Responding to a KLAS Research report last week which concluded that CommonWell Health Alliance’s interoperability services currently lack value, CommonWell’s Executive Director Jitin Asnaani defended his organization’s mission and attested that the network is continuing to grow and prove its worth.
Last week, KLAS’ report, “Interoperability: An Inside Look at Plug-and-Play Patient-Record Sharing,” asserted that CommonWell's interoperability efforts are being hindered by a lack of provider adoption, but when CommonWell and Carequality eventually connect, “instant value” will be created for users.
Speaking to Healthcare Informatics live at HIMSS18 in Las Vegas, Asnaani, the only full-time employee and first executive director of CommonWell—an alliance formed five years ago that operates a health data sharing network enabling interoperability by using a suite of services, including its record locator service (RLS)—said that every year since its inception, CommonWell has tried to “push the ball on enabling patients and their caregivers to get the whole-picture view of the patient.” To this end, every year since it was launched, CommonWell has had more of its members’ clients get on the network, and more of their patients enrolled as a result. “Every time the next provider gets on board and connected, it provides value to the entire network,” said Asnaani.
He noted that while healthcare does happen nationally, as people move around everywhere, folks also do get a lot of healthcare service in their local communities. “In places where you have ‘snow birds’ or ‘beach bums,’ [for example], they have found value [from CommonWell] on day one. We have patient and provider stories from day one [of use]. And in other places, they’re looking for the next provider to get on board,” Asnaani said. “So, I look at this and think that of course, as we get more and more [people] connected, you’ll get more value for everyone, and the fact that you are connecting to other organizations outside [the network] is as important as connecting our own organizations. You want to try to help every single patient across the U.S.,” he said.
According to CommonWell officials, the network has more than 8,000 provider sites live with thousands more committed to using the services. And together, CommonWell members and Carequality participants represent more than 90 percent of the acute EHR (electronic health record) market and nearly 60 percent of the ambulatory EHR market, officials say.
Speaking to the specific claim by KLAS that “when CommonWell connects to Carequality, the entire Epic base [Epic Systems is a Carequality implementer but is not currently part of CommonWell] will become available, creating instant value for most areas of the country,” Asnaani said that CommonWell’s leaders are fully aware that there is a need “to connect to the greater world, including those parts of the world that are not in CommonWell right now and may never be.”
This is where the CommonWell-Carequality partnership will prove its value, according to KLAS, a sentiment that Asnaani seems to agree with. Specifically, CommonWell, per the December 2016 agreement, would become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequality participant. What’s more, Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.
Asnaani said that these types of connections are in the process of being made. He noted that “real work” on the partnership took place last year, and that the design, development and integration testing parts with several Carequality implementers have been completed. “There has been very positive collaboration between our members and Carequality implementers, particularly Epic and others,” Asnaani said. “It has already been a working relationship with software development and coding happening together,” he added. Implementation is specifically being broken down into two phases, Asnaani explained—first, piloting to make sure things are working, and then working out the kinks. “That part is imminent, and [we’re expecting initial connections] this spring. Then we expect it to be generally available for all CommonWell members and Carequality implementers by the summer.”
Regarding Epic, Asnaani said he doesn’t know if the industry giant will eventually join the network. But for the short-term at least, and maybe for the long-term, CommonWell members will be connecting to Epic via the relationship with Carequality. “If you get most of the top 20 EHRs connected, [with many of them on either CommonWell or Carequality and some which overlap], “we can drive interoperability everywhere,” he said. “When I look into the crystal ball, what I can see clearly is increasing connectivity. The path is murky now. There might be [increased connectivity] because of Carequality and CommonWell doing more together. It could be because of TEFCA [ONC’s Trusted Exchange Framework and Common Agreement] requiring person-centered interoperability nationwide. There are quite a few of paths that an organization could take to achieve this.” Asnaani added, “The good news is that everyone will be connected.”
Critiques of the KLAS Report
Another finding from the KLAS report was that for essentially all of athenahealth (which is part of both CommonWell and Carequality) and Epic clients, plug-and-play sharing is a “normal, everyday occurrence,” and that those vendors’ customers get a “head start” since these providers’ patient records are available automatically for Epic and athenahealth users, in addition to the customers of other vendors within Carequality.
But Asnaani called this specific critique “totally bogus,” asserting that the quality of data sharing is dependent on the vendors rather than dependent on CommonWell or Carequality. According to Asnaani, “athenahealth has almost its entire client base live with CommonWell today, and people are getting that mistaken. When I was with athenahealth, I helped build their interoperability platform, so I know that their process [is about] turning on [both CommonWell and Carequality] for [just about] everyone. It really depends on the vendor. The Epic team has done a great job with Care Everywhere. The rest of the industry has to choose what the right approach is to scale up participation of their users,” he said.
Asnaani wasn’t the only person to find fault in the KLAS report. Paul Black, CEO of Allscripts, a vendor that is an original CommonWell member—but has not yet signed up with Carequality—wrote in a blog post that the report failed to evaluate other data sharing initiatives beyond CommonWell and Carequality. “KLAS did not assess other methods of interoperability, including point-to-point interfaces, local health information exchanges (HIEs) and application programming interfaces (APIs).” Black called the KLAS research and approach “short sighted and dangerous.”