater, permitted good.

Participant Directory

To properly implement the framework's standards, health organizations first need to know how to find the players they are looking to exchange information with. The patient directory contains the addresses, names, and the types of information each participant in the network is capable of sharing. The directory acts as a database, listing every health information exchange, healthcare provider, and other player involved within the network.


The Carequality framework is constantly evolving to support the trusted exchange of health information. In 2021, the eHealth Exchange — the primary way federal agencies access health information — became a Carequality implementor, permitting participation by government agencies.

A few years earlier in 2018, the Carequality framework welcomed CommonWell, a nationwide data-sharing network as an implementer, also significantly widening the net for data exchange.

Through the Carequality framework, participants benefit from a more efficient, yet less expensive healthcare-data sharing system. As the framework continues to leverage existing information networks to encourage the best interoperable practices, healthcare’s progression into an interconnected network continues to come close in view.

Are you a provider looking to gain access to Carequality? Be sure to check out Metriport's Medical API, which supports Carequality, enabling healthcare companies to access valuable health information for their patients.

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