Carequality Celebrates 10-Year Anniversary a Trusted Exchange Framework

Alan Swenson, Carequality executive director.
Carequality Executive Director, Alan Swenson


Nearly 800 Million Documents Exchanged Monthly

Carequality, the national-level, common interoperability trusted exchange framework to enable health information exchange between and among health information networks, celebrates 10 years since it was launched as an initiative under The Sequoia Project, a nonprofit trusted advocate for nationwide health information exchange. It is five years since Carequality became an independent nonprofit organization. Today, Carequality supports the exchange of more than 745,000,000 documents monthly across disparate technologies, geographies, and networks.

“Whether it’s a kid’s school sports physical or a patient’s complicated disease treatment requiring a team of doctors, every document exchanged represents a patient,” said Alan Swenson, Carequality executive director. “Carequality is aggressively expanding access to the clinical information when and where it is needed because lives depend on it.”

Carequality was founded in 2014, and one year later, the Carequality Interoperability Framework was published and adopted by 13 founding organizations. The Carequality Interoperability Framework consists of multiple elements, such as legal terms, policy requirements, governance, and more, which operationalize data sharing among health information exchange networks, vendors, payers, and others across the healthcare ecosystem.

By July 1, 2016, the first exchange of clinical documents for treatment purposes leveraging the framework occurred between a health system using the Epic electronical heath record (EHR) system and a clinic using the athenahealth EHR. It was a first-of-its-kind exchange.

Today, Carequality is enabling care coordination down the street and across the country with the nation’s most robust, widely adopted interoperability framework. The dynamic framework has evolved with the needs of the healthcare community, from adding HL7® FHIR® and public health support to expanding the use cases and exchange purposes.

Carequality plays a pivotal role in supporting the Office of the National Coordinator for Health Information Technology’s (ONC’s) new Trusted Exchange Framework and Common AgreementSM (TEFCASM). The Sequoia Project, in its role of Recognized Coordinating Entity® (RCETM), collaborates closely with Carequality to leverage its real-world experience in developing and operationalizing a nationwide, industry-led trusted exchange framework.

“Our 10 years of growth is testament to the support and trust of our implementer community and the dedication of our Carequality team,” said Swenson. “We look forward to continuing to be a pioneering force in the health IT industry, aiming to advance interoperability nationwide not only for the Carequality community, but as we support TEFCA.”

Alongside this milestone, Carequality is celebrating more than five years of being an independent nonprofit organization. At the time Carequality separated from The Sequoia Project, more than 59 million documents had been exchanged. It has rapidly grown since as more and more physicians use the expanding connectivity, and more than 6 billion documents have been exchanged in just 2023.

Carequality’s mission to connect health data sharing networks and communities under the common trust framework relies on participation from subject matter experts from across the industry. To learn more about Carequality and to get involved, visit