Interoperability: Coming to your practice sooner than you might think
“It’s all about interoperability,” said Jitin Asnaani, executive director of CommonWell Health Alliance. “And every provider will soon be dealing with it.”
CommonWell is a nonprofit organization that, together with its members and service provider, empowers providers to exchange clinical information with others live on the network through a vendor-neutral platform and interoperability best practice solutions. Common standards and policies are used to promote effective health data exchange. The Alliance’s vision is that health data will be available to providers regardless of where care occurs.
For many healthcare practices, interoperability — or clinical connectivity — is a key strategy to maintaining independence.
Recently on the Alliance’s blog, Jitin shared that CommonWell had achieved a major milestone in connecting to Carequality, an interoperability best practice framework with hundreds of thousands of providers. Greenway has a handful of initial provider sites live on the connection, helping validate and benchmark the CommonWell-Carequality Connection.
We talked to Jitin about that connection, and about interoperability best practices in general:
Greenway: Interoperability has been talked about in healthcare for a while, but lately it seems to be gaining momentum. Why is that?
Jitin Asnaani: I think a couple of things happened. Recall that back in 2013, CommonWell was started by a small group of EHR vendors who were ahead of the interop game. This small group was very motivated, but what we were doing was brand new and it took us a while to get significant traction. And then, on the heels of our pioneering success, two things happened. First, the Carequality Framework was formed, with Epic as an anchor founding member. This led many people to say, "Great, so now we're just going to deal with two competing silos?" Thankfully, that concern is being addressed imminently as CommonWell and Carequality start to connect, meaning that providers will be able to connect with Cerner and Epic and other key industry leaders like Greenway Health … that's extremely exciting.
The second thing that started happening, in parallel, is federal government regulation, which at this point is squarely targeting interoperability. It takes the form of the Promoting Interoperability Programs (PIP) from CMS and it also takes the form of 21st Century Cures from Congress and ONC. With a hyper focus on data blocking, as well as data fines coming from the federal powers that be, these laws are all about driving widespread interop.
That's why you're seeing a renewed momentum. There's just no way to get around it now. Everyone in healthcare is going to be dealing with it shortly. Interoperability will come to your practice whether you foresaw it or not.
GW: How should we be talking about interoperability today to providers?
Jitin: When I talk to some providers, they say, “Oh, yeah, I need certain data to take care of this patient. If I had just known X or Y or Z, I might have been able to confirm or change the diagnosis that I ended up making in the absence of that data.”
But when you talk to some of the same providers and say we’d like to be interoperable and exchange patient data, they say, “No, no, no. There’s all sort of regulatory compliance stuff. A real can of worms. I don't really want any part of it. Sure, we have to do it because we have to get our incentive dollars, but I don't need that at all.”
And so, there's a disconnect between what they know they need when they're doing clinical practice and what they have to use because somebody told them to, and I don't think everybody has made the mental leap to connect the two yet.
We need to frame the opportunity for them, and we must be very thoughtful in doing so.
GW: In your mind, what’s the timeline around interoperability?
Jitin: CommonWell, which has tremendous traction right now, has half of the top 20 EHRs in its membership. You have Carequality with many of the remaining half. If you bring these initiatives together — which we are, right now — over the course of the next two years, you’ll have a fair bit of broad interoperability capability …
If the CMS final rules can build upon what is going on right now, you'll see within just three years very broad-based access to patient data across the majority of the top 20 EHRs, as well as some of the innovative smaller EHRs.
I think within five years, you will see broad-based data exchange across all EHRs because of the impact of government regulation on pulling the laggards into the fold.
GW: How do you think Greenway is handling interoperability for its customers?
Jitin: Greenway has always had some of the better behind-the-scenes interoperability capabilities out there, and I hope that they will not relinquish their leadership.
Like all ambulatory EHR vendors, Greenway sits in this space where independent physicians are facing a lot of turbulence rightnow. It's going to be important as Greenway moves forward to align their products so that there's a good experience of interoperability across all its platforms.
For independent physicians, the good news is that there is new legislation that goes beyond the historical thinking about hospital-based ACOs and looks at questions like, “How do we make physician-based ACOs successful?” That’s a difficult question to answer! What is clear is that, from a technology standpoint, having interoperability across your user base will be critical. My personal perspective is that all user-facing platforms will become cloud-based over time because of the need to nimbly innovate and cost-effectively deliver innovations; but what I can observe already is that the process is starting with cloud-based interoperability. In fact, in the near future, I think people will view EHRs as connected platforms that deliver valuable user experiences, not just clinical platforms that happen to be connected.
GW: How much does education play in the topic of interoperability? How should we be thinking and talking about it going forward?
Jitin: There definitely is an educational component to this. As I mentioned earlier, providers constantly are saying that they “need X data to take care of a particular patient.” We need to ensure that they know interoperability is the way to get to that data, we need to show them the vision.
Fast forward a bit, and the end-result is akin to what has happened to computers over the last 20 years. If you used a computer 20 years ago, you were using it to run desktop applications. Now, if you think about it, what do you spend all your time doing? You spend half your time or more on a browser. Your browser is the thing you use. The computer just sits underneath it and largely helps you to power your browser.
So that's where we're going, too. That's what’s going to happen. Twenty years from now, it will all be about that connectivity to the world and it will transform the practice of healthcare as browsers, and now smartphones, have transformed our personal and business lives today.
GW: You were recently at ENGAGE18, Greenway’s customer conference, presenting on interoperability. And you ended up getting a standing ovation mid-session …
Jitin: Yeah, needless to say, I really enjoyed the experience. I found it very energizing. The audience in that room was highly engaged. They brought out a whole variety of different and very realistic questions, issues, and even solutions.
I also felt it was a great session because I learned more about what people want from interop. In particular, I received that mid-presentation ovation when I showed the audience the picture of the road ahead between the members of CommonWell and Carequality, who collectively account for nearly 90% of acute care EHRs. If a practice can get connected into those, it would be a huge jump in their ability to interoperate. In the past, that kind of connectivity has been financially and technically beyond their ability, and it has been beyond their ability for so long that I think seeing the future starting to materialize was just incredibly exciting for them.
Stay tuned for Part 2 …