Overview
Carequality is a nationwide health-information-exchange framework operated by The Sequoia Project that enables cross-organization data exchange between participants including EHR vendors, health systems, health information exchanges, payers, and other healthcare stakeholders. Members include Epic (via EpicCare Link and its Carequality endpoint), Oracle Health (Cerner), athenahealth, eClinicalWorks, NextGen, and many other major EHRs; CommonWell is also a Carequality participant, creating a bridged network effect.
The Carequality Connected framework is a trust architecture and technical specification set rather than a centralized exchange infrastructure. Participants operate their own endpoints conforming to Carequality specifications (primarily IHE profiles XCA for query and XCPD for patient discovery). When a clinician at Hospital A needs records on a patient whose prior care was at Hospital B, the Hospital A EHR queries Carequality's distributed query network, which locates Hospital B's endpoint and retrieves the patient's C-CDA documents. The transaction completes typically within seconds to minutes.
The network effect is substantial. Through Carequality and its CommonWell partnership, a clinician at any participating hospital can query and retrieve records from essentially every major US EHR vendor. This is transformative compared to the pre-Carequality era when cross-vendor data exchange required bespoke integrations or state HIE intermediaries.
Use cases include clinician record query at point of care (the most common), care transition support (inbound records for newly discharged patients), payer-to-payer data transfer (commonly under CMS-0057-F), quality-measure abstraction, and public-health reporting. The document payloads are typically C-CDA though FHIR-based exchanges are an emerging addition to Carequality specifications.
Carequality's governance includes the Connected Agreement that all participants sign, specifying permitted use cases, patient-matching requirements, data-use restrictions, and audit requirements. Participants must meet operational and technical standards to remain in good standing. The Sequoia Project operates the directory and provides governance oversight.
The interplay with TEFCA is evolving. TEFCA (Trusted Exchange Framework and Common Agreement) is the federal nationwide-exchange framework activated in 2023; Carequality and CommonWell have both signed on as Qualified Health Information Networks (QHINs) within TEFCA, integrating their existing networks into the federal framework. TEFCA's long-term vision is to federate Carequality, CommonWell, and other QHINs into a single interoperable national exchange; operational maturity is advancing.
For RCM and clinical operations, Carequality participation is standard for major healthcare organizations. The infrastructure enables care-coordination and referral workflows that would otherwise require manual record requests and fax-based exchange.
Carequality is one of the compliance areas where documentation discipline determines audit outcomes more than policy sophistication. Practices that invest in clean Carequality records, consistent commonwell workflows, and auditable tefca evidence come out of OIG, RAC, and MAC audits with materially smaller recoupment exposure than practices with equivalent policies but weaker paper trails.
Industry benchmark
Carequality participants: 400+ directly connected organizations including all major EHR vendors; indirect reach via CommonWell and other federated networks covers effectively all certified EHRs. Monthly transaction volume: hundreds of millions.
Worked example
A patient presents to an emergency department in a new state. The ED clinician queries Carequality for the patient's records and receives C-CDAs from three prior hospitals across the patient's history — records that would previously have required hours of manual fax requests and follow-up.
Frequently asked questions — Carequality
Is Carequality the same as TEFCA?
No. Carequality is a private-sector interoperability framework that predates TEFCA. TEFCA is the federal nationwide-exchange framework; Carequality operates as a Qualified Health Information Network (QHIN) within TEFCA.
How does Carequality differ from CommonWell?
CommonWell is an EHR-vendor-sponsored exchange network; Carequality is a broader framework including CommonWell as a participant along with many other networks. The two are partnered, so membership in either provides effective reach across both.
What transactions flow through Carequality?
Cross-organization document queries (primarily C-CDA), patient discovery queries, and increasingly FHIR-based exchanges. Payer-to-payer data transfers and public-health exchanges also use Carequality infrastructure.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.