CommonWell, Carequality Agree to Collaborate for More Advanced Interoperability

Dec. 15, 2016
CommonWell Health Alliance and Carequality have announced connectivity and collaboration efforts that will aim to provide additional health data sharing options for stakeholders.

CommonWell Health Alliance and Carequality have announced connectivity and collaboration efforts that will aim to provide additional health data sharing options for stakeholders.

The agreement specifically has three core aspects, according to officials in a joint press release announcement today:

  • CommonWell will become 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 work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.
  • CommonWell and The Sequoia Project, the non-profit parent under which Carequality operates, have agreed to these initial connectivity efforts and will explore additional collaboration opportunities in the future.

Officials noted that while future collaboration could touch on many different areas within healthcare IT, the immediate focus of the work between Carequality and CommonWell will be on extending providers’ ability to request and retrieve medical records electronically from other providers. Some types of information exchange capabilities, such as electronic prescribing and electronic lab results delivery, are already widely adopted. However, variation in data exchange implementation is still a challenge for some providers looking to exchange medical records with others across the care continuum, they said.

CommonWell Health Alliance operates a health data sharing network that enables interoperability using a suite of services aiming to simplify cross-vendor nationwide data exchange. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve multiple records for a patient from member systems.

Meanwhile, Carequality, an initiative of The Sequoia Project, is a national-level, consensus-built, common interoperability framework to enable exchange between and among health data sharing networks. It brings together electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks and platforms.

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 noted.

Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, 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, notes that the arrangement is “akin to AT&T and Verizon Wireless cell phones finally being able to talk to each other.” Tripathi says that as it previously stood, there was a lot of development and network formation, and maturity on both sides, but in siloes. “Providers were facing issues on the ground level.”

He adds, “A large provider organization I know is switching from Cerner to Epic. So Cerner is in CommonWell but not in Carequality, and [vice versa] for Epic. And the 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.

Adding more specificity, Tripathi notes the core interoperability functionalities that people are able to do now, such as sending lab results and the direct sending of email messages from one provider to another. “This ability to query from one system to another was the last core building block, and at least from a technical and network perspective, that is now solved.”

Tripathi further explains that CommonWell was built with an understanding that patient identification is a huge issue that needs to get solved among the different vendors in the clinical sites. And in order to do that properly, there is the need for a central infrastructure. “If everyone were to do that on their own at a robust level it would cost a lot more money compared with polling resources and building a central infrastructure. So in a sense [vendors] outsourced that to CommonWell to build that centralized infrastructure for patient matching and record location,” he says.

Meanwhile, Carequality doesn’t have record matching in the middle, as it’s a framework, Tripathi continues. “So they are basically saying that there is a phonebook of provider organizations, and you can look up a provider in that phonebook and ask them if they have X person’s medical records. No central infrastructure is needed for that.” Tripathi explains that a part of the reason for this is due to large vendors like Epic having only 300 customers or so but vendors such as athenahealth and eClinicalWorks having some 30,000 customers sprinkled around.

As such, for Epic, when they were designing their architecture 10 years ago, “they were thinking mostly about connecting to relatively smaller numbers of sites” in the beginning rather than connecting up to large numbers of other sites, Tripathi says. “In Cleveland there are four large Epic installs, so do I really need to set up a central infrastructure for record location or is it more efficient to set up a system where each of the four sites can ask the others for records and send them to each other? That’s basically how Carequality works; they still do record location but because there are fewer records, they decide to do it in a more efficient way for them. But for an athenahealth, you can’t send out a blast message to 10,000 different sites. So that vendor needs a central infrastructure that passively collects information from all sites on patient encounters. You have these two parallel paths based on different assumptions on what’s needed in the market and based on their customers, and they are now merging,” he says.

There is also another subtlety to the agreement that Tripathi points out as being significant: per this arrangement, an Epic customer, for example, who wants to purchase the CommonWell record locator service will now have it be available to them within Epic’s platform, serving a layer on top of the vendor's Care Everywhere interoperability software. “It’s almost like using Internet Explorer, Chrome, or Firefox,” says Tripathi. “An Epic customer can purchase the Surescripts record locator service or the CommonWell record locator service, or both. Epic and others have committed to being indifferent; they will offer it in their platform integrated into the workflow of the provider based on what service the provider wants to purchase,” he says.

Tripathi adds now that the query problem is solved, the next step is to improve on the content challenge. He notes that right now, the vehicle for exchanging multi-type clinical information is the continuity of care document (CCD) and clinicians aren’t happy with that for a variety of reasons such as too much optionality and not enough standardization. “So this agreement doesn’t solve the content issue,” he says.  “In a way all it does is make it easier for you to get that thing that you weren’t happy about to begin with. That’s the next challenge—how do we actually improve on that content so you’re happy with what you get back?”

What's more, both Carequality and CommonWell officials spoke to the importance of this agreement. “Collaboration and inclusion are the keys to success in health data sharing and interoperability,” explained Dave Cassel, director of Carequality, in a prepared statement. “The Carequality Interoperability Framework was developed by a group of diverse healthcare stakeholders, including members of CommonWell, determined to establish health data sharing as the standard of care by powering connectivity between and among health data networks of all types. With the promise of heath data sharing across Carequality’s participating networks and the CommonWell network, we continue to advance toward that goal. It’s a win-win-win for patients, providers, and their networks.”

Jitin Asnaani, executive director of CommonWell Health Alliance, added, “To achieve nationwide interoperability that truly improves patient care, two things are required:  collaboration across the healthcare industry and the will to take real action. We’re doing both.” He continued, “Our vision has always been for a patient’s health data to follow him/her regardless of where care occurs, and in turn give providers and caregivers increased access to critical health data when and where it is needed. We believe this connectivity between CommonWell and Carequality will continue to move the country forward on its path to achieving nationwide data exchange by bringing together such a sizeable majority of providers and patients that there will be no turning back for American healthcare.”

Officials from Watertown, Mass.-based EHR vendor athenahealth, a member and implementer of both CommonWell and Carequality, additionally weighed in, noting that healthcare providers on the majority of the country’s EHRs will now be able to electronically request and retrieve patient medical records from one another in a consistent, standard format. They added, “This alliance brings together otherwise competing market players, which is necessary for data sharing, but not sufficient for creating a fully-connected, integrated healthcare workflow. True interoperability is not just a matter of moving bits across the wire and deluging providers with every care note and encounter. True interoperability will be achieved when information can follow the patient in an unencumbered way.”