The California Trusted Exchange Network is a critical component of California’s strategy for statewide, inter-organizational health information exchange. It combines a multiparty data sharing agreement, a common set of policies and procedures, and a lightweight technical infrastructure to create a trusted environment for safe and secure sharing of health information.

Who Is on the CTEN?

Participant Since
Axesson 8/1/2014
California EMS Authority 8/18/2017
Connect Healthcare 11/20/2015
Manifest MedEx 11/20/2015
OCPRHIO 8/1/2014
RAIN Live Oak HIE and Telemedicine Network 8/1/2014
San Diego Health Connect 8/1/2014
San Joaquin Community HIE 3/18/2016
Santa Cruz HIO 8/1/2014

More information on CTEN participants and the types of exchange they conduct on the CTEN is available here.

Joining the CTEN

The CTEN is designed to be more efficient, more agile, and more flexible than national networks while remaining compatible with them. Unlike most other networks, the CTEN allows its participants to define the method and technical standards they will use to share health information. To join the CTEN:

  1. Review obligations for trusted statewide exchange on the CTEN found in the CalDURSA and CTEN policies
  2. Identify transactions of interest used by current CTEN Participants, or describe a new transaction
  3. Complete a CTEN Application

More detail is available on the complete CTEN Onboarding Process (coming soon), or send email to schedule an introductory call.

Cost of Participation

Onboarding to the CTEN for CAHIE members is $4,000 if using the MMPA, $5,000 if not using the MMPA. Onboarding for nonmembers is $10,000.

CAHIE currently bears the cost of operating the CTEN. Beginning January 1, 2018, participation fees to offset these costs will be $250 quarterly for CAHIE members, $500 quarterly for nonmembers.


CTEN Policies

The CTEN is governed by a common set of policies and procedures maintained by the California Interoperability Committee (CIC), a committee of the CTEN participants. See our Events page for a schedule of monthly CIC meetings which are open to all.

California Data Use and Reciprocal Support Agreement

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 compatible with the DURSA maintained by The Sequoia Project, allowing organizations to easily participate in both the CTEN and eHealth Exchange. It 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. If you are interested in adopting or developing a participant agreement that is compatible with the CalDURSA, consider starting with the MMPA.

CTEN Policies and Procedures

See CTEN Policies and Procedures for a listing of the current policies and procedures describing how the CIC performs its duties, the obligations of CTEN Participants, and the procedures for onboarding to the CTEN.


CalDURSA Signatories

The following organizations are parties to the CalDURSA.

  • Axesson
  • California Association of Health Information Exchanges
  • California Emergency Medical Services Authority
  • Connect Healthcare
  • Dignity Health
  • Manifest MedEx
  • North Coast Health Information Network
  • RAIN - Live Oak HIE and Telemedicine Network
  • Redwood MedNet
  • San Diego Health Connect
  • Santa Cruz Health Information Organization
  • San Joaquin Community Health Information Exchange
  • Sutter Health
  • UC Davis Health System

The following organizations have signed the Joinder Agreement, and are in the process of onboarding.

  • Los Angeles Network for Enhanced Services (LANES)
  • SacValley MedShare

More details about the California Trusted Exchange Network are available at:

Or send a message to the CTEN Administrator at to schedule an introductory meeting or for help with any of the onboarding steps.