Question

The 3HS executive vice president just stopped you in the hallway, saying she just read a piece in a listserve e-mail from HIMSS about the Sequoia project, the new advocate for nationwide health information exchange. Knowing your expertise in things HIT, the EVP has asked you for a quick update on the Sequoia Project. What do they do; and what is the relationship to eHealth Exchange, formerly known as the Nationwide Health Information Network by ONC?

Answer 1

Sequoia assumed stewardship of the nationwide health information network exchange (or NwHIN Exchange) from ONC in 2012. The eHealth Exchange is a public-private, health information network, and it happens to be the largest of its kind in the country. While an initiative incubated by The Sequoia Project, the network more than quadrupled in size to connect participants across all 50 states and support more than 120 million patients. Recognizing the maturity and sustainability of the network, the eHealth Exchange became independent of The Sequoia Project in 2018.

There are nearly a dozen data sharing use cases supported by the eHealth Exchange to date, but one of the most unique and popular is connecting the private sector providers and state and regional HIEs to federal agencies. The eHealth Exchange is unique in that it has a federated architecture, which means the network does not have a central hub through which all data passes. Rather, participants are able to securely connect and share data over the Internet in a standardized and seamless manner.

In addition to providing the ability to connect members to each other, the eHealth Exchange network does provide some shared services, including a rigorous testing program to ensure connectivity and interoperability.

Based on the history of the health IT market, The Sequoia Project agreed with the rest of the industry that there will not be a single national network that meets the needs of the entire industry. That created a challenge: If there will not be one national network, how will providers who connect through different networks be able to share data with each other?

The Sequoia Project partnered with health IT leaders in the public and private sectors to create the answer: Carequality.

Why is this important? Consider that today, many physicians already have access to a network through a technology vendor or a health data sharing network. However, physicians are often restricted to share data only with other providers in their same network. This is the equivalent of having a cell phone plan that only allowed you to call other customers of your carrier. That’s the situation for most healthcare providers today when they join a data sharing network.

The physician cannot join Carequality directly (remember, Carequality isn’t a network), but when their existing network adopts and implements the Carequality Interoperability Framework, the physician will be able to share healthcare data with other providers who connect through entirely different networks, without additional special effort.

Health data sharing opportunities are dramatically expanded to include additional providers, payers, and other care settings, and others as the Carequality community grows. This in turn helps patients receive better care, increases healthcare efficiency and decreases healthcare costs.

In response to the success of Carequality initiative, it was re-launched as an independent non-profit in 2018.