Skip to main content

CommonWell Plans EHR Pilot; Denies Data Will Be For Sale

 |  By smace@healthleadersmedia.com  
   June 04, 2013

A joint effort to provide interoperability among the electronic health records systems of competing vendors is proceeding without a great deal of transparency and openness outside of the participating members.

Three months ago this week, Cerner, McKesson, Allscripts, Greenway and athenahealth—rivals all—announced the CommonWell Health Alliance, a joint effort to provide interoperability among their electronic health records systems and others.

Technology companies are good at announcing such alliances, but customers often never see all the benefits promised. Making different technologies interoperate is difficult, and U.S. companies in particular are predisposed to compete with each other, making attempts at interoperability even tougher.

But since 90 days have passed, I thought it was time to check in with CommonWell to see how things are going, particularly since we haven't really gotten any general progress reports from the group.

As alliances go, it is my opinion that the work being done is being undertaken without a great deal of transparency and openness outside of the alliance members.

To its credit, CommonWell offered me time with two Cerner executives who addressed some of the recent issues brought forth by Epic founder/CEO and CommonWell skeptic Judy Faulkner. In recent comments at the Health IT Policy Committee, committee member Faulkner questioned whether CommonWell would be offering patient data for sale, or if it was trying to assemble a patent portfolio, both of which would definitely be unwelcome developments.

"We're very explicit that we will not use the data for any purpose other than to deliver the services of CommonWell," says David McCallie, senior vice president for medical informatics at Cerner. "There will be no data resale. We're not going to de-identify the data and do anything with it. We're not going to sell it in an identified form, and that's been clear from day one."

As to patents, McCallie says "if there is patentable innovation that comes out of the work, then the agreement would be to share that license with all of the members of CommonWell. But it would be sort of a side-effect, if necessary. We're not seeking a patent portfolio."

Faulkner has also recently been quoted as saying that Epic provides the most interoperability of any EHR vendor currently out there. I've heard tales that Epic will go to great lengths to connect its systems to a customer's other IT systems, but vendor and customers seem to be eager to keep such efforts on the QT.

CommonWell's top priority is to kick off a pilot later this year, McCallie says. A second big agenda item is to create a 501(c)6 not-for-profit trade association. Additionally, a "bunch of different committees" are defining the interface between service providers and EHR vendors.

In the pilot test, the service provider will be RelayHealth. CommonWell has to choose a metropolitan location for the pilot, a city where providers are using a variety of members' EHRs. If the city is dominated by Epic (some are) or by a CommonWell member's EHRs, that wouldn't be ideal.

This stage of CommonWell's work will culminate in an update and status report at HIMSS 2014, McCallie says.

After they launch, some technology industry initiatives spend a lot of time and energy announcing additional members as quickly as possible. Not CommonWell. In the first 90 days, industry reception to the alliance has been "enthusiastic," says Dan Schipfer, Cerner vice president for government and industry relations. And yet, CommonWell has yet to announce additional members.

"An invitation has gone out to the [EHR] industry broadly," Schipfer says. "We've had probably 45 to 50 different companies express interest." CommonWell has been asking these prospects what time and resources they can commit to the consortium this year. Some of those discussions are with non-EHR vendors. And around the industry, I've heard that those vendors talking to CommonWell have been asked to sign non-disclosure agreements. The truth is more nuanced, according to Schipfer.

"We've got these two goals," he says. "One of them is creating this technology, the services to go help facilitate the pilot demonstration, so there's work to do on that. And then there's this collective goal around formation and open and transparent supporting of interoperability.

Starting with the second goal, Schipfer is quick to say "there are no… NDAs and so forth, as it relates to how we're trying to go form that organization. We're trying to do this in a very open format. It's a new thing for all of us, but we're just methodically going through creating that, and expect to make this extremely very open."

Adds McCallie: "The process of creating the interfaces necessary to make this system work is complicated and cumbersome, and so we have limited the participation to those discussions [to] the vendors who have committed resources to deliver what we settle on. So these are all people with skin in the game, who if they agree on, this is what we're going to do, that means they're going to take it back to their companies and build that software.

"If somebody says, 'what are you going to do with standard such-and-such,' we'd be happy to tell them, and we'll give them the documentation to the degree that it's been settled and exists. So I think it's, at the moment, as open as it needs to be to move us forward. The APIs and all will obviously be completely open when we settle on them. There will be some open source developments done as we figure out what parts of the code are proprietary to the vendor itself, to the service provider, and then to CommonWell, and the CommonWell code could be opensourced, so we're just working all that out."

Recently, I talked about health information exchanges with a CIO who was confident that he could now wait for vendor-provided HIEs rather than rely upon regional, state or federal HIE efforts. I got the strong impression this CIO is expecting CommonWell to provide that HIE, and asked the Cerner executives if CommonWell was building a national HIE.

"A little bit of confusion stems from the fact that HIE has a lot of different meanings, and there are some functions that a traditional or typical HIE would deliver that CommonWell will overlap with," McCallie says.

"But there are other functions that some of the more successful HIEs are delivering that CommonWell will not try to deliver, so it's not a simple either/or question. The phrase that we've used, [is] we're focused on the plumbing, moving the data from where it lives to where the patient needs it with a current physician encounter."

To be specific, CommonWell is building the identity management and encounter locator services, as well as some consent management and "transparency services," says McCallie.

What does that leave HIEs to do? "HIEs are evolving in the direction of doing more in the realm of population health management, quality reporting, aggregation services, to abstract records, small provider access and the like, although they typically limit that to a region," McCallie says.

"CommonWell will obviously be able to pull data from anywhere in the network, which could be anywhere in the country. That's a long-winded answer, but it's not a simple answer, I'm afraid." And CommonWell members will be building out complete HIEs on top of the CommonWell platform, he adds.

"Each of the vendors has additional products like population health management or care coordination or continuity of care services that we will build on top of the data availability that CommonWell exposes."

So there you have it, an update on CommonWell at the three-month mark. Before CommonWell, there were already a lot of moving parts in healthcare IT, and we can hope that the additional activity of this new group will simplify the picture moving forward, and not complicate it further.

I wonder, however, if we can really afford to wait until 2014 for what amounts to a glorified demo, or if in the interim, we might see Epic suddenly reveal vast evidence of real interoperability happening now, tipping the market further in Epic's favor. The fate of dozens of competing EHR vendors probably hangs in the answer to that question.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

Tagged Under:


Get the latest on healthcare leadership in your inbox.