New CommonWell Chief Speaks Out: Interoperability Progress, Epic, and More

April 6, 2015
Jitin Asnaani, the new executive director of the CommonWell Health Alliance, speaks exclusively to Healthcare Informatics in this Q&A. He touches on the group’s back-and-forth with Epic, its progress in developing a patient record locator, and other pertinent topics.

Two years can fly by fast.

CommonWell Health Alliance, an industry trade group made up of many of the largest electronic health record (EHR) systems vendors, was born at HIMSS 2013 in New Orleans. As HIMSS 2015 approaches, this year in Chicago, the group, like any two-year-old, can signify that it’s growing.

This past week, the Alliance added MEDITECH and a few other companies to the fray. A few weeks before that, a few members of the group announced it was making CommonWell service agreements an option for all of their clients. This means its patient matching and other services can be rolled out to an even wider audience than the initial pilot phase. As of today, it has seven geographies, more than 20 providers, and more than 26,000 patients connected.

It hasn’t been all rainbows and sunshine though. The group, and a few of its more prominent members, have engaged in a noisy battle with Epic Systems (Verona, Wisc.), a large EHR vendor that has decided to not join. The two sides have engaged in a war of words since CommonWell was born at HIMSS 2013 and that hasn’t slowed down. Most recently, during a Congressional hearing, Epic made it appear as if CommonWell was trying to sell data.

Diving into all this fray of excitement is Jitin Asnaani, who was named first executive director of CommonWell a week ago. Asnaani, who has a background in public and private interoperability efforts, comes to CommonWell from athenahealth (Watertown, Mass.), where he headed up product innovation and interoperability. Before that, he was involved with technical standards development at the Office of National Coordinator (ONC), product management at a health IT startup and strategy consulting at Deloitte.

Asnaani recently spoke with Healthcare Informatics Senior Editor Gabriel Perna about his new role, what direction he will take CommonWell in, and of course, Epic. Below are excerpts from that interview.

Congrats on the new position, you obviously have the background in both public and private interoperability enterprises. Why do you think having experience in both is essential for heading up CommonWell?

It’s essential because what we’re trying to do in CommonWell is build on the collective experience of our stakeholders, of the industry, of the nation to break down barriers of health information exchange. Government is an important stakeholder in that equation as are providers, patients, and the private sector. That’s why the diverse background appealed to the board as they were looking at potential candidates.

What are some of your first directives as executive director of CommonWell?

My priority is very clear. There has been a lot of interoperability activity and talk over the last several years and the proof needs to be in the pudding. We need building working infrastructures that can be deployed nationally so that interoperability is not a concept. It’s something that’s needs to happen in the real world. That’s my number one priority. [Figuring out] how we encourage our Alliance members to deploy and how do we encourage other folks to join us in building out services into our community.

Obviously you have been involved with CommonWell before in your position with athenahealth, how will you look at the organization differently now that you’re involved from an internal position?

That’s a good question. In some ways, there is no change at all. athenahealth is one of the original founding members of the Alliance because it resonated well with their philosophy of openness and removing that barrier to HIE that is exposed by data silos. Now that I work for CommonWell, I can translate that philosophy directly. I have the opportunity to work with stakeholders across the community without having necessarily a different title that I use during the day. I can now have 100 percent neutral conversations across the stakeholder base, across the various participants that are part of the Alliance.

What are some of the inroads you guys have made in the national patient identifier efforts?

The number one problem that we’re trying to solve is that when a provider wants information about a patient, or if a patient wants information about themselves….there is no good way for them to get it.

If you are planning care physician and want information about a patient, you have to ask the patient where they have been and then call and connect somehow with that provider. That’s a process ripe with gaps, errors, and opportunities for missed information. We’re solving that problem technically, how do you get those locations where a patient has been and make it easy for a patient to verify which record is his or hers and then you know their information. And it’s a patient-centered view. It’s a three dimensional view.

You’ve been doing some pilots on this?

It’s more than pilots. This concept of getting that information and making it actionable for the provider really only happens when the services are part of [the provider’s] workflow. So the data comes into that workflow at that point and is not a separate process like picking up a phone. It’s very much inside of the process. We’ve gone beyond pilots. Two years ago, we launched CommonWell. Within six months, we built something and one year ago, we announced pilots. We’ve since turned those pilots into production. Those four geographies where we started are doing real clinical exchange. Since then, we have added more [three] more geographies and this year, we expect to add more geographies, providers, vendors, and patients into the mix as go into full-scale production. That’s where we’re at.

What will be the key to getting this adopted on a widespread, national level?

The key is really to demonstrate that it’s working. There have been a lot of discussions on how interoperability should work. What we’re learning it doesn’t just happen. You need to put parts together to create a working functional service that people can acquire at a very low cost. It becomes a utility. Information is flowing the way water flows from a tap. That’s what it needs to look like.

Obviously, your organization has run into a difference of opinion with Epic. I know you saw their comments from last week and you guys gave a statement on that. Care to expand on your response?

I can’t really speak for Epic. I’m happy to reflect a bit. The level of conversation has become elevated to what is happening, what is real, and what is not real. I love that we have the opportunity to talk about the best ways to enable interoperability.

Two years ago, we were not sure what we were going to do. We knew there was a problem to be solved and the only way to get a bunch of competitors in the same room to talk was to use a non-disclosure agreement (NDA). It’s a common business tool to have discussions and make sure you don’t expose anything you’re not supposed to.  Since last June, when we opened up membership, not a single member that has joined since has signed an NDA. That’s a testament to our openness and our engaging the process. It’s enabled us to be seamless to expand our impact. In several respects, the interest generated by the discussion [by Epic at a Senate hearing on CommonWell], have helped us realize that we’ve taken a lot of big strides from the beginning in building a service that is open, transparent, and people can use. It’s been fabulous.

Just to be clear, we don’t sell data, we never have, we never will.  The interesting thing to me is that a few weeks ago, Carl Dvorak [COO of Epic] spoke on the HIT Standards Committee workgroup and said the nation needs is a record locator service. That’s what CommonWell has built. He suggested the government build it, which is where I guess there is a difference in opinion. But if we have one built by an organization in an efficient way…why would we go a different direction where we may not get a result that’s in production? We built something within six months of conceptualizing it. [You can] only get that from a focused collaborative of vendors.  

So you’re saying Epic wouldn’t have to sign an NDA to join CommonWell?

Nope. They wouldn’t have to sign one.

What you say to them to join CommonWell?

I would say to them, if they do believe in a vision where health data should be available to patients and providers no matter where care occurs then they should participate in a record locator service, which by their own admission is the only way to get person-centered healthcare off the ground and into reality in the U.S., and join us in making that reality. We have focused on bringing the collective experience of our vendors together. We have 20 members and counting in the alliance, almost on a weekly basis we have someone joining us. They need to join in as well and make this a reality so interoperability becomes a utility and not a basis of competition.

One of the things, Epic has mentioned in the past, when asked about CommonWell, is that they participate in Carequality instead. What do you say to that?

[CommonWell and Carequality] are quite different. CommonWell is two things: It’s building an infrastructure…we’re building a working network that enables health information exchange today. The second thing we’re doing is a record locator service that provides a provider-centric point of view. That’s different from what everyone is doing, but certainly with respect to Carequality.

I’m not saying we’re not supporting them, it’s just very different. We’re involved with [Carequality CEO Mariann Yeager] and her team, who we respect a ton, and helping them be successful. But while we’re working on infrastructure in the here and now, they’re working, and we’re working with them, to figure out what interoperability looks like in future. Those are two different, important roles.

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