According to the Office of the National Coordinator for Health Information Technology, 96 percent of the health care industry is digitized with an electronic health record (EHR). Despite this level of digital engagement, getting a comprehensive view of a patient’s health record — regardless of when or where care occurred — has been a long-standing challenge for clinicians. According to a 2018 Black Book report, more than one-third of medical record administrators reported interoperability issues when exchanging health records with other providers. This impacts not only patient care, but also health care organizations’ bottom lines.
Improved access to patient data at the point of care can save patients the unnecessary cost and strife associated with locating health records and completing redundant tests. It also saves providers and their staff time in tracking down missing patient information. Access to relevant patient health data is a gamechanger for the industry that ultimately will result in better value, vastly improved patient experiences, reduced costs and decreased provider frustration.
To address many of these concerns and provide more streamlined access to patient data, CommonWell Health Alliance and Carequality announced a groundbreaking collaboration in 2016 to work together to improve nationwide interoperability. Most recently, CommonWell announced its connection to the Carequality Framework which will allow CommonWell- and Carequality-enabled health care providers, through some of the industry’s largest participating EHR vendors, to connect and bilaterally exchange health data to improve the delivery of care.
In this article, CommonWell Executive Director Jitin Asnaani, and Carequality Executive Director Dave Cassel share the collaboration’s progress and
Q: Can you give us a brief ‘state of the union’ for interoperability?
Dave Cassel: The analogy I use for the current state of interoperability is that Carequality has created something akin to a national electric grid. We’ve done a really good job setting up the grid and have seen a lot of success in some areas, but there is still plenty of work to do to get everyone connected. So far, the infrastructure has been used mainly for provider-to-provider exchange, and we’d like to work to get more stakeholders from across the continuum of
Jitin Asnaani: For CommonWell, we initially focused on creating a nationwide network, but also on creating a suite of interoperability services that our members could build directly into their software. Now, we want to expand beyond our own membership of CommonWell members, which is why we’re connecting to Carequality’s Framework. Now, content issues are becoming front and center. We’re questioning the quality and consistency of the data, and the degree to which it’s available as granular pieces of information versus whole documents. As Dave mentioned, we’d like to extend the grid. Organizations outside the mainstay of acute and ambulatory settings are an important part of health care’s fabric and are currently being underserved by interoperability. This is where we’d like to
Q: What are the basics of the CommonWell and Carequality agreement?
JA: The CommonWell and Carequality agreement has three parts. The first, and the most important part, at this stage, is that CommonWell has joined Carequality as an implementer. This means that once a CommonWell member agrees to participate in this connection, CommonWell-enabled clinical organizations have the option to connect to the 1,400 hospitals and 40,000 clinics nationwide that are part of Carequality. This enables providers, regardless of whether they are on a Carequality or a CommonWell network to directly query and retrieve data from one another. Preliminary rollouts of this connection with acute and ambulatory settings began in July 2018.
The second component is the introduction of the record locator service of CommonWell, which allows for access to patient data across the care continuum, into the
Finally, the third is a more general agreement for CommonWell and Carequality to collaborate on interoperability projects as they come up. Last year, for instance, CommonWell and Carequality had work groups dedicated to improving documentation templates that allow the exchange of patient charts. By working together on these sorts of initiatives, we can prevent work from going in two different directions and foster connections and partnerships where they previously
DC: The third part of the agreement — setting up mutual collaboration on interoperability initiatives between the organizations — might be overlooked given the first two items but will have increasing importance as time goes on. The combined CommonWell and Carequality community represents a large portion of the industry. Getting a group of providers, vendors and other health care organizations together to address specific issues with interoperability will help more effectively and quickly address the gaps in interoperability.
Q: What are some of the early results achieved?
JA: Since the initial rollout in July 2018 with two Cerner sites and five Greenway ambulatory sites, we’ve seen a fair bit of exchange. More than 400,000 documents have been exchanged between CommonWell and Carequality-enabled providers. Early reports from providers indicate an increase in access to patient records and a stronger foundation to deliver optimal patient care. We’re also learning that the way documents are produced varies from one EHR to another and it’s important for us to understand that. It underscores how difficult it is to meaningfully share data. Now there’s an opportunity for us to work on the granularity of the content and make the data itself higher quality.
DC: What we are hearing now is “give us more,” and that’s exactly what we expect to hear with CommonWell moving beyond its initial rollout of general availability to all of its members and their clients.
Q: What makes the collaboration between CommonWell and Carequality unique and different from other industry efforts?
DC: The scope of the collaboration is part of what makes it unique. When you look at the size of the CommonWell community and the number of organizations they represent and add them to those who were already engaged in Carequality, that’s a very large provider community linked into a national grid.
JA: The sheer magnitude and scale of CommonWell plus Carequality is unmatched. The fact that we’re connected and enabling a large swath of EHRs in a very competitive industry to work together in a productive way is unique.
Q: How will this collaboration improve both the provider and patient experience?
JA: This unfettered access to important, relevant patient health data cannot be underestimated. It is a gamechanger for the industry that will ultimately result in better value, vastly improved patient experience, reduced costs and decreased provider frustration. And the vision of driving more positive outcomes such as these is at the heart of why we do what we do.
Q: What is next for the CommonWell and Carequality collaboration?
DC: On the Carequality side, we are excited about the CommonWell rollout. Also, we’re looking to expand the usage of document exchange beyond provider-to-provider. We’re considering how we can get patients, health plans and other stakeholders engaged. The more we can provide a single on-ramp that everyone trusts, the better off we’ll be. Part of the focus for us will be to determine what policy and trust gaps might exist to hinder that goal. We’ve also expanded the technical platforms supported under the Carequality framework. We have work groups looking to apply our governance model to HL7®FHIR® standard-based exchange and to a push-based notification infrastructure.
JA: We are proud to break down yet another barrier to interoperability by making the much-anticipated connection available to our members and their clients. This increased connectivity will empower providers with access to patient data critical to their health care decisions. Our imminent goal is integrating our federated-query capabilities into the Carequality Framework; we want our record locator services to be available on Carequality. We’ll also be working hand-in-hand with Carequality on the FHIR-based exchange and push-based notification initiatives.
More than anything, we’ll see a continued connecting of the health care landscape. We both feel strongly about this collaborative approach; we see our members working together, reinforcing the fact that we all have a similar vision in mind — to not stand in the way of data exchange and help improve the delivery of care and health outcomes for us all.