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Health IT Expert Tripathi Digs Deep on Impact of Epic’s Share Everywhere Release

September 15, 2017
by Rajiv Leventhal
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Micky Tripathi feels that patients driving the innovation is the important takeaway from the big Epic news this week

Earlier this week, when Epic Systems Corporation, the Verona, Wis.-based electronic health record (EHR) vendor—a health IT giant company whose platform some 190 million patients have an electronic record on—announced its latest technology upgrade that will allow patients to grant access to their data to any provider they want, there seemed to be an overall sense of optimism amongst industry observers in terms of what this means for interoperability growth.

Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, is perhaps as well-connected as anyone when it comes to health information exchange (HIE) and interoperability. Tripathi sits on the board of directors of The Sequoia Project (of which the Carequality interoperability framework is part of) and also does project management work for the CommonWell Health Alliance, which operates a health data sharing network of its own. Tripathi has been a part of countless meetings, conversations and project work within and for these organizations, with the broad goal always being to advance nationwide interoperability.

Tripathi caught up with Healthcare Informatics’ Managing Editor Rajiv Leventhal after the Epic news was released to talk about its impact, what’s specifically unique about it, and more wide-ranging interoperability issues at hand. Below are excerpts of that interview.

What were your initial takeaways from this announcement as it relates to how it could spur interoperability, given the market share presence that Epic has right now?

I think it’s a great, incremental addition to functionality and it [continues] what Epic has already been doing, which is contributing a lot to interoperability growth across the U.S. There isn’t new technology here and I don’t see it as a huge driver of interoperability. I actually think they are doing other things that are better and more important for interoperability that they don’t get as much credit for, such as pushing forward into [efforts] like Carequality, and [helping with] the connection between Carequality and CommonWell. Those things are very critical for interoperability and will have a lot more impact on interoperability compared to this [announcement].

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That being said, what’s really cool about this is that Epic is very good at being practical about saying where they are now, and [realizing] what’s an important step to take forward that’s isn’t necessarily trying to be bleeding edge, but rather will offer real value to people in a practical way that they recognize. So let’s implement this in a solid way that we have high confidence people will use, it won’t break anyone’s workflows, and we’re not expecting anyone to do anything heroic. But it does push people to do things differently and think about where these types of technologies can take us.

What I think is really great about this is that Epic, along with other vendors, have always had the ability to allow portal access to a patient’s medical record information for providers who are not using that vendor’s EHR. So that part isn’t unique—the ability to say, you’re not an Epic user but here is a way to issue you credentials so you can log into a portal via a  basic browser and see a patient’s information regardless.  And the vendors all sort of have that; that’s part of the Community Connect solution in Epic.

But that’s something that’s always been provider-driven. The provider himself or herself says, ‘My patient is going to a cardiologist, I know they’re not on Epic, I am going to reach out and see if they’d be willing to get a username and password to come into this portal so they can see this important medical record for this patient who we share.’ And that’s for providers who aren’t able to partake in the interoperability that Epic already has in place, like through Care Everywhere or Carequality.

So the important innovation here is that it’s not the provider who is driving it, but the patient. So you have the patient who might be at the ED and the physician wants to know which medications the patient’s daughter might be allergic to. But the patient can’t remember all of them. Now, that patient can go into the MyChart app, get a code, give it to that provider, and he or she can log onto the Share Everywhere website, type in that code, and up will pop the medical record summary that the patient could have gotten through his or her MyChart portal, but now the provider can look at it. And the provider can also now look at it and type into a text box whatever he or she want, and that [note] will go back to the provider who has the patient’s medical record, and who can then decide if it should be incorporated into the medical record. I think that’s a really cool innovation—the patient is driving it, the patient can decide who gets it, and another provider gets access to it when he or she wouldn’t have before.

You mention that even before this, Epic has had the ability allow portal access even for those who are on another system. That’s interesting since Epic has long been criticized for not being motivated to interoperate with non-Epic users. Do you see this as a false narrative?

I can’t speak to the history of it, but I do think there is a little bit of a false narrative there. If you look at what they’re doing with respect with to their active participation in Carequality, their active participation in the connection between Carequality and CommonWell, and that Care Everywhere is not an open network, but does have transactions with other EHRs, yes, I think there’s bad rap on them which is probably related to the fact they are so large and easy to pick on. And yes they have competitive juices flowing, as does Cerner and Meditech and Allscripts, but in general I wouldn’t put them in the category of being prime suspect number one of impeding nationwide interoperability. They have done a lot to continue interoperability, and they are a key driver—not a blocker—for where we are and where we’re going in the next 18 to 24 months.

