Mostashari, policy committee take critical look at CommonWell

'The question to ask is, will it work, will it help move us forward?'

At a meeting of the Health IT Policy Committee on April 3, National Coordinator for Health Information Technology Farzad Mostashari, MD, and other committee members took a hard look at the CommonWell Health Alliance, a new vendor-led coalition to promote interoperability.

McKesson, Cerner, Allscripts, Greenway and athenahealth, along with RelayHealth, McKesson's connectivity business, announced the alliance last month at the 2013 HIMSS Annual Conference & Exhibition in New Orleans. Leaders of the nonprofit group say its aim is to make the exchange of data easier, but Mostashari and some members of the Health IT Policy Committee questioned whether the alliance might make things worse.

The debate over the new organization followed an extensive report delivered at the meeting, in which some members of the committee said they were confused over what CommonWell has to offer. Did the alliance intend to replace HIEs? How would data exchange work? What are the goals?

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

Software entrepreneur Paul Egerman, co-chair of the policy panel and one of two members to deliver the report, said the CommonWell alliance is "a nationwide endeavor; an example for the nation." Egerman, who based his report on briefings with alliance members, said the group aims to "solve" the nationwide data exchange problem, and it will do so with the following means:

  • Enabling providers to unambiguously identify patients – but not with a national patient identifier;
  • Providing a way to match patients with their healthcare records as they transition through care facilities;
  • Using existing unique identifiers (salted/hashed) such as cell phone number, email addresses or driver’s licenses for identity management;
  • Enabling patients to manage consent and authorization;
  • Creating a HIPAA-compliant and patient-centered means to simplify management of data-sharing consents and authorizations, focusing initially on the most common treatment situations;
  • Helping providers to find the location of patient records across care locations via a secure nationwide records locator service;
  • Enabling providers, with appropriate authorization, to issue targeted (directed) queries that provide for peer-to-peer (e.g., EHR to EHR) exchange.

The alliance's vision is that member EHR vendors will commit to this, and will be certified and use the CommonWell logo, according to its members. Governance is currently fluid, and still in early stages, Egerman said. "They also have a business model going forward. Vendors are going to pay. It’s a pay-to-play concept."

Charles Kennedy, CEO of Accountable Care Solutions for Aetna and co-presenter of the report, said that, although the group defends its altruistic purposes, he has his doubts, and wonders why competitors would want to cooperate. He conceded, however, that his sense from the group's founders was that they want to level the playing field for all vendors.

Panel member Judy Faulkner, founder and CEO of Epic Systems, said she felt excluded from the organization at the HIMSS Conference, where it was announced. "We were scolded for not being part of this group, and yet we weren’t invited," she told fellow panel members.

For his part, McKesson CEO John Hammergren told Healthcare IT News in March that he was "hopeful" that Epic "will see it the same way we see it" and sign on with CommonWell.

He added that "the only reason they weren't at the table," at the alliance's initial announcement "is that we needed speed to get the deal done, and I don't think anyone [at McKesson and Cerner] had as close a working relationship, perhaps, with Epic as we do with this group," referring to Allscripts, Greenway and athenahealth.

Hammergren said he planned to spend the coming months "engaged in trying to recruit more companies into the alliance," in hopes that "every day we'll have a more ubiquitous group of people saying, "This makes sense for us, and we want to participate."

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

On the surface, Faulkner said, CommonWell appears to be a business. "We do know it’s expensive to participate," she added. Faulkner also questioned whether the group would favor the founding companies and whether it planned to sell de-identified data.

Speaking at the press conference announcing CommonWell's launch, Cerner CEO Neal Patterson said, "It's time for vendors, even as they continue to compete in the marketplace, to break down their data silos." He added that progrss on the data liquidity front would have to come from the private sector: "Our government is not going to deal with this problem.

Egerman said he'd heard some concerns expressed that vendors may be using the organization to "go nationwide." And there are questions over whether the vendors will require users to go through the CommonWell Health Alliance, rather than through a regional health information exchange, he said. “I can’t project what a vendor will do," Egerman said.

Mostashari said the key question is whether the service is severable, or if it’s an exclusive network. If it’s an optional service that rides on top of a regional exchange, it could be useful, he said.

"The question to ask is, will it work, will it help move us forward?" Mostashari said. "Many efforts have tried to be 'the' network,” he added, but it can’t come at the price of inhibiting other good activities.

Panelist Joshua Sharfstein from the Maryland Department of Health & Mental Hygiene said he had to wonder whether the group would put up barriers to moving forward. He was concerned, he said, that the alliance could block national efforts to achieve interoperability because it could create a competitive advantage for doing something against a national interoperability effort.

With almost a year to wait until the CommonWell Health Alliance is beyond its pilot phase and open for business, most members of the panel opted to take a wait-and-see approach before recommending federal intervention.