Transforming Care Starts with a Connected California

The DxF enables health and social services entities to seamlessly share data with one another. 

This timely, secure exchange improves the completeness of an individual’s records—empowering organizations with the information needed to provide the best possible care. 

Today, thousands of health and social services providers across the state have proudly joined the DxF—helping lead our shared commitment to create a Healthy California for All. 

Prospective Participants must complete a series of actions to join the DxF, including: signing the Data Sharing Agreement (DSA), maintaining certain technological capabilities, and declaring exchange readiness to other Participants.

Many health entities are required by law to join the DxF. Learn more

Rules of the Road

The DxF is not a centralized data repository. Instead, DxF Participants are agreeing to follow rules of the road for securely and appropriately exchanging health and social services information to best serve patients and join a shared commitment to providing safe, effective, whole-person care across California.

More Information. Better Care. Improved Outcomes.

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View more stories of a connected CA

Slide 1 depicting step 1 of Lisa and Dr. Tom. An image of an ambulance in motion to the right with an overlaying icon of a distressed woman. Text to the left that says Lisa has a medical emergency. She notices swelling in her leg and calls 911.
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Shannon’s Journey to Improved Health: The Impact of Enhanced Care Management. Shannon, a Medi-Cal patient with diabetes, is living with her friend in Los Angeles. A lack of stable housing and transportation make it difficult for her to attend regular doctor’s visits and manage her condition. Shannon’s health-related social needs suggest she would benefit from Enhanced Care Management (ECM) under Medi-Cal.
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Slide 1 depicting step 1 of Lisa and Dr. Tom. An image of an ambulance in motion to the right with an overlaying icon of a distressed woman. Text to the left that says Lisa has a medical emergency. She notices swelling in her leg and calls 911.
Slide 2 depicting step 2 of Lisa and Dr. Tom. An image of the building exterior of an emergency room to the right with an overlaying icon of a distressed woman. Text to the left that says “Lisa is admitted to the hospital. Secure information exchange between Lisa’s providers allow the hospital to access Lisa’s medical records from her primary care physician (PCP).
Slide 3 depicting step 3 of Lisa and Dr. Tom. An image of a group of doctors and nurses discussing is to the right with an overlaying icon of a woman with a neutral expression. Text to the left that says “Lisa receives informed care. Having access to Lisa’s records helps the attending physician make a more informed evaluation. Her swollen leg is treated for cellulitis with antibiotics.
Slide 4 depicting step 4 of Lisa and Dr. Tom. An image of a Dr. Tom and Lisa is to the right with an overlaying icon of a happy woman. Text to the left that says “Lisa is on the road to recovery. Lisa’s PCP accesses her discharge summary from the hospital and uses it to prepare for Lisa’s next visit. At her next appointment, Lisa’s PCP reviews her discharge medicine and reconciles them with her maintenance medication.
Slide 5 depicting step 5 of Lisa and Dr. Tom. An image of a network of health icons connecting to an icon of a happy woman is to the right. Text to the left that says “Lisa’s modern patient experience. Lisa’s PCP and the Hospital exchange health information, giving them both a clear understanding of her full health history and the information needed to provide her with timely, safe, and effective whole-person care.
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Shannon’s Journey to Improved Health: The Impact of Enhanced Care Management. Shannon, a Medi-Cal patient with diabetes, is living with her friend in Los Angeles. A lack of stable housing and transportation make it difficult for her to attend regular doctor’s visits and manage her condition. Shannon’s health-related social needs suggest she would benefit from Enhanced Care Management (ECM) under Medi-Cal.
Slide 1 depicting step 1 of Shannon’s Journey. An image of the building exterior of an emergency room to the right with an overlaying icon of a distressed woman. Text to the left that says “Shannon Has a Medical Emergency and Receives Informed Care at the Emergency Department. One day, Shannon experiences severe stomach pains. Her friend drives her to the Emergency Room, her fifth visit in six months. The ER staff run tests. Her blood work indicates high A1C levels, a result of unmanaged diabetes. Doctors and nurses review Shannon’s medical records from her four recent ER visits. Shannon is treated with insulin, fluids, and electrolytes. Due to the frequency of her ED visits, the clinical staff designates Shannon as likely eligible* for Enhanced Care Management under Medi-Cal. *Shannon’s specific population of focus designation is, “Adult At Risk for Avoidable Hospital or Emergency Department (ED) Utilization”
Slide 2 depicting step 2 of Shannon’s Journey. An image of a group of doctors discussing in a hospital hallway to the right with an overlaying icon of a distressed woman. Text to the left that says “Secure Data Sharing Enables Providers to Quickly Enroll Shannon in ECM Services to Help Avoid Future Emergencies. The ED shares Shannon’s discharge and discharge diagnoses with its QHIO. The QHIO then shares a notification of the discharge with the Managed Care Plan (MCP) serving Shannon. The navigator assigned to Shannon verifies that she meets the eligibility criteria for ECM services and promptly submits an ECM enrollment request, which is swiftly approved. The navigator contacts Shannon and obtains her consent to receive ECM services.
Slide 3 depicting step 3 of Shannon’s Journey. An image of a doctor and Shannon to the right with an overlaying icon of a woman with a neutral expression. Text to the left that says “Shannon’s Care Manager Identifies and Helps Address the Root Causes of her Frequent ER Visits. Shannon is assigned an ECM care manager, Jack, who is responsible for coordinating community support to help address her health-related social needs. With Shannon’s consent, Jack queries the QHIO to receive information on Shannon’s admission, and schedules a meeting with Shannon. Reviewing the Emergency Department’s discharge summary that was shared with the QHIO, Jack learns that Shannon is housing insecure and has difficulty attending regular medical appointments to manage her diabetes. Jack refers Shannon for housing transition navigation services offered by the ECM program.
Slide 4 depicting step 4 of Shannon’s Journey. An image of Shannon happily eating to the right with an overlaying icon of a happy woman. Text to the left that says “Comprehensive Care Management Leads to Lasting, Improved Health Outcomes for Shannon. With the support of her care manager, Shannon is able to secure a new apartment. The stability made possible by reliable housing allows Shannon to begin seeking regular care from a nearby provider, and effectively manage her diabetes. Shannon no longer experiences regular emergencies due to her condition, and is living a healthier, happier life.