A big part of this news is that interoperability will be more in the hands of patients, as you alluded to. Is this a direction where more interoperability efforts will be going in the future?

I think it’s a question of [patient] willingness, and that’s an important point. So that’s why I don’t think [this news is] a big driver of interoperability, but an important capability to put out there for those patients who want to do it. It also pushes the market a bit more; it’s another example of the market to say, here is another incremental step forward to putting more power in the patients’ hands—and that’s a good thing for everyone. This is not groundbreaking technologically, but it moves us one step closer to the world we want, which is patient-controlled apps. This specifically doesn’t preclude that or do that, but offers an incremental step towards that by saying patients aren’t teaming with apps right now, but I can offer something in a portal that can be helpful.

For the most part, the majority of patients at any given time don’t want to do this type of thing. They want their providers to be connected; they don’t want to be in the middle of it. At any given time, 10 to 15 percent of us have chronic conditions and have to think about the sharing of our records every day, but that’s not even close to half of all of us. Providers have to think about this every day, while patients necessarily do not. They come and go in terms of their episodic need for this kind of thing.

When you think about the interoperability initiatives out there right now, with CommonWell and Carequality, with CommonWell having sparred with Epic before, how might other vendors in CommonWell react to this?

I want to give credit to the other major vendors who are also leaning forward into interoperability. It’s not just an Epic thing; all vendors are doing important work—Cerner, athenahealth, Surescripts, Allscripts, [and others], too. You can point to Congressional testimony and tweets sniping back and forth between different entities, but I really think that’s completely behind us.

The work [I am talking about] that’s going on right now, and I can attest this since I directly observe and participate in conversations with Carequality (which includes Epic) and CommonWell (which includes Cerner), when we had the agreement last December, we’re now talking actively about where we are in implementation. The market needs this, so let’s keep track of it. By the end of the calendar year is the commitment goal for implementation at the first production site. We had a check-in last week and everyone is still committed to it. So it’s water under the bridge. Epic and Cerner are working cordially and collaboratively. And yes they are head-to-head competing, of course. That’s part of the [business].

When I say that I’m bullish on nationwide interoperability, if you asked a person not involved in health IT that we will, in the next 18 to 24 months, have live a system where most (80 to 85 percent) providers in the U.S. will be able to securely send a medical record to most other providers anywhere in the U.S.; and that most providers will be able to request and receive a medical record from most other providers in the country, would you consider that nationwide interoperability? And I’d bet most people would say yes. I am confident we will have all this in the next 18 to 24 months.


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Where is the Information Blocking Rule? Health IT Now Criticizes Missed Deadline

December 17, 2018
by Heather Landi, Associate Editor
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Industry group Health IT Now, a coalition of healthcare and technology companies, responded today to the Trump Administration's latest missed deadline for publication of a proposed information blocking rule as required under the 21st Century Cures law.

The proposed rule was sent by the Office of the National Coordinator for Health IT (ONC) to the Office of Management and Budget (OMB) on September 17, 2018, setting off a 90-day timeline for the agency to complete its review; a period which was now expired without publication of a proposed rule, according to Health IT Now.

The onus to publish the regulation falls on ONC, the health IT branch of the federal government that is tasked with carrying out specific duties that are required under the 21st Century Cures Act, which was signed into law in December 2016. Some of the core health IT components of the Cures legislation include encouraging interoperability of electronic health records (EHRs) and patient access to health data, discouraging information blocking, reducing physician documentation burden, as well as creating a reporting system on EHR usability.

The information blocking part of the law has gotten significant attention since many stakeholders believe that true interoperability will not be achieved if vendors and providers act to impede the flow of health data for proprietary reasons.

“Now, more than two years after 21st Century Cures was enacted, patients and providers are still without an information blocking rule - undermining the intent of the law,” Health IT Now officials stated.

ONC has delayed regulation around information blocking a few times already, previously stating that the rule would be released in April then revising its timeline to September, before finally submitting the rule to OMB on September 17th.  

As previously reported by Healthcare Informatics Managing Editor Rajiv Leventhal, during an Aug. 8 episode of the Pulse Check podcast from Politico, National Coordinator for Health IT Donald Rucker, M.D., said that the rule is "deep in the federal clearance process." And even more recently, a bipartisan amendment to the U.S. Senate's Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for Fiscal Year 2019 includes a requirement for the Trump administration to provide Congress with an update, by September 30.

