Athenahealth, Epic and Other EHR Vendors Adopt Carequality Interoperability Framework

Jan. 22, 2016
Five major health IT vendors – athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescripts – have signed on to be the first to implement Carequality’s framework for interoperability and data sharing principles, the organization announced Thursday.

Five major health IT vendors – athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescripts – have signed on to be the first to implement Carequality’s framework for interoperability and data sharing principles, the organization announced Thursday.

Carequality, a Washington, D.C.-based public-private collaborative and an initiative of The Sequoia Project, released its interoperability framework in December, which consisted of multiple elements, including legal terms, policy requirements, technical specifications, and governance processes. The Framework operationalizes data sharing under the previously-approved principles of trust—the policy foundation for connecting health data sharing networks throughout the U.S.

Dave Cassel, director of Carequality, said the adoption of the framework by the five health IT vendors represents “a major leap forward for nationwide interoperability.”

The five organizations have agreed to provide health information exchange services for their customers under the comprehensive Framework. “The most fundamental thing that they have essentially agreed to do is to allow their customer bases to all connect to one another so that once this is all fully rolled out any athenahealth client can connect to any eClinicalWorks client who can connect to any participating Epic client,” he said.

Cassel experts the first wave of organizations to have live connectivity during this first quarter.

“First and foremost, with this agreement, we have agreed to a framework of trust, which we think is the biggest barrier to interoperability between different healthcare delivery organizations,” Girish Navani, CEO of eClinicalWorks said.

As the initial implementers, eClinicalWorks, athenahealth, Epic, Surescripts and NextGen Healthcare, and their clients, will benefit from accelerated, less costly health data sharing agreements, according to Carequality officials.

Until now, health information exchange was preceded by one-off legal agreements between individual data sharing partners, which involved lengthy and costly negotiation and inconsistent experience in quality and quantity of data exchanged.

“What this will do for us and our customers is speed the time from end user agreements to being able to go live with real interoperability between disparate systems,” Navani said. “It’s not a new technology framework because most companies have already implemented standards around their own product lines of interoperability and we’ve had these standards incorporated into our products for years, but it gets away from point to point and system to system, making it faster to do it.”

“The problem with interoperability, Navani continued, “is the amount of time and energy and resources it takes to go live as everything has to goes through a testing process, a legal review  process and everything requires a new installation to be proven by two end parties. This eliminates that big runway.”

These five health IT vendors, as the initial adopters, will focus first on query-based exchange of clinical documents and Cassel said he envisions eventual expansion to other use cases.

“There are lot of other things we’d like to enable, such as better care management workflows and care coordination between members of a care team at more of an individual level and image content as opposed to just document content. And, all of these individual technical use cases, we can now develop relatively easily because we have a unifying governance framework that we can apply to technical challenges as we have the implementation guides for those particular use cases,” he said.

He also anticipates the Carequality community to grow to include not only other vendors, but also providers, payers, government agencies and health information exchanges (HIEs). “I think likely the next type of organization that you would see would be HIE networks, whether state, regional or otherwise, and we hope to have the national eHealth Exchange network adopt the framework as well.”

The collaboration between competing health IT vendors, particularly EHR vendors, may seem surprising. Some in the industry have complained about Epic's lack of "openness." And, Epic declined to join CommonWell Health Alliance, a vendor-led interoperability initiative, of which athenahealth is a founding member. As previously reported by HCI, executives from Epic, Cerner and athenahealth traded jabs last year after an Epic executive, during a Senate committee hearing, reffered to CommonWell as an "aspiring" network and pointed to CommonWell's membership and service fees.

However, Cassel said getting all five health IT vendors to the table to collaborate was not a challenge.

“I think they all understand that it’s in healthcare’s best interest, and ultimately their best interest and their customers’ best interest, to be able to exchange with one another and they see the benefit of doing that in a standardized way and it saves them and their customers a lot of time and effort to not do these connections individually,” he said.

In a statement, Doran Robinson, vice president of network integration for athenahealth said, “athenahealth believes that physicians should be allowed to focus on patients, not the hassles of coordinating care. We’re thrilled to join other major players in reducing the legal and regulatory barriers that impede the development of a national health information backbone that connects care settings, regardless of vendor or service provider.”

“The Carequality Framework is a testament to healthcare vendors’ commitment toward making seamless interoperability a reality for patients and providers,” Dave Fuhrmann, vice president of interoperability for Epic, said. “Shared rules and guidelines are going to make it possible for all of us to dramatically increase the number of connections we have across systems to make care safer and more efficient.”

Cassel said he believes providers and health IT vendors are attracted to Carequality because it’s a “vendor-neutral, technology-neutral” exchange and the underlying principles were developed by an “open, broad stakeholder governance process.”

Mariann Yeager, CEO of The Sequoia Project, said Carequality was “born out of a spirit of collaboration.” She continued, “The most compelling thing about Carequality is that it’s not just one problem that we need to solve to enable this data sharing, it’s the process and the forum and the collective voices of our broadest industry that’s helping us to solve this together.”

“I think that it’s exciting four our country to now have a foundation of policies and a governance process that can support a multiple of use cases and data sharing and needs going forward,” she said.