EHealth Exchange

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The eHealth Exchange, formerly known as the Nationwide Health Information Network (NHIN or NwHIN), is an initiative for the exchange of healthcare information. It was developed under the auspices of the U.S. Office of the National Coordinator for Health Information Technology (ONC),^[1] and now managed by a non-profit industry coalition called Sequoia Project (formerly HealtheWay).^[2] The exchange is a web-services based series of specifications designed to securely exchange healthcare related data. The NwHIN is related to the Direct Project which uses a secure email-based approach. One of the latest goals is to increase the amount of onboarding information about the NwHIN to prospective vendors of health care systems.{{citation needed|date=August 2012}

A health care system participating in the NwHIN acquires an Object identifier (OID). The OID, issued by the ONC, allows the individual health care system or vendor to receive and send messages to trusted entities within the NwHIN through an interface such as Mirth Connect or a custom-built Java UI.{{citation needed|date=August 2012} e software|open source]] code utilizing the Java platform.^{[citation needed]} This creates a need for technical mers]] with the ONC also making information available.^{[citation needed]} According to former Health and Human Services Secretary Michael Leavitt the NwHIN would be a public-private venture, and as of 2009^[update] the Markle Foundation, Robert Wood Johnson Foundation and California HealthCare Foundation were funding research and demonstration projects.^[3]

The NwHIN is funded through the Office of the National Coordinator for Health Information Technology, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Centers of Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Indian Health Service.^[4]

The stakeholders that participate in the NwHIN will be four broad classes of organizations:

• Care delivery organizations (CDOs) that use electronic health records (EHRs).
• Consumer organizations that operate personal health records (PHRs) and other consumer applications.
• Health information exchanges (HIEs): multi-stakeholder entities that enable the movement of health-related data within state, regional or non-jurisdictional participant groups.
• Specialized participants: organizations that operate for specific purposes including, but not limited to, secondary users of data such as public health, research and quality assessment. The specialized nature of these organizations means that they may require only a subset of the shared architecture (standards, services and requirements), processes and procedures used by the other participants.^[5]: 9

Some organizations may lack the necessary technical or operational competencies to conform to the architecture and provide the core services. Instead, they may choose to use the services of a Health Information Service Provider (HISP). A Health Information Service Provider is a company or other organization that will support one or more NwHIN participants by providing them with operational and technical health exchange services necessary to fully qualify to connect to the NwHIN.^[6]

The business, trust and technical arrangements that will enable the NwHIN generally will be local and between organizations. Nonetheless, the primary users of the NwHIN will be people: healthcare providers, healthcare consumers and those who use the data in the NwHIN for public health, quality assessment or other purposes. These people will have several ways to take advantage of the information exchange available through the NwHIN.

Access Paths to the System:^[6]

• For healthcare providers:

1. Providers may use features of the electronic health record (EHR) systems of their own practice or hospital to connect to an HIE, and the HIE, in turn, will support information exchange with other EHRs or PHRs on that HIE or on other HIEs through the NwHIN;
2. They may not have an EHR, so they may use the Web to access a portal operated by the HIE to access information.

• For healthcare consumers:

1. They may use features of a PHR that they designate as the repository of their personal health record, and that PHR may be connected to an HIE which, in turn, will provide a connection to the NwHIN;
2. They may use features of a multi-regional PHR that will participate directly in the NwHIN;
3. If they do not have access to a PHR, they may achieve some limited functionality by using the services of an HIE through its portal.

CMS-Aligned Network

In July 2025 the Centers of Medicare and Medicaid Services (CMS) announced its Digital Health Technology Ecosystem^[1], a voluntary program that calls on like-minded data networks, electronic health record (EHR) systems, health application developers, health care providers, and innovators to align around a shared framework for health data and access. The goal is to further accelerate existing interoperability initiatives, so all parties engaged in health care have access to the health data they need. On July 30th, 2025, eHealth Exchange committed to meet the CMS Interoperability Framework criteria to become a CMS-Aligned Network.

Da Vinci trebuchet project

Trebuchet was created when Da Vinci members Regence, MultiCare Connected Care, and Blue Cross Blue Shield Arkansas sought ways to pilot Da Vinci use cases on the emerging TEFCA framework. They contacted multiple QHINs to gauge their interest in joining the pilot. eHealth Exchange joined the effort to perform the QHIN functions and provided valuable project management support. The team named the coalition “Trebuchet” to illustrate how the success of a third-century military catapult could inspire providers, payers, and a QHIN to accelerate trusted and scalable exchange.

As efforts advanced and participants increased, Trebuchet asked Da Vinci to take over project management^[2].  Now a priority project adopted by Da Vinci, Trebuchet is proving how eHealth Exchange’s nationwide trust model and “Networked FHIR” architecture rapidly deploy Smart-on-FHIR Prior Authorization and Clinical Data Exchange (CDex) at scale.

The initiative was recognized by KLAS Research with a Points of Light and Peak Award in 2024^[3] and 2025^[4].

Bulk FHIR quality coalition

The Bulk FHIR Quality Coalition—led by the National Committee for Quality Assurance (NCQA) in collaboration with health plans, providers, and health information networks—set out to prove that exchanging clinical data for digital quality measurement can be fast, scalable, and standards-based ^[5]. Key participants from the inaugural NCQA Bulk FHIR Cohort include MultiCare, Cambia Health Solutions, and eHealth Exchange ^[6]. This multi-stakeholder collaboration leveraged FHIR-based APIs, USCDI/US Core standards, and TEFCA-aligned infrastructure to reduce chart chasing, improve data quality, and accelerate HEDIS performance measurement.

NIH "All of Us" program

A groundbreaking initiative led by the National Institutes of Health (NIH) All of Us Research Program^[7], in collaboration with leading health information networks and providers, tested new ways to securely share real-world data with patient authorization. They explored both the opportunities and challenges of enabling a “research” exchange purpose under TEFCA — and what this could mean for the future of discovery. Early adopters include eHealth Exchange participants: University of North Carolina at Chapel Hill, Manifest MedEx, Cedars-Sinai Health System.

eHealth Exchange is actively encouraging participants to make the transition from traditional fax technology and begin FHIR-based exchange with payers and public health agencies to reduce burden and increase quality. Many payers, including the CMS, are actively pursuing electronic data exchange, but further preparation is needed to manage the volume of clinical data it is likely to receive. eHealth Exchange is actively engaging payers and others to help prepare for the 2027 implementation of new standards for processing electronic prior authorization requests.

In the longer term, eHealth Exchange anticipates skyrocketing volumes of data exchange as its participants expand their use cases beyond clinical treatment. In addition to public health, prior authorization, and payment, future use cases the network expects to enable include risk adjustment, healthcare operations, individual access, government benefits determination, and more.

In keeping with its commitment to exchange for the public good, eHealth Exchange sees the greatest value to patients in driving data sharing for public health. When the next pandemic arrives, public health agencies need much more information than they were able to access during COVID. The network aims to get ahead of this need by helping the Centers for Disease Control and Prevention (CDC) as well as state, tribal, local, and territorial agencies achieve true connectivity and real-time exchange.

• Sequoia Project official website.
• Direct Project official wiki.
• HIEWatch (formerly NHINWatch), by HIMSS Media.
• CONNECT Community Portal
• "Nationwide Health Information Network (NwHIN)". ONC. http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network-nwhin. 
• "Nationwide Health Information Exchange (HIE) Resources". ONC. http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-exchange-hie-resources. 

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