“It is stunning that, more than two years after 21st Century Cures became law, we are still waiting on regulators to actually do what the law says,” HITN Executive Director Joel White said in a statement issued Monday. “Patients and providers have looked on with disappointment as the administration blows through one missed deadline after another for publicly releasing a proposed information blocking rule. It is time to say 'enough.' By continuing to slow walk these regulations, the administration is adding to uncertainty in the marketplace and is quickly reaching a point whereby it will be in obvious defiance of the spirit of the Cures law.”

White further stated, “Lawmakers who worked doggedly to get this landmark, bipartisan bill across the finish line should be incensed by the way that bureaucratic delays have weakened their signature achievement. This holiday season, the best gift that OMB could give consumers would be an expedited completion of its review and the public release of a robust information blocking rule. In the meantime, we are hopeful that industry stakeholders will not delay interoperability initiatives as a result of the ambiguity created by these continued delays.”

It is not the first time that the Health IT Now executive director has been publicly critical of the Trump administration for not yet publishing any regulation on information blocking. In an op-ed published September 8 in STAT, White wrote, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.” White added in frustration, “Health IT Now has met with countless officials in the Trump administration who share our commitment to combat information blocking. But those sentiments must be met with meaningful action.”

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Intermountain CMIO Stan Huff on the Need for Greater Interoperability: “We’re Killing Too Many People”

December 6, 2018
by Rajiv Leventhal, Managing Editor
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About 250,000 people die per year due to preventable medical errors, and that’s the biggest motivator there is for more advanced interoperability, says one clinical IT leader

Stan Huff, M.D., chief medical informatics officer (CMIO) at the Salt Lake City, Utah-based Intermountain Healthcare for the past 31 years, has long been a top leader in his field. Working on the leadership team for a health system like Intermountain and serving as a co-chair of the HL7 Clinical Information Modeling Initiative (CIMI), while also having been a former member of the ONC Health IT Standards Committee, Huff has a wealth of knowledge coming from both provider- and standards-focused perspectives.

Huff, who represented Intermountain at a White House meeting on interoperability this week, recently chatted with Healthcare Informatics about all things interoperability, including the different types of data exchange that exist today, the greatest barriers, and how potential pending regulations could shake up the landscape. Below are excerpts from that discussion.

When you look at the interoperability landscape today, how bullish are you on where things stand, broadly speaking? Or rather than bullish, are you more concerned?

I don’t know if I am bullish or not, but I think we are making progress—and it’s significant progress. There is an incredible amount of work to be done. I’m not concerned at the progress; I am happy, but mindful of how much work is left to do to really reap the benefits that people are hoping for.

You’re currently a co-chair of the HL7 Clinical Information Modeling Initiative while also having been a member of former the ONC Health IT Standards Committee. How important is it to figure out the issues around standards before things can progress?

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I wish it had a higher priority. Most of the time when people are talking about interoperability now, they are thinking about caring for an individual patient and thinking about sharing information between different systems that have information on that patient. They are usually thinking about EHR [electronic health record]-to-EHR for patient care—they have a very focused idea.

But there are other dimensions. There is interoperability relative to public health, meaning how we share data from an organization to a public health [entity] so that we understand what’s going on with a whole population relative to a particular disease.

There is also research interoperability, so we can share data that’s coming from research activities. And closely related to that is interoperability of clinical trial data and all of the randomized controlled trial data that comes with that.

Then there is interoperability that comes from devices and data coming from devices, which is a whole field onto itself. So you have to be careful when you talk about interoperability. This is one axis of interoperability, in that it has to do with the scope of systems you are communicating with.

The other axis of interoperability has to do with how truly interoperable you are, and there are different levels there as well. One level is the interoperability you get with the HL7 version 2 [standard], where you have a structure and people know how to send messages between systems. And there is a lot of negotiation that happens when you set up an HL7 version 2 interface to say what terminology you are using, and if you send something as two fields or one field. There is a lot that goes on there and that’s helped quite a bit when you talk about HL7 FHIR [Fast Healthcare Interoperability Resources]—it has a more defined structure and has more things specified about terminology use.

And then you can get an even better of interoperability if you are using the Argonaut [Project] profiles. But even at that Argonaut profile level, you aren’t plug-and-play interoperable. There still is ambiguity in the Argonaut definitions that lead to different implementations by different companies and organizations.

