iKnowMed Generation 2 and Carequality Network Frequently Asked Questions

Updated February 2025

Interoperability facilitates organized and effective data exchange between health information systems. The ability to share the most up-to-date patient medical records, regardless of the health system, not only reduces costs but also improves patient care and enhances patient outcomes.

In August 2023, we completed our final steps to integrate the Carequality framework into iKnowMed Generation 2. Carequality enables nationwide care coordination by giving your practice the ability to communicate electronically and seamlessly with your community partners.

Carequality is an interoperability framework that enables a nation-wide connection between participating hospitals, clinics, and health care organizations to securely access patient information to seamlessly support care coordination.

Your practice can join more than 600,000 providers and 4,200 hospitals currently participating in Carequality.

Staff at your practice will have more time to spend with patients and spend less time on requesting and sending documents, looking for your patients’ latest information. Carequality helps eliminate this administrative burden and the need to chase records for patients.

Data is only shared with Carequality Network participants who share patients with you. This patient data is only shared when they request it.

Just as your practice has signed a terms of use agreement, all participants in the Carequality Network have agreed to the same terms of use.

Carequality is a document-based exchange. Most members of Carequality support the industry standard C-CDA format for sharing clinical data.

iKnowMed will respond to incoming requests with two types of documents, a Progress Note C-CDA and C-CDA, containing clinical data which the requesting practice will be able to access and import if desired.

When a request is made for patient data through the Carequality network and the patient is active for Carequality, iKnowMed sends a Continuity of Care C-CDA document. If the patient had an appointment with a qualified provider and an E/M and/or procedure was charged by the same provider, then a Progress Note CCDA is also sent.

The Progress Note CCDA shows a time bound set of data which also includes a section for notes which contains electronically signed clinical notes and non-signed nurse notes. Progress Note CCDAs are linked to appointments with providers (MD, NP, PA, APP) which have an E/M and/or Procedure documented by the same provider.

The Progress Note C-CDA document contains:

  • Allergies and adverse reactions: all active display

  • Medications: All active display

  • Problems: All active display

  • Encounter section: Displays problem(s) tied to E/M code or procedure (need to validate if this held true when we added procedures)

  • Results: Only results recorded during the encounter time frame

  • Vital Signs: Only vital signs documented during the encounter time frame

  • Immunizations: Only immunizations given during the encounter time frame

  • Assessment Section: Always says “See Note”

  • Plan: Includes lab and imaging orders, appointments for service orders, and Instructions from the “Other” care plan “Instructions” section if documented.

  • Note Section, which includes Clinical and Nurse Notes:

    • Clinical Notes tied to the encounter date of service where an E/M code or procedure code has been documented by a specific user role (Physician, PA, NP, APP, Physician- Read Only, or APP- Read Only), and the note is electronically signed. The note will reflect any updates such as “Replaced”, “Amended”, or “Addendum” if applicable. The Progress Note CCDA does not look at the title of the Clinical Note Template.

    • Nurse Note which are not electronically signed. The Progress Note CCDA looks to see if anything is generated if “print” is selected on the Nurse Note tab and “Release Drug Code” has been selected on a Charge Capture Report during the time frame. Electronically signed nurse notes cannot be generated by the Progress Note CCDA at this time.

The CCDA contains:

  • Allergies and Adverse Reactions

  • Care Plan

  • Reason for Visit

  • Cognitive Status

  • Performance Status

  • Immunizations

  • Diagnostic Results

  • Medications Administered

  • Medications

  • Patient Education

  • Problems

  • Procedures

  • Social History

  • Vital Signs

  • Mental Status

  • Functional Status

The first step to preparing your practice for participation in the Carequality framework is to sign the Carequality service agreement in iKnowMed.

NOTE: This agreement may only be signed by one individual at your practice, and the agreement may only be signed once. Signing the agreement automatically starts to onboard your practice for enrollment in Carequality.

Practices will also need to complete an opt-in opt-out document to determine how patients are enrolled with Carequality. Once we receive this document, Ontada will configure and activate your practice with Carequality and alert you when this is complete.

The length of this process is dependent on the volume of responses that are received and will be handled on a first-in, first-completed basis.

Your Ontada Account Manager will reach out to help your practice to sign the agreement and begin the onboarding process.

Please contact your Ontada Technology Account Manager to discuss options for signing the Carequality Terms of Use Agreement.

Your practice controls user access to Carequality and External Records. When your practice joins the Carequality Network through iKnowMed, all permissions will be defaulted to none. Practices decide who should have access and then grant permissions accordingly. For step-by-step directions, review our August 2023 release notes.

August 2023 Release Notes

Practices need to determine whether they want to require explicit patient consent to share patient information with the Carequality Network.

Your patients may all be enrolled in the Carequality Network depending on your state’s laws. Regardless of those laws, you always have the option of manually opting patients in and out of the Carequality Network based on their preferences.

If you choose to require explicit patient consent, no data for your patients can be sent or requested to the Carequality Network until the patient consent for Carequality is enabled in iKnowMed. For step-by-step instructions, please review the July 2022 release notes.

July 2022 Release Notes

Please contact your practice’s legal counsel for relevant information and guidance.

If a patient or their authorized caregiver wishes to opt out, update the patient’s consent under Demographics > Patient Preferences > Consents > Carequality. Consent should be changed to either Patient Opt Out or Personal Representative Opt Out obo Patient.

When a patient’s consent is updated to opt out of the Carequality Network, iKnowMed immediately stops exchanging the patient’s data.

Practices do not pay any additional costs to use the Carequality functionality through iKnowMed.

You can take as much time as you want to review and sign the Carequality Terms of Use Agreement. Once signed, it can take up to a few days for the practice to be enabled on Carequality through iKnowMed.

Please contact your Ontada Technology Account Manager immediately or call our Technical Support team if they are unavailable. The Ontada team will need to perform some updates to ensure that all your patient information is thoroughly removed from the Carequality system.

A practice or organization’s ability to participate in Carequality primarily depends on whether their EHR has adopted the Carequality Interoperability Framework.

Many prominent EHR vendors such as Epic, Athenahealth, and Allscripts, as well as networks such as Commonwell Health Alliance, comprised of Cerner, Meditech, Greenway and other EHR vendors, have adopted the framework and are Carequality participants.

Carequality is the standard framework that enables sharing patient information between participants. Epic participates in the Carequality Network. Care Everywhere is the module in Epic that enables their users to participate in Carequality.

All organizations using Epic are already participants of Carequality. No additional setup in Epic is needed by the Epic customer to start sharing data with your practice once your practice is live.

Automated processes in Epic frequently check for new listings in the Carequality directory and enable connectivity to new participants.

All organizations using Epic are already participants of Carequality. No additional setup in Epic is needed by the Epic customer to start sharing data with your practice once your practice is live.

Automated processes in Epic frequently check for new listings in the Carequality directory and enable connectivity to new participants.

We are working on making a report available for each practice.

You can visit the Carequality website, see the full list of Carequality members and supports, or use the Carequality Participant Search Tool.

Carequality Participant Search Tool