Interoperability 2.0 Through Collaboration

Published on
Tuesday, May 22nd, 2018
Author: Brian Ahier

There is a great deal of discussion on the subject of interoperability lately. Continuing the theme of an upgrade to this important notion leads me to today’s post. Interoperability 2.0 can best be achieved through collaboration. No single entity has the capacity to ensure seamless, ubiquitous, nationwide interoperability. However, if we all work together we can make some great strides. The HITECH funding saw a resurgence in the creation of state-level HIE organizations. Some of them were unable to achieve a fully sustainable business model when the funding ran out so they either closed up shop or are continuing to chase after decreasing government funding. But private market efforts with clear and sustainable business goals and revenue models are doing quite well. I would point to states like Colorado and Ohio, as well as regional HIE’s such as in the Great Lakes region of Michigan.

And now with established HIEs in place it is imperative to connect these networks, as patients will rarely only seek care at home. This is where the Sequoia Project and its initiatives come into play. The eHealth Exchange (eHX) is one of the oldest and largest health information networks in the U.S., and Carequality is an interoperability framework that makes it possible for different health information networks to share records with each other electronically. The Sequoia Project has announced a new corporate structure which will assure that each of these vital initiatives has the governance and management resources that eHX and Carequality require to continue flourishing.

The eHealth Exchange network is working in 75 percent of all US hospitals. It is used by over 15 EHR vendors and 59 regional or state HIEs. Four federal agencies participate in the network to share patient information with private sector partners as well as other agencies:

• Centers for Medicaid and Medicare,

• Department of Defense,

• Department of Veteran Affairs, and

• Social Security Administration

In all, the eHealth Exchange supports secure exchange of the records for more than 120 million patients.

The CommonWell Health Alliance is another important initiative. They are an independent, not-for-profit trade association primarily made up of EHR vendors (including Cerner, athenahealth, MEDITECH, eClinicalWorks, and many others – but notably not Epic). CommonWell services include patient enrollment, record location, patient identification & linking and data query & retrieval which are offered by their service provider RelayHealth. They have been live for over three years with numerous clinicians exchanging valuable health information to improve care. CommonWell has nearly 9,800 provider sites committed to using CommonWell core services, including more than 5,000 sites currently live.

CommonWell has announced they will become a Carequality Implementer this year on behalf of its members and their clients, thus enabling CommonWell subscribers to engage in health information exchange through directed queries with any other Carequality Implementer (including many existing CommonWell participants as well as others, including Epic and the Federal partners).

The eHealth Exchange also plans to become a member and implementer of Carequality this summer, thereby extending the eHealth Exchange’s reach to all other networks that also participate in Carequality. The Carequality framework adds important capabilities towards interoperability enabling query and retrieve at national scale for a specific patient’s clinical documents. With the addition of the eHealth Exchange and CommonWell as Carequality Implementers the potential number of query responders is magnified.

Of course, at Medicity we believe that simply acquiring data is only the start and ingesting and meaningfully using these data to create useful information at the point of care is the direction that the industry must take. We add to these basic exchange capabilities by taking the raw documents (generally CDA formatted Continuity of Care documents) and combining and organizing these diverse data sets into a common vocabulary. This allows clinicians to have a complete, customizable, longitudinal patient record at the point of care where it is needed for informed clinical decision making. The aggregation of these normalized and de-duplicated data thus becomes a valuable strategic asset for reporting and analytics, submission of quality measures, and value-based care and payment models.

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