The highest level is what I would call “plug-and-play” where this no bilateral negotiation around terminology or anything like that. The standard is explicit enough so that it could be tested for conformance and you can say whether a given system is conformant or not, and the data can be used in the way it was intended. We don’t have any plug-and-play interoperability to speak of right now, and that’s what I’m trying to shoot for.

One of three biggest motivators for me is patient safety. There is really good and convincing data that shows we are killing 250,000 people per year due to preventable medical errors. And that won’t be solved by “zero harm” programs, or by “sort of” interoperable systems. In the end, the “sort of” interoperable systems means that a person still has to look at things and make a judgment. And people are not perfect information processors. So you need a situation where the data is explicit enough where I can write rules that prevent the death or improper treatment of patients.

And we are not at that level yet. How urgent is it? I think it’s incredibly urgent and you can make an argument that it’s more important than lots of other things we’re spending money on that would have less of an impact on patient care. I work in this area, so yes, I am biased.

But I’m persuaded that it’s worth an investment, and to get to where I want to get to will not be easy. This won’t be something where you make one $20 million investment and then it’s done; it will take five or 10 years, and you will make incremental progress over that period of time. Think of it like a military campaign or a crusade, because it’s that type of timeframe and scale where you need planning and infrastructure to really accomplish what we want to do in the end—which is save lives, decrease the cost of care, and reduce the burden of clinicians.

Many folks believe that until the business incentives change, stakeholders will not be incentivized to be open with their systems. Do you agree with this and how much incentive exists today?

There isn’t a whole lot of incentive yet. If the patient care and safety issues were sufficient enough incentives, then this would have been solved a long time ago because those incentives have been there. People know and understand that we’re not caring for patients in the best way possible. And it’s the financial and proprietary considerations that keep us from doing that, ultimately.

We have to be careful [with incentives] though, because there are unexpected consequences. Going back to when I was on the HIT Standards Committee, we thought that we were doing useful and good for U.S. healthcare when we set up the meaningful use measures. And while meaningful use solved the EHR adoption issue, what it taught people was how to manage measures but not manage quality.

People became incredibly good when it came to managing the measures to get paid and to meet the qualifications, but I don’t think anyone would assert that those things improved the quality of care in any measurable way. So I think we didn’t meet the goal that we were shooting for—providing better quality care at a lower cost.

The ONC annual conference took place last week, and there seemed to be significant conversations around pending regulations such as possibly making interoperability a requirement to stay in Medicare and prohibiting information blocking. How does all of this land for you?

I welcome the change; it’s a good as thing you move from meaningful use to promoting interoperability. What I don’t know is if these specific [rules] being proposed are going to accomplish what [we want]. We thought we were doing the right things back when we were doing meaningful use.

At a high level, I would agree that it would be wonderful to require interoperability as a requirement for Medicare participation. But it’s undefined. When talking about the dimensions and these things, there has to be an understood and a useful level for the interoperability that’s required. But I haven’t seen the details to know whether what’s being asked for is both achievable and valuable if it were to be achieved. But I do agree with the [overall] direction.

Intermountain is often at the forefront of health and health IT initiatives such as its sponsorship of the Opioid Community Collaborative. How can these learnings be shared so they can improve the digital healthcare ecosystem?

The thing I try to emphasize to people is that if you look at what we are doing, and you take it in aggregate across the country—the things people are applying decision support to—it’s a tiny part of what we could do. And the reason for that is we don’t have interoperability. You can create a good program at Intermountain, or at Kaiser Permanente, or at Mayo Clinic, but the only place it works well is where it was developed. You cannot move it. If you move it, you have to recreate it. Until you have interoperability, I can’t write a rule that works on top of a Cerner system and also on an Epic system, or for that matter works on two different Cerner implementations. This cannot happen until you have those platforms supplying APIs so I can hook my decision support up to their system without rewriting all of the logic in a different technology platform.

So we are doing good things, and want to continue to do good things, but wouldn’t it be wonderful if what we did, or what the University of Utah is doing with opioids, can be directly moved and used, in the same way people can buy apps for their iPhones in the app store, or any other platform.

The realization is we might be doing 150 things at Intermountain in terms of decision support applications, but there is an opportunity to do 5,000 things, and we will never get to those 5,000 things unless we get to an interoperable platform so that when knowledge is created it can be shared. That’s my real emphasis behind interoperability.

