Interoperability is all around us. That’s where it can get confusing.
There are countless interoperability initiatives in operation today. Whether it’s a dedicated health information exchange, a standards development workgroup, or something else, they’re going on at both the national and regional levels across the country, from private and public stakeholders. Some of them bleed into each other and others are competing. Some organizations run multiple interoperability efforts.
Such is the case for one of the industry’s more well-known administrators of interoperability, Healtheway, a nonprofit organization based in McLean, Va., that runs the Carequality and eHealth Exchange initiatives. Healthcare Informatics Senior Editor Gabriel Perna recently spoke with Mariann Yeager, CEO of Healtheway, to get a better idea of those initiatives, what the organization does in each, and how they are progressing on advancing interoperability. Below are excerpts from that interview.
Healtheway has two major initiatives – Carequality and the eHealth Exchange. For our readers, can you explain how these initiatives differ?
We support two initiatives. One is the eHealth Exchange. The simplest way to think of the eHealth Exchange is it’s the country’s largest health information exchange network, which enables the federal government and private sector to really share records using a common governance structure and a common framework. It connects 30 percent of U.S. hospitals, 10,000 medical groups, and one hundred million patients. It’s a completely federated network. There is not a centralized connection point. It’s an open, interoperable approach using standards.
Carequality is a multi-stakeholder initiative to build a connected web of data sharing networks. It’s recognizing that there are other networks out there and however providers and vendors are getting connected, we need to get those networks to share data with each other. It’s like how cellular networks work regardless of which plan you’re on, you can still make calls nationwide.
Carequality is driven by the work of volunteers from 70 different organizations across the health IT ecosystem coming together to figure out how to interconnect those data sharing networks.
Can you give me an example?
You have different networks that connect hospitals to each other. Some are regional, CommonWell, that’s a network, it just happens to be built around a record locator service. The eHealth Exchange is a network. Surescripts supports a network. There are a lot of networks that share data, but they’re built around a particular technology platform or a particular architecture or use case. Careequality is about bringing the community together to minimally agree to establish trust to connect those networks to enable information exchange while respecting their autonomy.
The eHealth Exchange community would like to share information with other networks without having to have all the other participants in the eHealth Exchange network join and onboard five or six or seven other networks. Carequality is trying to solve the issue of connecting different networks and not boil the interoperability ocean. There are many facets of interoperability. We’re trying to connect those networks for specific business cases, starting with the query for records.
Do you guys plan to be broadly interoperable or more on a case by case basis?
It will ultimately be broadly interoperable, but it’s focusing on solving interoperability one step at a time. The issue of interoperability is really just an overused term and can cover many aspects. You need standards, a critical mass of those systems, you need providers and hospitals having access, and then you can talk about connecting them. [Carequality] is leveraging the market to figure out what we need to work with at the time. It’s an incremental approach, rather than trying to boil the ocean.
What is the latest with Carequality?
There has been phenomenal progress. Carequality was first launched in early 2014. In 2014, the multi-stakeholder governance process was set up and established. It was formally chartered and has been working for about nine months now. It’s been working very well. There are foundational policies that have been agreed upon in the community and have currently been translated into a legal framework, so that a network that wishes to be Carequality will be obligated to comply with those policies. They ensure trust from the stakeholder and ensure that it will work. We’re finishing up developing the query-use case, which are the standards the community has agreed to implement to enable the query of information. Testing is underway, and we’ll be demonstrating the connectivity across the platforms at HIMSS, which will be followed by a pilot.
Shifting to eHealth Exchange, where are you in that initiative?
The eHealth Exchange has had a really incredible trajectory of growth in adoption. The eHealth Exchange has six years of production experience in extensive connectivity. On top of the 30 percent of hospitals and 10,000 medical groups, we’re starting to see other types of care providers able to connect through the exchange. The vendor community is coming together and realizing the benefit of using a standards-based approach for information exchange. The eHealth Exchange supports a common governance structure process and a legal framework support that can support a multitude of use cases. The idea is it’s connecting communities, through hospitals, HIEs, HIOs, government entities. It’s a nationwide network.
How are you recruiting?
The demand and interest in joining the eHealth Exchange has been driven by the desire and need to share data with others in their community. We don’t really recruit. Providers are finding value in using a standardized approach to share data with others, rather point-to-point agreements. There is also interest because by joining the eHealth Exchange, eligible hospitals and providers can get for transitions-of-care measures for meaningful use Stage 2. There is also the ability to exchange data with the government. If a patient receives care at a VA [Department of Veterans of Affairs] medical center, a provider at another hospital has the ability to exchange data with them. That’s incredibly important. It’s value driven from demand.
How is it paid for?
With the eHealth exchange, they pay annual network dues in a tiered structure ranging from just under $5,000 per year for smaller organizations up to $19,000 per year. Those are network fees. No transaction fees, it’s just a flat fee. That covers the support that is provided to them, both in maintaining the legal framework, supporting the workgroups and governance process, as well as the digital certificates used to authenticate an exchange and the registry. The things we manage to support the network is what it covers. It’s a nominal fee compared to a lot of different approaches.
We’re seeing a lot of challenges with HIEs, with sustainability and getting organizations to work with each other. What’s the advantage that you guys have?
Healtheway is a neutral third party, we’re Switzerland. We are charitable organization. Our mission is to serve the public good and we will continue to lead through collaborating across industry and government to what’s best for the industry. We’ve had a lot of success to date, and believe our future success will be continuing on this path.