CommonWell Alliance Inches Toward Better Interoperability

The ideal interoperable electronic health record system will never be as simple to use as an ATM. Healthcare data is just not that simple.

During this past summer's Congressional hearings on healthcare IT interoperability, the CommonWell Health Alliance was held up as a shining example of the kind of industrywide cooperation that should be emulated, and perhaps even given legislative blessing.

It was also compared to the banking industry's interlocking network of ATM networks, which has made getting cash from any ATM so easy, the question practically asks itself: Why can't getting healthcare data be just as simple?

But while the Alliance has done some laudable work, it remains unable to provide anything like that ATM network-of-networks experience today. I'm here to say that the interoperable EHR will never be just as simple as getting cash from the worldwide banking network, because it's just not that simple.

Today, the CommonWell experience, to the extent that it exists, is allowing a small, but growing number of physicians to query and retrieve some patients' medical records from far-flung healthcare systems and EHRs.

In fact, CommonWell set itself the goal of being live in 5,000 provider sites by the end of this year. If they make their goal, it's certainly progress. "We're still deploying it," says Jitin Asnaani, CommonWell's executive director.

But back to managing those expectations. Asnaani and others have positioned Epic's CareEverywhere network as the equivalent of Bank of America's closed ATM network in the 1990s, while the growing CommonWell network is akin to Cirrus, an ATM network-of-networks of that era. Cirrus did much to get us to where we are today, where pretty much any ATM from any bank can produce cash for an ATM cardholder.

Not So Fast
There's a problem with this analogy, however. First, CommonWell proposes to locate patient records anywhere they reside, and even with 5,000 providers online, it's more likely than not that any physician query at this point will not return any records on that patient.

Second, patients themselves have no idea how to choose physicians if one of their criteria is, whether the physician participates in CommonWell? It's as if the Cirrus network never put that familiar logo on the backs of all those ATM cards back in the 1990s.

So, ironically, although Asnaani describes CommonWell as a patient-centric network, patients really do not yet have the ability to use their market power to choose providers who are connecting to CommonWell. No directory of providers yet exists where CommonWell services are live and functioning.

This gives Epic's CareEverywhere a distinct advantage when it comes to the all-important marketing side of HIT interoperability. And Asnaani knows it.

"I actually agree wholeheartedly with your premise on the shortcoming of CommonWell," Asnaani says. He acknowledges that CommonWell has been totally focused on the physician experience. "The physician wants to either get the patient's information, or know there's no information out there, and once he knows one of those two things, in five seconds, he's done," he says.

"If there's no information out there, the moment he has to pull up a directory, the game is over. He's not spending any time on it."

And yet, Asnaani notes that parties who do care about the directory [of Commonwell participants], such as "the physician in an extreme case, but definitely the hospital administrator, definitely a third party who is trying to understand what the CommonWell network is—then I don't have a way of getting the list of places from CommonWell today. I need to go talk to individual vendors, and that's a pain."

This also makes it difficult for healthcare executives to interpret the ongoing stream of announcements of this or that provider—now including HIEs—which CommonWell keeps announcing have joined its alliance. Asnaani concedes there is no strong champion within the alliance to turn those announcements into information the public can use, such as, which providers are actually live on the network right now?

The bigger issue, even within CommonWell, is one of consent for disclosure of patient records across its network. While all providers who sign agreements with EHR vendors who support CommonWell are expected to sign reciprocal use agreements, to share and share alike what patient information they have, there are differences among how the different vendors approach patient consent for release of information.

For instance, as of the middle of 2015, all healthcare providers and practices using the Athenahealth EHR are opted into the CommonWell sharing agreement by default, and must opt out if, for some reason, they wish not to share records, Asnaani says.

In contrast, Cerner chose to approach each of its customers, many of whom are much larger systems and providers than Athenaheath services, and obtain opt-in consent to participate in the CommonWell network.

Despite that hurdle, Asnaani says Cerner has already signed up "thousands of facilities. They'll give their numbers at the end of the year, and it will be impressive, but it will be even bigger next year, because all the clients who have signed up this year are starting to roll out now, but they'll continue rolling out through next year."

Another initial CommonWell Alliance member, CVS Pharmacy, "indicated strong alignment with the vision and they still do, but there was not a use case that applied to the pharmacy at that point," Asnaani says. "Now we have a pharmacy use case that is almost complete, and should get completed in the next month. Then they can incorporate that into their product roadmap. So they'll take a little more time."

One other actor is also waiting in the wings, about to take the stage. Its name is Carequality, a collaborative announced in 2014 and which I mentioned here. A who's who of EHR vendors already belong to this organization, and CommonWell is in regular conversation with Carequality to identify mutual areas of interest. "I'm hopefully going to join Carequality in a more formal way over the next few months," Asnaani says.

So while the ATM network analogy quickly breaks down when healthcare reality intrudes, it could be that a new cadre of empowered patients, not just asking for their "damn data" but also name-dropping CommonWell or Carequality or CareEverywhere while making that request of their providers, might force some interoperability inroads in 2016.

There's been scant progress so far. We shall have to wait and see.