 


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KLAS: EHR Vendors Making Significant Progress with CommonWell, Carequality Connection

December 4, 2018
by Heather Landi, Associate Editor
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While most EHR vendors have connections to the national network, only athenahealth and Epic customers have connected en masse, KLAS reports
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With the establishment of connectivity between CommonWell and Carequality, announced back in August, as well as other interoperability advancements by electronic health record (EHR) vendors, the ability to exchange patient records is within the reach of most acute care or clinic-based provider organizations, regardless of size or financial situation, according to a new report from Orem, Utah-based KLAS Research.

In the report, “Interoperability: Real Progress with Patient Record Sharing Via CommonWell and Carequality,” KLAS researchers note that since the last KLAS report on interoperability, which was published in March 2018, the acute care/ambulatory EHR market has taken critical steps forward in sharing data via national networks. The most notable advancements include the establishment of the CommonWell-Carequality link, Meditech’s initial connection to CommonWell, and notable Carequality adoption among NextGen Healthcare customers, according to KLAS researchers.

Most of the prevalent acute care/ambulatory EHR vendors are connected to the national framework, marking significant progress for interoperability, according to KLAS researchers. The report findings come a few weeks after CommonWell and Carequality announced that the connection to the Carequality framework was “generally available.” Cerner and Greenway Health successfully completed a focused rollout of the connection with a handful of their provider clients, who have been exchanging data daily with Carequality-enabled providers, CommonWell officials said.

In August, CommonWell Health Alliance and Carequality announced initial connectivity, which is the beginning of a broader effort to increase health data exchange nationwide, and builds on an announcement made almost two years ago. In December 2016, CommonWell and Carequality 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.

Now, since the connection went live in July, officials noted that CommonWell-enabled providers have bilaterally exchanged more than 200,000 documents with Carequality-enabled providers locally and nationwide, as reported by Healthcare Informatics in November.

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CommonWell, an alliance formed five years ago, operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Major vendors connecting to CommonWell include athenahealth, Cerner, CPSI, eClinicalWorks, Greenway Health and Meditech.

Meanwhile, Carequality, an initiative of The Sequoia Project that launched about a year later, is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. Vendors using Carequality include athenahealth, Epic, eClinicalWorks and NextGen Healthcare. Nearly all major EHR vendors have aligned with one or both of these options, according to KLAS.

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 attest.

This latest KLAS interoperability follows a report back in March in which KLAS researchers positioned that the CommonWell Health Alliance’s interoperability efforts were hindered by a lack of provider adoption and its interoperability services currently lacked value. However, when CommonWell and Carequality eventually connect, “instant value” will be created for users, KLAS researchers attested in that report.

Currently, Epic is not a member of CommonWell, despite other major EHR vendors pushing them in that direction. Back in 2015, athenahealth CEO Jonathan Bush famously tweeted to Epic’s CEO Judy Faulkner that his company would pay for Epic to join.

Indeed, KLAS reported in March that CommonWell will likely see a significant adoption increase with a solid Carequality connection. “Since its launch five years ago, the tendency to over-market the level of adoption of CommonWell has created apprehension and a lack of trust among potential participants and prompted this report, showing a snapshot of providers’ success,” the researchers said in the March report. KLAS researchers also claimed that when CommonWell connects to Carequality, “the entire Epic base will become available, creating instant value for most areas of the country.”

Following the publication of that report, CommonWell’s Executive Director Jitin Asnaani, in an exclusive interview with Healthcare Informatics, defended his organization’s mission and attested that the network is continuing to grow and prove its worth.

Asnaani also critiqued the KLAS report’s claim that vendors such as athenahealth and Epic give their customers a head start by enabling plug-and-play data sharing via Carequality. 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.

KLAS Assessment on the Progress of CommonWell-Carequality Connection

In this latest report, KLAS researchers focused specifically on the progress EHR vendors have made in sharing patient records via the standardized (plug-and-play) networks of CommonWell and Carequality.

KLAS researchers assert that this focus is important because the “plug-and-play” option is the “only option” that allows provider organizations “avoid significant costs, delays, and organizational workload.”

KLAS also acknowledged that “virtually all major EMR vendors can successfully share patient records through the traditional point-to-point connections (a costlier approach in terms of time, resources, ongoing maintenance, and money), local HIEs (health information exchanges) and direct exchange (where records are manually sent to other providers).”

