Healthcare Analytics, Population Health Management, Healthcare Big Data

Quality & Governance News

Epic, Carequality Challenge CommonWell on EHR Interoperability

By Jennifer Bresnick

- After years of providers and rulemakers complaining that the healthcare industry has made little to no progress on EHR interoperability, a flurry of activity from the vendor community is starting to shake up the scene.  At HIMSS15 today, Epic Systems and a number of partners including Healtheway, Surescripts, and Kaiser Permanente announced the rollout of Carequality, a health data interoperability framework intended to connect disparate health information exchange networks.

EHR interoperability and health information exchange

While the Carequality collaboration views its role somewhat differently than the CommonWell Health Alliance does, there’s no question that the two heavyweight organizations will be jostling up against each other as each pursues its own vision – and each attempts to secure as many stakeholders as possible.

The CommonWell Alliance, launched at the HIMSS Conference in 2013, brings together EHR vendors and other partners to develop and deploy technical standards that ease the process of data sharing and health information exchange on a provider-to-provider level.  The coalition started to implement its interoperability services in the provider community at the end of 2014, and it’s refining the process each time it connects a new partner.  The Alliance has also contributed heavily to industry-wide discussions about the adoption of data standards such as FHIR to demolish long-standing data siloes, but its real-life footprint has thus far been relatively small.

“I predict that CommonWell will become a major interoperability-enhancing utility and network in the years ahead, but like most networks, it will take time to get a large enough mass of users signed up and content flowing to make a real difference,” said Cerner CEO Neal Patterson in November, when CommonWell’s commercialized service first say the light of day.

With the appointment of its first executive director and a growing membership base, however, the Alliance is accelerating its progress.  CommonWell is positioning itself as the physician-friendly answer to the population health management problems that will soon be integral to receiving value-based reimbursement and engaging in effective clinical analytics.

READ MORE: Unfiltered EHR Data Overloads Physicians, Perpetuates Burnout

But its efforts haven’t sat well with Epic Systems, which has been famously set against the CommonWell Alliance since its inception.  As Congress urges the industry to make progress on EHR interoperability and the ONC takes steps to chide vendors actively blocking data sharing, Epic is hoping to thaw its reputation for failing to promote meaningful EHR interoperability by leading the way with Carequality.  The new framework hopes to be the big picture, network-to-network answer to CommonWell’s approach, which Epic views as little more than an aspiration that hasn’t yet brought meaningful change.

“[CommonWell] aspires to be a nationwide network with a record locator service that will tell you where every part of a patient’s record is,” Epic Systems’ Director of Interoperability Peter DeVault told Congress last month in a hearing on the sluggish progress of EHR interoperability across the industry. “They are not that today. According to their latest report that I have seen, they have four different sites live on their network, fewer than a 1000 physicians compared to a 100,000 thousand in Care Everywhere and almost 10 million records exchanged a month now.”

Care Everywhere, Epic’s interoperability package for healthcare providers, forms a large part of Carequality’s 200,000-strong physician user network.  With a number of large integrated networks like Kaiser Permanente and Intermountain Healthcare, as well as health information exchange organizational partners, like the Kansas Health Information Network, Utah Health Information Network, HIE Texas, and Healtheway, Carequality’s framework is starting off its mission on solid footing.

“This agreement will be a game changer for patients and the physicians who care for them,” said Steven Lane, MD from Sutter Health in Northern California. “Each month, we make over 3.5 million queries for records at outside organizations using Epic’s Care Everywhere Network and exchange over 700,000 patients’ records. With the Carequality Framework in place, our search reach will expand exponentially across all kinds of different networks. This will be a tremendous help to expedite the right treatment and avoid unnecessary costs.”

“A single network can’t address all stakeholder needs across all scenarios,” added Mariann Yeager, CEO of Healtheway. “The eHealth Exchange, state and regional networks, and vendor-led networks such as CommonWell and Surescripts, will all play a role and will need to connect with each other. In the cell phone industry, you see multiple networks with the ability to make calls across carriers. Healthcare will need the same structure to enable a learning health system.”

READ MORE: As FHIR Matures, Healthcare Interoperability Comes into Focus

CommonWell Alliance and EHR InteroperabilityBut despite its noble intentions to bring CommonWell and its hard working providers into the fold, Epic Systems has made no secret of its antagonism towards the vendor-led coalition, headed by rival EHR developers such as athenahealth, Cerner, Allscripts, and McKesson.  Epic has repeatedly slammed CommonWell for everything from its membership fees to its non-disclosure requirements, and the Alliance has responded in kind, not convinced by DeVault’s assertion that CommonWell would be wise to join forces with Carequality.

“Carequality is meant to be that fabric that connects all of the networks together,” DeVault argued. “So you have health information exchanges, you’ve got the Care Everywhere network, you will eventually have CommonWell.  Carequality then will be the fabric that stitches all of that together.  So we hope that they will join Carequality.”

Epic and its partners may wish CommonWell to put its muscle behind the EHR interoperability work so critical to the healthcare industry at large, but it seems likely that Carequality will try to be the one dictating the terms.  How that will sit with CommonWell’s leaders remains to be seen.

Yet some organizations, like Greenway Health, are attempting to bridge the divide and possibly cool down the rhetoric.  The health IT vendor is on the founding membership list of both CommonWell and Carequality, and may be an interesting test case to see if the two coalitions can play nice, and how organizations putting effort into both strategies can win or lose the loyalty game.

Will the budding rivalry between the two networks, each professing their willingness to cooperate for the good of healthcare providers, be a good thing for the industry?  After all, competition breeds innovation while knocking down barriers to participation.  If CommonWell and Carequality come together and agree on amicable terms, healthcare providers could certainly benefit from the two-tiered structure of connecting organization to organization under CommonWell, and then tying those networks together using Carequality to bring true EHR interoperability to the largest possible proportion of providers.

READ MORE: New Epic Systems EHR, Big Data Features Zero In on Interoperability

Can the industry learn to put aside its sniping, engage providers in a positive environment for EHR interoperability, and solve some of the most intractable problems of the health IT ecosystem?  Both Carequality and CommonWell think so.  While their strategies may be different and the irritants of competition are unlikely to be soothed immediately, each organization feels up for the challenges that lie ahead.

“We’re going to learn a lot over the coming months as the initial participants adopt the Carequality framework,” says Michael Hodgkins, MD, Chief Medical Information Officer of the American Medical Association and Chair of the Carequality Steering Committee. “Connecting 200,000 physicians is just the beginning; there will be many more as we expand beyond the initial rollout. There’s a responsibility that comes with that kind of scale, and we need to get it right. If it were easy, it would have been done a long time ago.”


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