Building on an announcement made almost two years ago, CommonWell Health Alliance and Carequality announced today initial connectivity, which is the beginning of a broader effort to increase health data exchange nationwide.
In a blog post published today, CommonWell, a non-profit trade association providing a vendor-neutral platform and interoperability services for its members, announced it had started a limited roll-out of live bidirectional data sharing with an initial set of CommonWell members and providers and other Carequality Interoperability Framework adopters.
Currently, the production use is limited, yet this marks the first step in a collaborative effort to increase health IT connectivity across the country by enabling CommonWell subscribers to engage in health data exchange through directed queries with Carequality-enabled providers, and vice versa.
In the blog post, Jitin Asnaani, executive director of CommonWell Health Alliance, said that the organization has made “significant strides” and has met all Carequality requirements to move into production. Currently, Cerner and Greenway Health have a “handful” of initial providers live on the connection, allowing the CommonWell team to “validate and benchmark the CommonWell-Carequality Connection,” Asnaani wrote.
“In just the first two weeks of a few CommonWell-enabled providers being connected, we saw more than 4,000 documents bilaterally exchanged with Carequality-enabled providers,” Asnaani wrote.
CommonWell and Carequality are on track to make the data sharing services “generally available” to subscribing members and, in turn, their participating providers and healthcare systems, by the end of the summer, officials from both organizations said.
In December 2016, CommonWell and Carequality, an initiative of The Sequoia Project, announced connectivity and collaboration efforts with the aim of providing additional health data sharing options for stakeholders. Officials said that the immediate focus of the work between Carequality and CommonWell would be on extending providers’ ability to request and retrieve medical records electronically from other providers. In the past year and a half, teams at both organizations have been working to establish that connectivity.
Together, CommonWell members and Carequality participants represent more than 90 percent of the acute EHR market and nearly 60 percent of the ambulatory EHR market. Today, more than 15,000 hospitals, clinics, and other healthcare organizations have been actively deployed under the Carequality framework or CommonWell network, officials noted.
“This is the ‘golden spike’ moment, connecting the two big railroads, like when AT&T and Verizon finally got connected. This is building that bridge,” says Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, who also directly observes and participates in conversations with Carequality and CommonWell. “It will take a while for all of the production sites and different vendors to get up and running. That will probably take a couple of years. But you have to have the bridge to connect them to begin.”
Carequality is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to ﬂow between and among networks and platforms.
CommonWell Health Alliance operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve multiple records for a patient from member systems.
With regard to progress on healthcare interoperability, Tripathi says this connectivity solves one particular type of transaction: “It provides a low-cost ubiquitous way to get basic clinical information among provider organizations for treatment purposes. So, I can get the basic medical record information contained in a CCD (Continuity of Care Document), wherever it is, among these vendors who represent [90 percent] of providers in the U.S. It serves that basic purpose.”
An analysis by KLAS Research issued back in March noted that the CommonWell-Carequality connection will be key to interoperability value. In that report, KLAS analysts noted that the CommonWell Health Alliance’s interoperability efforts were hindered by a lack of provider adoption, but when CommonWell and Carequality eventually connect, “instant value” will be created for users.
Currently, Epic is not a member of CommonWell, despite other major EHR vendors pushing the giant EHR vendor in that direction. “Because sharing among Epic customers is already universal, when CommonWell connects to Carequality, the entire Epic base will become available, creating instant value for most areas of the country,” the KLAS report said.
Once there is “general availability” of the data sharing services for all Carequality and CommonWell members, the competition factor will become less important, Tripathi says.
“It makes both networks more valuable,” Tripathi asserts. He notes that when the 2016 announcement was first made, an interview was done with Nael Hafez, who is CIO of Pediatric Physicians' Organization at Children's Hospital (PPOC), an ambulatory physician’s group affiliated with Boston Children’s Hospital. As Tripathi explains, PPOC is on Epic and Boston Children’s is on Cerner, and neither organization had seen any value of connecting to the other side. But once the 2016 announcement was made, both saw the value of joining the other. “They wouldn’t need to [do] point-to-point interfaces anymore. This [connectivity] makes each of the things more valuable. Cerner customers want to connect to Epic customers and vice versa. And this is the bridge for them to do that,” Tripathi says.
Tripathi notes that every organization that is an implementer of Carequality has access to the provider directory that Carequality makes available, and that directory has a list of every provider organization that is accessible through the Carequality framework. “So as CommonWell is becoming a Carequality implementer, as more and more of their sites go live, they will start going live on the Carequality provider directory. And for the ones who are limited in production now—such as some Cerner and Greenway sites, per this update—if you are a Carequality implementer and you look in that provider directory, you will see those sites right now. And they are fully able to exchange information. It is only some 4,000 documents right now, but that’s because all those [sites] asked for. There are no restrictions. Over time as the sites go live, you will just see the Carequality provider directory grow and grow with more of these CommonWell sites, as they become available,” he says.
Tripathi also notes that there are both technical and business considerations of the CommonWell-Carequality connectivity, and CCDs are what’s currently being exchanged. “For Carequality and CommonWell, while each have different architectures, the payload is exactly the same. It’s the CCD that any of those EHRs are able to generate,” he says.
In this regard, Dawn Van Dyke, director of marketing communications at The Sequoia Project, wrote in a blog post that members of both Carequality and CommonWell also participated in a Joint Document Content Workgroup, which recently issued recommendations with respect to data content contained in clinical documents. Carequality will incorporate these recommendations into an updated Implementation Guide for all networks participating in the framework, Van Dyke said.
Tripathi applauds these joint efforts to improve the quality of the CCD. “People get the CCD but they hate it, currently. Right now, that’s the vehicle for exchange: document-based exchange among providers.” But moving forward, there is plenty of opportunity for more sophisticated data exchange, he says.
To this point, CommonWell has already implemented Argonaut Project's FHIR (Fast Healthcare Interoperability Resource) specifications and one vendor, Meditech, has said it is the first EHR vendor in the CommonWell Health Alliance to deploy FHIR, Tripathi says. “Over time, you envision that each of them would introduce those standards that will enable a data-level query capability so you don’t have to get the whole CCD. Right now, if you ask a provider if he or she has any [information] on person X, that provider will send back a CCD. In the future, you might be able to ask for allergy information on person X and the provider will return just that allergy information. That’s obviously much more valuable.”
But for now, the CommonWell-Carequality connectivity solves the basic interoperability use case, from technical and business perspectives, Tripathi says. “There are all sorts of higher-level interoperability things we want to accomplish, and the goal posts will keep moving. Ten years ago, we weren’t expecting our phones to do everything they do now.”
Moving forward, it becomes an issue of adoption, he says. “Each of those [CommonWell] members will have their own processes to go through, since you have to sign an agreement for Carequality, so that’s how you get into the varying timelines for vendors,” he says. “It could take a few years for all of that to happen. And there will then be no excuse for a provider or vendor to say, 'I cannot do this.' I am hoping that this status update leads to providers telling their vendors to get this [ability] into their EHRs.”