From the federal government on down, there is no denying that the main goal of health IT companies in the next several years is to develop more interoperable electronic health record (EHR) systems that can “talk” to one another. In the middle of this strive for greater interoperability is an ongoing feud between CommonWell Health Alliance, an industry trade group made up of many of the largest EHR systems vendors, and the Verona, Wisc.-based Epic Systems, the giant health IT vendor which has decided not to join the alliance.
The two sides have been going at it since CommonWell was launched at HIMSS 2013 in New Orleans. Most recently, at a U.S. Senate’s Committee on Health Education Labor & Pensions (HELP) hearing, Peter DeVault, director of interoperability at Epic, suggested that CommonWell sells data downstream, which is a reason why Epic has not joined the alliance, according to DeVault. What’s more, Epic officials have said that in order to join CommonWell, they would have to sign a non-disclosure agreement (NDA), which DeVault noted in the hearing would suggest the possibility that CommonWell would indeed sell data.
CommonWell has since adamantly denied such claims—in a recent interview with HCI Senior Editor Gabe Perna, the alliance’s new executive director, Jitin Asnaani, asserted that CommonWell does not sell data and Epic would not have to sign an NDA to join them. Additionally, during an April 8 webinar on interoperability that was open to the press, two executives with the San Francisco-based McKesson—a member of CommonWell—further disputed these accusations, going into significant detail on how Epic is off-base with its comments.
On the call, Arien Malec, vice president of data platform solutions for RelayHealth (the Alpharetta, Ga.-based McKesson business unit that focuses on improving clinical connectivity) and former staffer at the Office of the National Coordinator (ONC), and Joe Ganley, vice president of federal affairs for McKesson, maintained that these Epic accusations were completely false. “We knew going in that the answer [to the question of us selling data] was no from the very beginning,” Malec said. “We have advocated for the notion of a centralized record locator service to enable interoperability and we knew going in that we had to be a trusted partner. Part of that is knowing that we were going to use data only for the purposes that we have been delegated for. We keep clarifying this, and I am hoping with this call, people will have a level of clarity. The answer is no, was always no, and will always be no,” he said.
Arien Malec
During the Q&A session of the call, when asked if Epic would need to sign an NDA to join CommonWell, Malec again said the answer was no, as it would be for every other vendor who wants to join. Originally, Malec said, there were discussions that would require collaborators to sign NDAs, but once the group became a non-profit association, those discussions ended. “There were technical details that people were concerned about, so that’s why you needed to design an NDA, but once we formed the alliance, we removed all of those obstacles,” Malec said. “Now, there is no NDA required for anything,” he asserted. Ganley added, “The NDA discussion was in the early days before the alliance was even formed. When competitors come together to talk about collaborating, that could happen. But it’s not an impediment then or now, and it’s not related to selling data.”
Another member of the press asked if CommonWell’s alliance was exclusive. To that, Malec said that the association cannot legally exclude anyone, and in fact added, “there has not been a single health IT provider who hasn’t been invited, both formally and informally to join. There are enough folks who are a part of us now, where it’s clear that if you want to join you can. This is a mission, we have a moral obligation to drive person-centered interoperability,” he said.
As such, when asked about Epic’s ability to share data, compared to CommonWell’s, Malec said that Epic has done a good job with data flowing on a point-to-point basis. “It’s like saying CompuServe is good on its own, though. [Epic’s systems] are good for two large systems, say Kaiser Permanente and the Department of Veteran Affairs (VA), that want to exchange data to each other,” he said. “If that’s how you define interoperability, by in large that job can get done right now. That’s not how we define interoperability, though.”
Malec said that CommonWell defines interoperability as person-centered, in which they are driving information around the person. “So you might have bits of your care record in the ER, bits at a pharmacy, and bits at long-term care facilities. You need the ability to pull that information together for the person and for care providers,” he said. “If you look at an example of a veteran or a service member, their care may be in five different places, so the point-to-point exchange isn’t getting the job done there,” Malec said. “That’s in many ways why we believe setting a high bar and high definition is important. It helps make it clearer what [the difference between] good point-to-point work and person-centered interoperability is.”
Speaking from a policy perspective, Ganley added that there has been positive reaction to CommonWell on Capitol Hill. “One of the myths you hear is that interoperability is way too hard to do, and that it’s not the same as with other industries. There is some truth to that but, they know [on the Hill] that there’s a way to do this,” he said. “And at CommonWell our message is ‘look, we’re doing this.’ We can communicate in an interoperable way across platforms. For all of the stakeholders in space, do they have the will to use this new business model and abandon the one that has you competing from closed systems?” asked Ganley.
As such, he added that the federal government has a crucial role to play in person-centered interoperability. “It’s important that policymakers avoid the temptation to micromanage efforts through incremental steps and an overly bureaucratic system,” he said. “We are advocating for the government to pay attention to the ‘what’ and ‘by when’ rather than the ‘how’ and ‘by who.’ That’s an important distinction as we move forward.”
