CommonWell, Carequality Combine EHR Interoperability Efforts

Ken Terry

December 16, 2016

The ability of disparate electronic health records (EHRs) to exchange patient information — known as interoperability — took an important step forward on Wednesday with the announcement that CommonWell Health Alliance and Carequality, the leading private-sector interoperability initiatives, had agreed to work together.

Meanwhile, the Office of the National Coordinator for Health Information Technology (ONC) made another, less publicized announcement that could eventually have greater implications for interoperability than the CommonWell-Carequality tie-in. At a recent conference in Maryland, ONC said it coordinated a demonstration of the use of the Fast Healthcare Interoperability Resources (FHIR) framework to compile patient medication lists, using data transmitted from EHRs made by Allscripts, CareEvolution, Cerner, and Epic to patient-friendly applications.

Many observers view FHIR-based apps as the future of interoperability, because they can be used to connect different EHRs to apps at the level of discrete data. In contrast, CommonWell Health Alliance and Carequality are improving the ability to exchange clinical documents such as care summaries.

However, their collaboration signals a significant step forward: Epic, the largest EHR vendor, is not part of CommonWell, but it is a Carequality member. Together, a news release said, CommonWell and Carequality participants represent more than 90% of the acute-care EHR market and nearly 60% of the ambulatory-care EHR market.

As of June 2016, CommonWell members — which include such technology vendors as Allscripts, Athenahealth, Cerner, Greenway, McKesson, eClinicalWorks, and Meditech — represented 68% of the hospital market and 37% of the ambulatory care market. So this collaboration represents an advance in terms of sheer volume.

The other area where the partnership will make a difference is in the ability of disparate EHRs to exchange standardized care summaries. The press release pointed out that "variation in data exchange implementation is still a challenge for some providers looking to exchange medical records with others across the care continuum." Carequality has been working for years to improve and tighten the specifications for the Consolidated-Clinical Document Architecture (C-CDA) care summary format, so that different EHRs can exchange C-CDAs more easily.

Under the terms of the agreement between the two organizations:

  • CommonWell will become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequality participant.

  • Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.

  • CommonWell and The Sequoia Project, the nonprofit parent of Carequality, have agreed to explore additional collaboration opportunities in the future.

CommonWell Health Alliance operates a health-data sharing network that offers several services to simplify cross-vendor data exchange. Among these services are patient ID management, record location, and query/retrieve broker services, which allow a single query to retrieve multiple records for a patient from member systems. While CommonWell is vendor-led, its members also include hospitals, physician practices, postacute and long-term care providers, imaging centers, and pharmacies.

As of last June, CommonWell said, more than 8000 providers had "committed" to using its services. Of these providers, 4700 had "gone live."

Carequality facilitates interoperability between and among data sharing networks and service providers, including payer networks, EHR vendor networks, accountable care organizations, and personal health record and consumer services.

The Carequality interoperability framework provides the necessary legal terms, policy requirements, technical specifications, and governance processes to bridge networks and services, according to the news release.

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