How to Join the DxF

The DSA is an agreement to share information timely, securely, and appropriately while following a common set of terms, conditions, and obligations set forth in shared Policies and Procedures (P&Ps).
SIGN THE DSA

Signatories must have the technological capabilities to engage in the DxF. Participants may choose to exchange data through a QHIO, nationwide network or framework, other intermediary, point-to-point connections, or a combination of these methods.
GET CONNECTED

Announce to other Participants you’re ready to exchange data and improve outcomes, by entering your exchange choices in the DxF Participant Directory—the DxF’s “phone-book” that lists Participants and the intermediaries and technologies they use to exchange data.
ENTER CHOICES

Utilize the Participant Directory to exchange data with other Participants, helping deliver timely, safe, and effective whole-person care to Californians statewide.
BEGIN SHARING

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DxF Participant Center

Driving meaningful improvements in secure data sharing

California has made remarkable, transformative progress—but the work is ongoing. The DxF remains committed to supporting and collaborating with the thousands of dedicated Participants across the state to advance secure data sharing.

Access key tools and find upcoming meetings, implementation updates, and improvement efforts in the Participant Center.

 

 

 

The Data Exchange Framework is a giant leap forward for healthcare in California—access to information makes care safer and always serves to enhance quality, enabling providers to deliver the care that patients need.
— William Isenberg, MD, PhD, Chief Medical Officer of Sutter Health

Frequently Asked Questions (FAQ)

Entities required to sign the DxF DSA are listed below, as defined in Health and Safety Code section 130290(f).

