CommonWell gets rolling on data exchange

Big name competitors cooperate on interoperability, 'ubiquity' of information
By Mike Miliard
09:27 AM
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CommonWell Health Alliance has tapped the first three geographic locations for its rollout of interoperability services. Hospitals and ambulatory practices in Chicago, North Carolina and South Carolina will connect to exchange patient data.

The providers taking part in the interoperability project include Lake Shore Obstetrics & Gynecology in Chicago; Hugh Chatham Memorial Hospital in Elkin, N.C.; Maria Parham Medical Center in Henderson, N.C.; and Midlands Orthopaedics and Palmetto Health, both of Columbia, S.C.

The project represents the first fruition of the mission announced when CommonWell's first six vendor members – Allscripts, athenahealth, Cerner, Greenway, McKesson and RelayHealth – came together at HIMSS13 in New Orleans this past March: connecting providers of all stripes, helping them exchange data with ease among disparate care settings, irrespective of vendor or IT system.

Together, the alliance's members – CPSI and Sunquest joined the founding companies in July, and more firms are invited to join, officials say – represent 42 percent of the acute and 23 percent of the ambulatory EHR market.

[See also: Two join CommonWell Health Alliance]

"Our goal was to not build new standards where standards already exist," Scott Stuewe, director of client results at Cerner, who leads CommonWell's program management committee. "We pretty much tried to utilize the existing IHE standards around XCA document exchange as our starting point."

It was crucial that those standards be "built-in." said Stuewe. "The big differentiator, I think, is that since the suppliers are leading this exercise, it's a matter of us building these capabilities into our applications and committing to do that."

The participating sites hope to validate CommonWell's patient-centric vision of identity and matching, officials say, enabling a consent-driven record sharing and retrieval process across their care facilities.

The initial providers will manage patient consent protocol, identify whether other providers have data for patients enrolled in the network and transmit data to fellow providers who have consent to view data on those patients.

When CommonWell was first announced in March, Cerner CEO Neal Patterson emphasized that, "We're competitors. We're going to go back and compete. We're here because of a common value system."

[See also: Q&A: McKesson and Cerner execs discuss CommonWell Health Alliance]

Indeed, says Stuewe, that competitive spark made for some challenges.

"We're constrained a little bit," he said, by the "issues that you might imagine competitors would have. We can't, for instance, share our client lists. This was one of the big challenges: Come up with a list of places where we could exchange data, but not share our client lists.

The sites chosen "had a good understanding of their marketplace and their network," said Stuewe. "We could leverage that to flesh out the opportunities. It was pretty challenging to find the places we could all work, but we were in the end able to find good value for clients by working with some of those anchor clients."

Participating providers should reap the benefits of the speed and cost efficiency afforded by interoperability. Patients will be empowered too – controlling access to their data through an opt-in process and facilitating the linking of their records by confirming matches and by providing additional information to validate their identity.

"On the provider side, the thing we have have to get right is we have to provide some value," said Stuewe. "The challenge you have when you're building a fledgling network is what do you do when there's only two phones … the network effect doesn't exist on a very small scale. So you have to try to focus on where there is enough value to get the organizations interested and participating."

"We were able to find that through what you might call the choke points in the referral process, which is the specialists. Specialists are a good focus of our attention and allow us to sort of identify a value lane, if you will, between primary care, through the specialist, and into the inpatient setting."

For example, the launch in Chicago will focus on several ambulatory practices, running on an array of systems, such as Chicago Lake Shore Medical Associates – Northwestern Medical Faculty Foundation and Lake Shore Obstetrics & Gynecology.

"As an academic and hospital-affiliated practice, we are constantly pursuing best practices within coordinated care, so we are excited to join CommonWell's approach toward secure and patient-friendly data structures contributing to the maturity of information exchange across care settings," said Phyllis Wright, practice manager at Lake Shore Obstetrics & Gynecology, in a statement.

In North Carolina, the focus will be on exchanging data between acute care and ambulatory practices. Hugh Chatham Memorial Hospital and Hugh Chatham Family Medicine will be the participants in Elkin, while Maria Parham Medical Center and Premier Women's Health Professionals will be the participants in Henderson. In North Carolina, the launch enables the sharing of patient data across rural settings and county lines, as these patients often drive far to receive care.

"The sharing of patient data is critical to improving health care quality and patient outcomes, as well as reducing costs to patients, providers and payers," said Lee Powe, chief information officer at HCMH, in a press statement.

[See a video interview with Lee Powe interview here.]

In South Carolina, Palmetto Health, an acute care facility, and Midlands Orthopaedics and Capital City OBGYN, both ambulatory practices, will exchange patient data among themselves, all while using their own EHR systems.

Tripp Jennings, MD, system vice president, medical informatics officer at Palmetto Health, tell Healthcare IT News that suboptimal – or nonexistent – data liquidity has always beeb problem when it comes to delivering care.

As an emergency medicine physician, he speaks from experience. "Making quick decisions with incomplete information, is a reality that in some aspects will always be there," he said. "But is improving significantly. And technologies like this dramatically change the way we do emergency care, and the way we deliver care across the whole continuum."

Poor data exchange "certainly increases duplicative tests and costs," he says. "But most importantly it restricts informed decisions by providers."

Palmetto Health uses both Cerner and Allscripts technology. When approached to take part in the CommonWell initiative, Jennings was "very enthusiastic," he said. "I had been keeping up with it through the news, but I was somewhat unaware of the true number of vendors we had in our area that could really revolutionize what we have as far as information sharing at the patients discretion.

"We had actually launched our own Cerner-based health information exchange that linked our acute care facilities with our ambulatory practices," he said. "We had done a lot of the legwork, which takes a significant amount of time. But I think the most surprising thing really was outside of the walls of Palmetto Health – the number of ambulatory centers that were on one of the other four vendors and were extremely excited about this opportunity."

The "long-term goal," says is to "reduce the silos we have, of our own healthcare data and in our community" and "enable patients that choose to opt in to be the center of their healthcare data."

Of course, privacy and security is paramount. "The biggest one is that the great thing about digital data is that it's so easy to share information," said Jennings. "The downside is it's so easy to share information. You have to make sure you do the right thing securely and have the patient make the decision."

[See also: Six HIT heavy-hitters announce interoperability organization]

The process of making this happen has been "very interesting," said Stuewe. "Working together as seven competitor partners is not to be underestimated."

But it's been worth it. "Organizations are excited about the difference that we represent," he said. "Since everybody is making their own connection to the network, it means there isn't a custodian of the data. The data is flowing more or less peer-to-peer between the organizations. Because of that, there isn't a middle man that needs to be trusted the way a state HIE has to be."

That "ubiquity" of data access is what will be most appealing as this small-scale experiment gains traction and expands.

CommonWell Health Alliance plans to show some preliminary results the service launch the 2014 HIMSS Annual Conference & Exhibition in Orlando in February. It also plans to add more providers in different cities as it moves toward nationwide interoperability.

"Everyone understands that, at scale, this is motherhood and apple pie," said Steuwe. 
"It's absolutely going to be the way it needs to be. Once everyone can expect that documents are available wherever they are, that's a huge change."