Nationwide health data sharing agreements eliminate the need for point-to-point arrangements while sharing the costs to implement and maintain a legal agreement, policy, specifications and testing across a large community of exchange partners. These agreements improve health outcomes, increase patient and provider satisfaction, eliminate lengthy legal negotiations and accelerate growth of secure electronic health information exchanges. As calls for a government-led common trusted exchange framework are renewed, what are some of the lessons learned from successful, real-world agreements in use today? The eHealth Exchange and Carequality, initiatives of The Sequoia Project, both rely on common trust agreements for data sharing. The eHealth Exchange developed a government-supported common agreement that saved the eHealth Exchange’s first 75 participants an estimated $60M. Industry-driven Carequality leverages the vast experience of stakeholders from across the healthcare ecosystem to connect networks to networks under a common framework.