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Tuesday March 14, 2023  |  Luke Marinac

Advancing Interoperability in the Age of TEFCA: An Interview with CommonWell's Executive Director, Paul L Wilder: Part 2

2023 marks the 10th Anniversary of the CommonWell Health Alliance, a ground-breaking non-profit trade alliance of over 70 companies working in the health IT marketplace to advance Interoperability nationwide. During the last decade, CommonWell has played a pivotal role in uniting healthcare organizations and industry leaders in pursuit of that goal.

As a proud member of the Alliance, we're delighted to share an exclusive Q&A with Paul L Wilder, Executive Director of CommonWell. In part two of this interview, we delve into the current state of Interoperability, the impact of COVID-19, and how the Trusted Exchange Framework and Common Agreement (TEFCA) is changing the way we share information across the care continuum.

MEDHOST: From your perspective, where does interoperability stand today? 

Paul L Wilder: We need to work on two things.

The first one is moving into other treatment areas that present roadblocks. Our inability to transfer mental and physical health records together is a problem, especially as healthcare consumers are increasingly interested in taking a more active role in mental health treatment. These conditions often go hand-in-hand with physical health, like in the instance of drug abuse. Not having access to the whole picture can hurt patients in those situations.

Second, we're missing the mark on health equity as an industry. The disparities here are readily apparent. Some hometown provider in Montana isn't going to be as connected; they can't provide the same level of care as, say, a multi-state IDN.

Getting connected is how we democratize healthcare. It allows you, as a provider or an EHR, to act big and make a big impact, even though you may have a smaller footprint.

You'll have access to the same data as these bigger guys when you're part of a network. That means you don't have to get bought out by some IDN or close your practice, and you can provide the best possible level of patient care for your community.

MEDHOST: How do you think COVID-19 has affected Interoperability?

Paul L Wilder: What's interesting is that we saw a curve. When COVID started, there was a "dip" in records exchange; everything just shut down—no elective surgeries, etc.

Then, suddenly, there was a tremendous acceleration. Since these offices and practices were flat-out closed and couldn't fax documents over, providers that were open and treating patients started to ask, "How do I get the information I need?" So, electronic health information exchange, the backup option for a long time, suddenly became the go-to.

Another thing we learned is how vital the demographics are we use to match and share this information. A good case study for this was COVID testing.

So, you probably got a test at one of those big drive-through tents, and if you think back to the demographics they collected—they were missing everything. In some cases, it was just your name and birthday.

That information was supposed to go back to our local health departments. But in the end, they didn't even know how to contact people. What happened was that local HIEs were able to fill in the gaps. Using a birthday and name, they could help provide demographics and facilitate contact tracing.

A national identifier number is one potential solution and may help in a future scenario like COVID-19. There are disagreements around that and politics, but working toward something like that is necessary to avoid making high-profile public health mistakes in the future.

MEDHOST: You mentioned earlier that a record locator service is crucial for Interoperability. Why are you committed to this solution, and how do you think CommonWell is going to evolve under TEFCA?

Paul L Wilder: Well, TEFCA for us is definitely evolutionary, not revolutionary, right?

We're already at a large scale. What we like about TEFCA is that it adds a level of efficiency for how we want it to interoperate from us to the outside world.

Truth be told, a fair amount of those other super nodes, or qualified health information networks, won't have an actual MPI-driven RLS (as opposed to CommonWell, which does have a true MPI-driven RLS). They may do some fan-in and internal geosearching. But right now, for us to find all the data for our patients, we are throwing out something like 50 transactions for every time you see a doctor just to go find the rest of your data. It's almost a random shot.

It's geofencing, right? If you live in one spot, the assumption is that most of your days are spent there. So, we draw a circle and just hit every provider in that bucket. But we can't hit all of them. We start with a sample of 50, then keep going because we need to know what we've missed.

With TEFCA, the other side may still do geofencing, but I only have to send them one request, and that's it. So, I've gone down from 50 to five. That's a big deal.

And this has implications for patient outcomes. We are not a society that operates around these arbitrary boundaries. I shared my story earlier in this interview, and the second hospital we went to was 75 miles from the first—outside of the typical geofence boundary.

MEDHOST: What would you say if you had to explain to a hospital why they should care about TEFCA?

Paul L Wilder: I'd start with the 4 Ps: providers, patients, payors, and public health.

Every time you cross from one of those categories to another, things get messy. But within each, the exchange of information is relatively easy. What TEFCA is going to accelerate is the "crossing of the Ps."

That's always been relatively uncomfortable. But as these conversations happen and adoption increases, people will see the benefits of easier relationships with their payors and the rest of the 4 Ps.

Check back here for part three, where we'll discuss some challenges facing Interoperability, like the secure exchange of patient health data and reducing data overload for physicians.

To learn more about how MEDHOST partners with CommonWell to help create a more interoperable care network, email or call us at 1.800.383.6278.

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