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Healthcare’s Latest Interoperability Push

January 17, 2017
by Rajiv Leventhal and Mark Hagland
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Recent collaboration among big-name EHR vendors signals a new push towards greater health information exchange, although barriers in the market still remain

Across the healthcare ecosystem, it’s hardly a secret that providers struggle to get pertinent medical information from exchange partners who use a different electronic health record (EHR) from their own. And if the provider wants to do something impactful with that health data—say receive it in a way that facilitates improvement in patient care, for example—the struggle becomes even more real.

These viewpoints were confirmed in KLAS’ Interoperability 2016 report last October which found that, based on a previously-developed interoperability measurement tool, providers are reporting very low rates of impactful data exchange. In the report from the Orem, Utah-based KLAS, which included interviews with more than 500 EHR end-user clinicians, providers were quick to say that interoperability is more than just access to outside patient records. For interoperability to truly move the needle on better care, outside records must be (1) available, (2) easy to locate, (3) situated within the clinician workflow, and (4) delivered in an effective way that facilitates improvement in patient care. But KLAS found that true “home runs” in which all four criteria are met were only reported by 6 percent of providers surveyed.

Indeed, the concern that “real” interoperability in healthcare has yet to be accomplished is not new. But recently, there have been developments on at least one major front: big-name EHR vendors have shown an increased willingness to collaborate as their hospital and health system clients ramp up the pressure for patient data to be made available whenever and wherever they need it.

To this end, early on in 2016, five major health IT vendors—athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescripts—signed on to be the first to implement Carequality’s framework for interoperability and data sharing principles. Carequality, a Washington, D.C.-based public-private collaborative and an initiative of The Sequoia Project, released its interoperability framework the previous December, which consisted of multiple elements, including legal terms, policy requirements, technical specifications, and governance processes. Prior to the framework, health information exchange was preceded by one-off legal agreements between individual data sharing partners, which involved lengthy and costly negotiations and inconsistent experience in the quality and quantity of data exchanged.

This partnership was also particularly noteworthy as there have been rifts between the Verona, Wisc.-based Epic Systems and the CommonWell Health Alliance, a vendor-led interoperability initiative, of which athenahealth is a founding member. Epic had until recently refused to cooperate with CommonWell; but, publicly anyway, that quarrel seems to have been quashed. 

More evidence of vendor collaboration is the very recent agreement between Carequality and CommonWell that will make CommonWell 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. Carequality will also work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.

Indeed, the effects of these efforts could ripple through the industry as 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. More than 15,000 hospitals, clinics, and other healthcare organizations have been actively deployed under the Carequality framework or CommonWell network.

How else will this agreement spur interoperability progress? According to Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, the arrangement is “akin to AT&T and Verizon Wireless cell phones finally being able to talk to each other.” Tripathi, who was heavily involved in the facilitating and negotiating of the agreement as he sits on the board of directors of The Sequoia Project and also does project management work for CommonWell, says that as it previously stood, there was a lot of development,  network formation, and maturity on both sides, but in siloes. “Providers were facing issues on the ground level,” he says.

Tripathi mentions a large provider organization he knows that is switching from Cerner to Epic. Previously, that organization’s switching from Cerner to Epic could have led to complications, as Cerner is in CommonWell but not in Carequality, and vice versa for Epic. “The [organization’s] CIO said to me six months ago that he’s not looking forward to the conversations he will have to have with his clinicians, which is that you have great interoperability with your current system, and your future system, but the bad news is you won’t have the interoperability with the same people. Now he doesn’t have to say that to his doctors anymore since [they all] are connected to the same people regardless of what network you are on,” Tripathi says, speaking to the impact of the agreement.


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