  1. General Acute Care Hospitals, as defined by Health and Safety Code Section 1250.
  2. Physician Organizations (e.g., Independent Practice Associations that exchange health information) and Medical Groups.
  3. Skilled Nursing Facilities, as defined in Health and Safety Code Section 1250.
  4. Health Plans
    1. Health Care Service Plans and Disability Insurers providing hospital, medical, or surgical coverage that are regulated by the California Department of Managed Healthcare or the California Department of Insurance.
    2. Medi-Cal Managed Care Plans that have signed a comprehensive risk contract with the Department of Healthcare Services pursuant to the MediCal Act1 or the Waxman-Duffy Prepaid Health Plan Act2 , and that are not regulated by the California Department of Managed Healthcare or the California Department of Insurance.
  5. Clinical Laboratories, as defined in Business and Professions Code Section 1265 and that are regulated by the California Department of Public Health.
  6. Acute Psychiatric Hospitals, as defined in Health and Safety Code Section 1250

1 Cal. Welfare and Institutions Code section 14000, et seq.

2 Cal. Welfare and Institutions Code section 14200, et seq.

Under AB 133, all mandatory signatories must sign the DSA by January 31, 2023. Some of these organizations, such as smaller physician practices and clinics, rehabilitation, long-term acute care, psychiatric, and critical access hospitals, and smaller rural acute care hospitals, will have until January 31, 2026 to fully implement the Data Exchange Framework even though they signed the agreement in January 2023.

After signing, DxF DSA signatories will be required to exchange health and social services information or provide access to health information to and from every other signatory in real time as specified in the DSA and its Policies and Procedures (P&Ps).

Most entities required to sign the DSA will be required to begin exchanging health and social services information on or before January 31, 2024.

Some organizations will have until January 31, 2026 to begin exchanging this information. These organizations are as follows: physician practices of fewer than 25 physicians, rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, critical access hospitals, and rural general acute care hospitals with fewer than 100 acute care beds, state-run acute psychiatric hospitals, and any nonprofit clinic with fewer than 10 health care providers.

CalHHS is working with stakeholders to develop processes to support signatories in meeting DxF DSA requirements, including by establishing a program to qualify eligible health information organizations (HIOs) to facilitate data exchange between signatories. More information on the program will be available soon.

Participants must follow all applicable state and federal law when sharing Health and Social Services Information through the DSA. For example, if the information is covered by the Health Insurance Portability and Accountability Act (HIPAA) and the Lanterman-Petris-Short Act (LPS), the Participant would need to meet an exception in both HIPAA and LPS in order to share the information. In addition, health information can generally DxF Frequently Asked Questions 4 Last Updated: February 28, 2025 be shared with a valid authorization for release of information from the patient/individual.

For more information on how to share some types of health information in California, please see CDII’s State Health Information Guidance (SHIG).

The Data Exchange Framework allows Participants to provide access to or exchange information including through any health information exchange network, health information organization, or technology that adheres to the DSA and Policies and Procedures found on our web site at Data Sharing Agreement and Policies & Procedures. The DxF is not intended to be an information technology system or single repository of data, rather it is a collection of organizations that are required to share health information using national standards and a common set of policies

The Data Exchange Framework requires that every Participant provide access to or exchange health and social services information with every other Participant consistent with the Permitted, Required and Prohibited Purposes Policy and Procedure. Note that Participants are not required to share health and social services information if sharing would violate federal or state law. For information on required Participants, see the required signatories FAQ. For technical requirements for data sharing, see the Data Elements to Be Exchanged P&P and the Technical Requirements for Exchange Policy and Procedure, currently in development.

  1. Review the Data Sharing Agreement (DSA) and its policies and procedures available on the CDII website so you are aware of your organization’s obligations once you sign the DSA. The DSA and its policies and procedures are final drafts that were developed alongside a wide variety of stakeholders and were previously available for public comment. Neither the DSA nor the policies and procedures are open for negotiation.
  2. Determine who at your organization is authorized to sign the DSA on behalf of the organization.
  3. Determine if there are subordinate entities or facilities for which the authorized person would like to sign.
    • What is a subordinate organization?
  4. Gather necessary information in order to register in the CalHHS Data Sharing Agreement Signing Portal and request a copy of the DSA to be signed.
    • What information will I need to register for the CalHHS Data Sharing Agreement Signing Portal?

 

The Data Exchange Framework is not a technology, but instead rules of the road for how organizations will provide access to and exchange health and social services information. Health and social services information will not reside on any state DxF system. The Permitted, Required and Prohibited Purposes P&P describes the purposes for which DxF Participants are required or permitted to exchange health and social services information under the DSA with other Participants. The Privacy and Security Safeguards P&P describes the minimum privacy and security safeguards required by the DxF for Participants to implement.

More Questions? View the Full DxF FAQ