Over the last couple of years Interoperability between EMRs and other medical information systems has been a hot topic — largely because it’s such a difficult issue to solve.

In the absence of regulation, a veritable Tower of Babel has emerged with a range of competing initiatives with names such as Epic CareEverywhere, CommonWell Health Alliance, The Sequoia Project, eHealthExchange and Carequality being oft heard, but rarely understood.

This series of articles attempts to set the record straight on each of these initiatives by interviewing key personnel within their organization and explaining their responses in laymen’s terms that make sense to folks in the medical industry who may not have a deep background in interoperability.

I recently had the great fortune to spend an hour on the phone with Jitin Asnaani, Executive Director of CommonWell Health Alliance, who explained to me the vision of CommonWell and how he believed this industry consortium would help shape the healthcare IT landscape.

Disclosure: my company eHealth Technologies recently joined CommonWell, but is also a member of a number of other national interoperability efforts.

First, a little history.

CommonWell as a concept was born of a challenge laid down by Dr. Farzad Mostashari, former National Coordinator for Health Information Technology at a Bipartisan Policy Center Meeting. Faced with a federal law prohibiting even discussion of a national patient identifier, Dr. Mostashari challenged the assembled health IT leaders to come up with a market-driven solution to the patient identity since the government was unable to address the problem for them.

Two members of the Health IT Standards Committee, Dr. David McCallie from Cerner and Arien Malec from RelayHealth, accepted the challenge and began conversations about how services might be setup to identify and map patients between different care settings, and to use that knowledge to facilitate “universal” data sharing among the physicians caring for a patient.

As other vendors were drawn into helping to create that solution, the industry consortium that came to be known as the CommonWell Health Alliance was born.

What does CommonWell do?

CommonWell is built around core services to enable the exchange of patient clinical data. CommonWell provides a central “switch” and network approach that enables a scalable model for vendors and providers. The services provided through this central switch include:

CommonWell services
CommonWell services

Patient Identity Management based upon the Integrating the Healthcare Enterprise (IHE) PIX and Health Level Seven (HL7) FHIR standards that allows systems to easily lookup patients.

A Record Locator Service extending the FHIR standard with RESTful protocols for finding the patient’s records.

A Broker for Query and Retrieve using the IHE XCA & XDS.b protocol for document exchange.

 

What does CommonWell not do?

When I spoke to Jitin Asnaani (ED CommonWell Alliance), he drew me a fascinating mental image of a continuum of services that CommonWell is, is not currently, and will never be.

  • CommonWell is always about patients, their clinical care, and ensuring that patients and their medical personnel can access their health information..
  • CommonWell is not currently providing concepts like Social Security Eligibility — although the Social Security Administration has joined as a member of CommonWell to explore how CommonWell can support their needs. The Alliance is also not fundamentally about population health, but that’s a realm with such broad scope that excluding all possibilities is premature.
  • CommonWell will likely never provide solutions such as finding beds for patients, enabling financial transactions, or the use of population health for surveillance purposes.

Can patients access CommonWell?

It’s a misnomer that CommonWell is only intended for use at point of care by clinical staff. In fact, member companies such as MediPortal and Mana Health are looking to provide patient facing apps that use CommonWell to retrieve data on behalf of patients. So called “tethered EHR patient portals” also will soon make use of CommonWell services to make health information directly accessible to patients.

How does CommonWell interact with other initiatives?

  • CareEverywhere is an Epic initiative that allows for records exchange between Epic sites and has APIs that other vendors can use to access the data. Jitin Asnaani remains convinced that CommonWell and Epic will work together in the future, especially as more Epic customers express interest in being connected to the CommonWell network.
  • The Sequoia Project evolved out of the Nationwide Health Interoperable Network (NwHIN), and has two key exchange initiatives:
    • Carequality, which exists to promote a network-to-network trust framework and the common usage of standards within participating organizations.
    • eHealth Exchange, which consists of government agencies and other organizations that have grouped together to allow for peer-to-peer data sharing within their community.

The Sequoia Project also leverages standards based upon IHE and HL7, so there may be natural ways in which its initiatives will cooperate or even interoperate with CommonWell moving forward.

  • Private APIs are sprouting everywhere and there are now a very large number of companies who claim to get you access to a complete patient longitudinal record through a single point of entry into their “healthcare operating system”. Most of these are based on either FHIR-based access to the local record or foundational services such as CommonWell or Sequoia while providing additional layers of functionality aimed to simplify access or add value to the data returned by the network.

Why will CommonWell be successful?

With so many efforts underway in interoperability, it can be hard to see the forest from the trees, much less understand which of these competing initiatives will forge the new path into the interoperable health system.

Jitin Asnaani believes the success of CommonWell lies in the fact that it is a patient-centered solution that takes vendors and locations out of the equation and focuses on care. The solution “requires and engenders collaboration among vendors that other solutions cannot enjoy, by having vendors build CommonWell access into their products”.

I believe that CommonWell will be successful because it has developed a solution that fundamentally “works” and now includes a sufficient mass of participants (more than 4,500 connected healthcare facilities and counting) to create the momentum necessary to attract further interest and participation. CommonWell is based on an established technology, provided by RelayHealth, that ensures that APIs are well defined. Also important is the work by CommonWell to drive real-word Use Cases (as defined by its participants) to define how CommonWell is utilized. All of these components add up to an effort that is moving in the right direction and has attracted enough interest and real-world application to be a long-lasting national interoperability platform.

 

One thought

  1. Great piece Colin. I absolutely believe that a national system for electronic sharing of health information is necessary and inevitable. My concern is that there is far more buzz being generated by the promise of these initiatives (CommonWell included) than is yet justified by their progress to date. The journey is long and complex. CommonWell and the other national level initiatives underway are still early in the process; taking the initial steps necessary to build a critical mass of connected participants. There remain important questions about how existing state and regional networks will be integrated into their national systems, and compensated for sharing their data. Also a concern is the Opt-In/Opt-Out status of individual states, and how reciprocity will be equitably maintained. The answers to these and other such questions will provide important insight into CommonWell’s future prospects. If the ONC’s HIE Cooperative Agreement Program taught us anything, it’s that defining a workable sustainability model early on is critical for long term success. I am all for big hairy audacious goals and articulating a compelling vision. As to whether or not they’ll actually reach the promised land? It’s still WAY too early to tell.

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