> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# California Data Exchange Framework (DxF) and Elation

> How Elation supports California practices meeting their Data Exchange Framework (DxF) data sharing requirements through the Carequality integration.

<Note>
  This article is written by Elation Health for informational purposes only. It is intended as a summary of how Elation's tools relate to the California Data Exchange Framework and should not be relied upon to ensure compliance. Each practice is responsible for understanding and meeting its own DxF obligations. For official DxF requirements, contact [CalHHS](https://dxf.chhs.ca.gov/) directly.
</Note>

## Overview

The California Data Exchange Framework (DxF) is a statewide initiative established under AB 133 and SB 660 that requires California healthcare entities to exchange health data electronically. The framework is administered by the California Health and Human Services Agency (CalHHS).

As part of the DxF, healthcare entities must sign a Data Sharing Agreement (DSA) and establish a method for electronic health data exchange. The DxF allows participants to fulfill their data exchange obligations through several pathways, including connecting through a Qualified Health Information Organization (QHIO), through an agreement with another entity that provides data exchange, or through their own technology.

**Elation provides the tools and integrations to facilitate data exchange, but compliance with the DxF — including signing the DSA and understanding your practice's specific obligations — is the responsibility of each individual practice.**

## How Elation supports your data exchange requirements

### Carequality integration

Elation's [Carequality integration](/articles/Carequality-Integration-Introduction) enables your practice to exchange patient data bidirectionally across the national Carequality network. This includes sharing and receiving Continuity of Care Documents (CCDs/C-CDAs) with other Carequality-enabled EHRs, health systems, and Health Information Exchanges (HIEs).

Carequality is a recognized data exchange pathway that can help satisfy the DxF's technical requirements for health data exchange.

To enable Carequality in your practice:

<Steps>
  <Step title="Open Security & Privacy settings">
    Go to **Settings > Security & Privacy**.
  </Step>

  <Step title="Turn on data sharing">
    Toggle **Patient Data Sharing with Outside Care** to **ON** and agree to the terms.
  </Step>
</Steps>

For full setup instructions, consent management, and usage details, see [Elation-Carequality Integration Introduction](/articles/Carequality-Integration-Introduction).

### USCDI support

The DxF requires USCDI v2 at a minimum for data exchange. Elation supports the USCDI standard for data exchanged through the Carequality integration. For details on USCDI data classes and how they map to Elation data, see [21st Century Cures Act Guide - Patient CCDAs and U.S. Core Data for Interoperability (USCDI)](/articles/Cures-Act-Patient-Data-and-USCDI).

## Recommended next steps

If your California practice needs to comply with the DxF:

<Steps>
  <Step title="Understand your obligations">
    Review the DxF requirements that apply to your practice through the [DxF participant portal](https://dxf.chhs.ca.gov/for-participants/). Requirements vary based on entity type and size.
  </Step>

  <Step title="Sign the Data Sharing Agreement">
    If you have not yet signed the DSA, you can do so through the [DxF participant portal](https://dxf.chhs.ca.gov/for-participants/).
  </Step>

  <Step title="Enable Carequality">
    If Carequality is not yet enabled in your Elation account, follow the setup instructions in the [Carequality Integration Introduction](/articles/Carequality-Integration-Introduction) to turn it on.
  </Step>
</Steps>

## Frequently asked questions

### Does enabling Carequality satisfy the DxF data exchange requirement?

The DxF allows participants to meet their data exchange obligations through several pathways. Carequality is a bidirectional data exchange framework that can serve as one of those pathways. Your practice should review the specific DxF requirements that apply to your entity type to confirm.

### Is Elation responsible for my practice's DxF compliance?

No. While Elation provides the tools and integrations to facilitate data exchange, each practice is responsible for its own DxF compliance. This includes signing the DSA, understanding applicable deadlines, and ensuring your practice meets the framework's requirements. For compliance questions about the DxF, contact [CalHHS](https://dxf.chhs.ca.gov/) directly.

### What about Manifest MedEx?

Elation integrates with Manifest MedEx, a California-based Health Information Exchange. However, the Manifest MedEx integration is inbound-only (receiving data) and does not support bidirectional exchange. If the DxF requires bidirectional data exchange for your practice, the [Carequality integration](/articles/Carequality-Integration-Introduction) is the recommended pathway.

### Where can I get help with technical configuration?

If you have questions about enabling Carequality or configuring your Elation account for data exchange, contact [Elation Support](https://app.elationemr.com/support/). For questions about DxF compliance requirements, contact [CalHHS](https://dxf.chhs.ca.gov/).

## Related articles

* [Elation-Carequality Integration Introduction](/articles/Carequality-Integration-Introduction)
* [Data Sharing Guide - Sharing data outside Elation via CCDA, Carequality, Direct messaging, Connect and Patient Passport](/articles/Sharing-data-outside-Elation)
* [Patient Consent Regulations Guide](/articles/Patient-Consent-Regulations-Guide)
* [21st Century Cures Act Guide - Patient CCDAs and U.S. Core Data for Interoperability (USCDI)](/articles/Cures-Act-Patient-Data-and-USCDI)