Referring to the CommonWell-Carequality connectivity as the “connection heard round the U.S.,” KLAS researchers contend that this connection should be “key in driving value and opening the floodgates so that any provider organization that desires to can exchange patient records with relative ease and little cost.” KLAS plans to measure the impact of this sharing in a 2020 interoperability report.

According to the report, this fall, two CommonWell-connected Cerner organizations tested and validated the ability to connect with Epic sites via Carequality. “Their initial reports are that the connection enables data sharing with critical partners otherwise out of their reach and adds tremendous value to their existing CommonWell exchange. The Epic sites involved indicate that they also are able to see and consume data via the new connection,” KLAS researchers wrote.

In a blog post, KLAS researcher Corey Tate, the author of the latest KLAS report, reiterated the value of the CommonWell-Carequality connection with regard to the availability of Epic data to provider organizations who connect. “Access to the Epic data is exactly what was talked about by the initial sites that tested the CommonWell connection to Carequality. Ironically enough, Epic’s intra-operability, which was initially dismissed, will likely be the catalyst that pulls widespread patient-record sharing forward. “

Currently, all but two of the other major EHR vendors—athenahealth, Cerner, CPSI, eClinicalWorks, Epic, Greenway Health, MEDITECH, NextGen Healthcare, and Virence Health (formerly GE Healthcare)—have customers connecting, according to KLAS. At this point, Allscripts and MedHost have yet to connect to CommonWell or Carequality. However, Allscripts recently announced more solidified plans to have their Carequality connection ready in Q1 2019 and to then roll it out in product updates throughout the year, according to KLAS. MedHost has been aligned with CommonWell since 2014 but has yet to have any live connections, KLAS researchers state.

While all of these vendors have connections to this national network, only athenahealth and Epic customers have connected en masse, according to Tate, in his blog post. “Each vendor has more than 90 percent of their customers connected. Cerner is next at around 35 percent. Many other vendors’ customer bases are just getting started,” Tate wrote.

“Epic and athenahealth have near complete uptake among their customers, allowing them to work on the next steps for interoperability, such as fine-tuning usability and increasing value for clinicians,” KLAs researchers wrote in the latest report. The researchers noted that plug-and-play sharing is “virtually invisible and automatic” for athenahealth and Epic customers, and “both vendors remove the big obstacles” to providers’ success.

KLAS researchers also highlight Epic’s and athenahealth’s approach to facilitating participation, via an opt-out approach, and removing governance barriers, via predetermined handling of outside data. The researchers contend that this indicates that “regardless of customer size, vendors can facilitate widespread adoption if they choose.”

NextGen Healthcare and eClinicalWorks show the most notable progress in connecting to the national framework, according to KLAS. Since NextGen Healthcare made their bidirectional connection available in Q1 2018, customers have rapidly taken up connections to Carequality. “With 80 customers connected, there is still much room for additional uptake—though NextGen has removed both financial and technical barriers to make this a reality. eClinicalWorks customers have also rapidly taken up connections, with nearly triple the number participating today (~2,500) compared to March 2018,” according to the report.

Meditech also made their first connection to CommonWell, and CPSI has made notable progress this year as well, KLAS reports. Cerner continues to actively push for customer participation and has added 35 hospital customers.

“Virence Health (GE Healthcare) has been slower to get out of the gate despite good feedback from early adopters,” the KLAS researchers wrote. “Greenway Health also doesn’t have much momentum, and overall, interviewed Greenway organizations are the least excited about their CommonWell connection.”

KLAS researchers also note that with CommonWell and Carequality linked, the biggest technical obstacle to widespread patient-record sharing has been removed, and the biggest remaining obstacle is local community adoption. “The healthcare industry is rapidly approaching the point where an organization using any of the major acute care/ambulatory EMRs should be able to easily connect to other provider organizations with minimal cost and effort,” KLAS researchers state. “Many vendors have eliminated obstacles on the path to data exchange—all but Virence offer connections to customers at no cost, and all but Cerner have made this plug and play by removing technical barriers.”

“Today, the biggest barriers preventing widespread participation are governance and the need for organizations to decide to participate. Even Epic and athenahealth customers report diminished value from their connection when local exchange partners opt not to connect to the national networks,” KLAS researchers wrote in the report. KLAs also believes that until other vendors take an opt-out approach, provider organization leaders will need to be proactive in promoting local connections to the networks to ensure high value from the connection.


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