The California Trusted Exchange Network (CTEN) is a critical component of California’s strategy for statewide, inter-organizational health information exchange. It combines the a multiparty data sharing agreement, a common set of policies and procedures, and a lightweight technical infrastructure to create a trusted environment for covered entities and business associates to safely and securely exchange health information.

The CTEN currently utilizes Direct messaging and query-based exchange using eHealth Exchange specifications. However, the California Interoperability Committee (CIC) is currently expanding the framework for CTEN’s technical specifications, policies for exchange, and onboarding and testing procedures to make the CTEN independent of specific transaction standards, to be more broadly applicable to stakeholder needs in California, and to reduce redundancy with existing successful national network initiatives. These changes should be finalized by the CIC in 2017.

CTEN Participants

OrganizationDirect MessagingQuery-Based ExchangeParticipant Since
Axessonyes1 Aug 2014
California EMS Authorityyes18 Aug 2017
ConnectHealthcareyes20 Nov 2015
Manifest MedExyes11 Nov 2015
OCPRHIOyesyes1 Aug 2014
RAIN Live Oak HIE and Telemedicine Networkyes1 Aug 2014
San Diego Health Connectyesyes1 Aug 2014
San Joaquin Community HIEyes18 Mar 2016
Santa Cruz HIEyesyes1 Aug 2014


The California Data Use and Reciprocal Support Agreement (CalDURSA) is a multi-party data sharing agreement that establishes common policies, procedures, and operational practices necessary for trusted statewide health information sharing in California. The CalDURSA is maintained and administered by the California Interoperability Committee (CIC), a committee of the CTEN participants.

The Sequoia Project maintains a federal version of a data use agreement, the DURSA. The CalDURSA is compatible with the DURSA, allowing organizations to participate in both the CTEN and eHealth Exchange. It is the intent of CAHIE and the CIC to track important changes made to the federal DURSA and maintain compatibility with it. A redlined comparison of the DURSA and CalDURSA is available for comparison.

The CalDURSA is also designed to work well with the Model Modular Participants Agreement (MMPA), a model agreement between HIOs and their exchange participants used by several California HIOs, including several CAHIE members. If you are interested in adopting or developing a participant agreement that is compatible with the CalDURSA, consider starting with the MMPA.

The following organizations have executed the CalDURSA.

OrganizationSignedFully ExecutedCTEN Participant
California Association of Health Information ExchangesyesyesN/A
California Emergency Medical Services Authorityyesyesyes
Dignity Healthyesyes
Los Angeles Network for Enhanced Services (LANES)yes
Manifest MedExyesyesyes
North Coast Health Information Networkyesyes
RAIN - Live Oak HIE and Telemedicine Networkyesyesyes
Redwood MedNetyesyes
SacValley MedShareyesin testing
San Diego Health Connectyesyesyes
Santa Cruz Health Information Exchangeyesyesyes
San Joaquin Community Health Information Exchangeyesyesyes
Sutter Healthyesyes
UC Davis Health Systemyesin testing

Onboarding to CTEN

Any organization can utilize Direct messaging and query-based exchange specifications to share health information with organizations they trust and with whom they have data sharing agreements. CAHIE, through the CTEN, provides a framework to make statewide trust and data-sharing efficient, and to ready organizations for sharing health information nationally. Organizations interested in participating in exchange using the CTEN should follow these steps to get started:

  1. Review the goals and activities of CAHIE, become a member, and participate in CAHIE activities as they benefit your organization.
  2. Become familiar with the California Data Use and Reciprocal Support Agreement (CalDURSA), and verify that your organization can satisfy the provisions in the agreement.
  3. Identify the message transaction patterns and related specifications applicable to your organization, and ensure your system(s) satisfy the technical requirements for participation in the CTEN.
  4. Review the Exchange Policy and Procedure (EPP) documents for the transaction(s) of interest to your organization, and ensure that your organization and your system(s) satisfy the business processes for participation in the CTEN.
  5. Sign and submit the CalDURSA Joinder Agreement to
  6. Complete and submit the application form(s) for the transaction(s) of interest to your organization to, attesting to and providing evidence for your adherence to business process requirements and your eligibility to participate in that transaction on the CTEN.
  7. Complete and submit the testing form(s) for the transaction(s) of interest to your organization to, documenting your adherence to the technical specifications for that transaction.
Cost for Participation

Onboarding to the CTEN is applicable to those organizations that are responsible for creating and/or enforcing information exchange policies, through agreements such as Participant Agreements, with participating users. Onboarding fees are due each time an organization submits new applications to onboard for one or more additional transaction patterns more than 12 months after their last full application.

  • Onboarding to CTEN for CAHIE members – $4,000 for organizations using the MMPA, $5,000 for organizations not using the MMPA
  • Onboarding to CTEN for nonmembers – $10,000

CAHIE currently bears the cost of operating the CTEN. Beginning January 1, 2018, participation fees to offset the costs of operating the CTEN will be $250 quarterly for CTEN participants that are also CAHIE members, $500 quarterly for nonmembers. At that time, participation fees will be applicable for each onboarded organization, independent of whether they receive their technical services from another organization or service provider already onboarded.

Onboarding Forms

The CIC is expanding the CTEN, and will be replacing these forms with a more generalized framework. A draft of the new process for validation testing is now available. All changes should be finalized in 2017.

CIC Meetings

The CIC is authorized by participants of the CTEN under the CalDURSA to provide oversight, facilitation, and support for exchange over the CTEN by:

  • Determining which transaction patterns and specifications will be used on the CTEN;
  • Maintaining the CalDURSA, and the policies and procedures governing CIC and CTEN operation; and
  • Determining whether to admit a new participant, and managing suspensions and disputes.

The CIC meets monthly or as deemed necessary by its members. All meetings are open to the public. Upcoming meeting information is available on our Events page.