At Boston Children's Hospital, an Interoperability Win is Imminent

The hospital runs Cerner, but its affiliated physicians organization is implementing Epic, so new connections are arriving just in time.

Last month's announcement that Carequality and CommonWell are connecting their networks has apparently caught the imagination of health IT leaders at providers across the country.

Perhaps no organizations stand to benefit more in the immediate term than Boston Children's Hospital and its affiliated Pediatric Physicians Organization at Children's Hospital (PPOC). The hospital is running Cerner's EHR, and PPOC is going live on Epic's EHR at 80 practices representing 400 providers this March.

Moreover, the hospital actually runs Epic as well, to manage its revenue cycle.

Such a mixed bag of EHRs is practically a poster child for the need for CommonWell and Carequality to connect, which will first occur via pilots beginning in the first half of this year.

Two Networks Pledge to Work Toward Interoperability

To round out Boston Children's perfect storm of EHR interoperability needs, the organization faces exponential growth this year in the number of covered lives which will be in the organization's Medicaid ACO operated in conjunction with the commonwealth of Massachusetts, says Dan Nigrin, MD, the hospital's chief information officer.

"You can't provide the optimal care for the patient without knowing fully what's happening to them, so this interoperability is going to be a huge component of our ACO effort," he says.

By sharing patient data gathered by the practices and the hospital, both organizations stand to see a significant reduction in the cost of duplicative imaging studies and other tests. "It will reduce hard costs right away," Nigrin says.

"Don't ask me to put a number to it. I'm sure if I query the literature, I probably could find a number, but I don't know what that is."

Even though it is a Cerner customer, prior to now, Boston Children's had not joined CommonWell. It will now do so, even as the PPOC organization will join CareQuality, in order to enjoy the benefits of membership that will flow from CommonWell members being able to send directed queries to Carequality members, and Carequality members being able to access CommonWell's record locator service.

The integration will also finally quiet the chattering of fax machines currently moving records between the hospital and the independent pediatricians who belong to PPOC.

Faxing Persists
"Frankly, there's a whole lot of faxing that still occurs, despite having some of the interoperability infrastructure here within the state," Negrin says.

That infrastructure, the Mass Health Information HIway, was of limited value, because providers usually were invited to push patient data to other providers via the Direct protocol, when in fact physicians at the point of care wanted to pull that data from other providers–services delivered by both CommonWell and Carequality.

"From my perspective, the [Mass HIway] health information exchange is nonexistent, even in the context of being able to fax and or send messages through Direct," says Nael Hafez, CIO of PPOC.

"Those faxes are simply not received at the right time by the right person to be able to be of any use to them, and I've heard from many of our providers that they end up having to refax multiple times the documents that they they've sent to organizations including Boston Children's.

In addition, the CommonWell and Carequality integration will relieve PPOC and other providers from having to establish point-to-point or bilateral exchange agreements with other providers, Hafez says.

Progress Will Focus Providers
"When I look at a lot of my list of trading partners, 10 of them are either Meditech or Cerner [EHR] organizations. And we would have had [to have had] conversations with each one of them to establish contractual relationships and trust and figure out technically how to connect."

Both providers liken the new connections to those that built the current network of interconnected automatic teller machines. Like what occurred in banking, this progress will focus providers, including HIEs, on providing more valuable services on top of this network.

"We have to be prepared as organizations to continuously improve obviously on the services that we make available and provide through this architecture," says Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.

Tripathi, who helped facilitate the CommonWell/Carequality agreement, says such networks will allow the best services to compete and win on top of the unified networks. For instance, some customers may opt for or add additional record locator services, such as the one provided by the Surescripts network.

"It opens up a little competition," Tripathi says.