National Initiatives

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Nationwide Health Information Sharing Initiatives

With the growing attention on interoperability and emergence of national “networks”, the HIE landscape has become somewhat confusing. Below are some comparisons of the major national exchange initiatives people ask about the most, along with a contrast with community or regional health information exchange.

eHealth Exchange



Care Everywhere




Community HIE

Provider-centric network

Patient-centric network


network-to-network trust framework

Provider-centric network 

Secure messaging network

Person-centric alerting network

Provider-centric network w/ person-centric tendencies

Person-centric network

Peer-to-peer primarily query-based exchange

Query-based exchange based on centralized record location

Peer-to-peer query-based exchange

Peer-to-peer primarily query-based exchange

Peer-to-peer, content-agnostic secure messaging

Directed alerting of care events that facilitate query-based exchange

Peer-to-peer transaction- and content-agnostic trust framework

Various use cases, including alerts, results delivery, order entry, query, public health reporting, longitudinal records, and analytics

Centralized CA, provider-organization directory

Centralized MPI and RLS Centralized 

provider-organization directory

Vender-based enabling infrastructure

Enabling trust framework

Regional and nationwide alerting network

Centralized provider-organization directory

Various levels of centralized resources necessary to meet participant needs

Federal agencies, hospital systems, HIEs

EHR vendors and networks

EHR vendors, networks, HIOs

Limited to Epic users

Direct HISPs and certificate authorities

Community, regional, and statewide HIEs

HIOs interested in statewide exchange, state agencies

Systems may include nearly any EHR, lab, pharmacy, or other HIT system

eHealth Exchange and Carequality are both initiatives of The Sequoia Project. Today, eHealth Exchange provides unique access among national initiatives to exchange with federal agencies.

CommonWell is an initiative of the CommonWell Health Alliance.

eHealth Exchange, CommonWell, Carequality, and Care Everywhere are primarily driven by a single use case: query-based retrieval of a summary medical record with data arriving as a CCDA document. With all but CommonWell, information is retrieved through a query directed to specific provider organization(s). Little information is delivered outside of queries on eHealth Exchange, and CommonWell and Carequality do not have the capability for anything but query-based exchange.

The PCDH (Patient Centered Data Home) is an initiative of the Strategic Health Information Exchange Collaborative (SHEIC). PCDH is based on triggering episode alerts which notify providers a care event has occurred outside of the patients’ “home” HIE and facilitates exchange of information.

The CTEN (the California Trusted Exchange Network) is an initiative of CAHIE, currently limited to stakeholders doing business in California. It is unique among these initiatives in that it is both transport and content agnostic. Today, CTEN also provides unique access to California state agencies.

Community HIE, by contrast, focuses primarily on addressing the priority use cases of the participating stakeholders through community collaboration and governance. Infrastructure is based on flexible technologies capable of supporting many technical standards and many information payloads, all through very robust patient matching and patient identity management. These organizations provide alerts, results delivery, e-prescribing and electronic order entry, query-based exchange, community-wide consolidated records, public health and quality reporting, population health analytics, and other services as required to meet the needs of participants.