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March 04, 2013

Interoperability Unbound: CommonWell Health Alliance unveiled at HIMSS

Today, six EHR companies announced their formation of the CommonWell Health Alliance to promote seamless interoperability of electronic health records.

From the presser:

Top health care information technology (HIT) companies Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies® and RelayHealth announced today the launch of the CommonWell Health Alliance™, planned to be an independent not-for-profit organization that will support universal, trusted access to health care data through seamless interoperability. This historic effort is aimed at improving the quality of care delivery while working to lower costs for care providers, patients and the industry as a whole.

The Alliance intends to be a collaborative effort of suppliers who are focused on achieving data liquidity between systems, in compliance with patient authorizations. The Alliance will define, promote and certify a national infrastructure with common platforms and policies. It also will ensure that HIT products displaying the Alliance seal are certified to work on the national infrastructure.


Elements of the Alliance’s national infrastructure will be tested in a local pilot within the next year. Early components will include the following core services:

  • Cross-entity patient linking and matching services: Help developers and providers link and match patients as they transition through care facilities, regardless of the underlying software system
  • Patient consent and data access management: Foster HIPAA-compliant and simple patient-centered management of data sharing consents and authorizations
  • Patient record locator and directed query services: Help providers deliver a history of recent patient care encounters, and, with appropriate authorization, patient data across multiple providers and episodes of care

E-Patient Dave greeted this news warmly at As I commented over there:

Promoting greater interoperability of electronic health records is one of the goals of the meaningful use regulations. Unfortunately, because of a combination of factors the standards for interoperability leave something to be desired, both in the stage 2 regulations and in the draft stage 3 standards. One factor is the tight deadline under the law for achieving meaningful use, and the other is the determination of the federal government to get as many folks qualified for meaningful use incentive payments as possible — both factors tend to reduce the strength of the criteria against which EHR systems are judged.

The Direct project and other initiatives can already point to some success in this arena.

More meaningful success in this arena, however, has been left up to individual EHR vendors. The development of this new alliance is not, strictly speaking, in response to a regulatory requirement or deadline. So the question arises: Why now? The answer is that the EHR vendors must see a competitive advantage in banding together in this way, and this changed view of the world may be credited, in part, to the demands of patients (and clinicians) for interoperable EHRs and all the benefits that are supposed to flow from their ubiquitous appearance.

Let’s not forget that one revenue stream for cloud-based EHR vendors may be the licensing the use of de-identified patient data (license fees to be shared with, or perhaps retained entirely by, providers). And let’s not forget that one source of the growth in our collective knowledge, and improved evidence-based medicine, will be the licensed use of such data by third parties who aggregate and analyze data extracted from EHRs.

Bottom line: it appears to me that the EHR vendors are acting based on a multiplicity of motives; it is gratifying to know that at least one of these motives is related to market demands generated by consumers.

This is a promising step, but in some respects it appears to be a defensive maneuver directed at a dominant "big iron" EHR vendor notably absent from the group (Epic). There will probably still be work to be done by interoperability standards committees beyond the Alliance.

Update 3/5/2013: Verizon announced its Secure Universal Messaging Service (SUMS) at HIMSS. It is essentially a secure email-like system that allows for sharing of attachments. The security is also applied at the user registration level: you need an NPI or DEA number to get an account. The service is in beta now. Like Direct, it leaves something to be desired in terms of robust functionality; on the other hand, it's here now and it appears to work.

What do you think?

Interestingly, one of these vendors (athenahealth) also announced at HIMSS an HIT Code of Conduct, calliing on all vendors to meet its provisions as a way to respond to National Coordinator for Health IT Farzad Mostashari's recent challenge to the industry to go beyond what is required by regulation in building the health IT of the future. Specifically, the presser identifies the following core elements: 

  • Empower Data Portability and Provider Choice
  • Build a True Nationwide Information Backbone
  • Protect Patients
  • Prevent Fraud
  • Drive Meaningful Use

Other vendors at HIMSS announced the formation of the imPatient Movement, advocating for data portability.

Again, these developments are all driven by the evolution in the national conversation about health IT and a growing recognition of the need for patient-centric solutions.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting 


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As part of strategic planning for the sustainability of ONC funded REC's you can expect to see a new patient centered service line for at least some of the 62 REC's who work with over 140,000 docs in the US (43% of all primary care docs).

How do I know? I am responsible for developing the community of practice to develop it using a startup style approach.

IE - If you think of ONC's 2 billion dollar investment in REC's, HIE, training as the startup funding for 62 regional branches of a national consulting firm for small practices and critical access hospitals to adopt health IT we are now just moving into the operations stage of the organizations life-cycle.

Check out Adrian Gropper's post on CommonWell at The Health Care Blog. The long lead time until the first use is rorolled out is of some concern, and Adrian identifies some other fundamental issues:

CommonWell Is a Shame and a Missed Opportunity | The Health Care Blog –

Adrian expands on what he means by "patient directed exchange" on the Society for Participatory Medicine listserv --

Patient-mediated exchange is what the old Blue Button provides. It's a form of digital sneakernet where the patient has to be actually involved in every transaction. That's much better than nothing but it won't really work for physician workflow and apps that need to monitor what's going on as best they can.

Blue Button+ allows the patient to authorize a recurring PUSH or QUERY of data from an EHR. The policy for PUSH might define what a trigger event is and what information is included in the Direct message (yes, it's just a standard Direct secure email message). The policy for QUERY would do the same but also allow the requester to see a list of available documents or datapoints and choose the ones they want to get. Both methods also allow for bi-directional transfer so you can add information into the EHR. Patients can revoke PUSH or PULL authorization selectively at any time.

Either way, the Blue Button+ transfers are policy-driven rather than needing the actual intervention of the patient each time.

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