Interoperability in a Time of Healthcare Crisis: A Q&A with Paul Wilder of CommonWell Health Alliance: Part 2

In the first part of our conversation with Paul Wilder, Executive Director of CommonWell Health Alliance, we spoke about his vision for interoperability and the implication it has on the current COVID-19 pandemic.

Part two of our conversation is a discussion about how interoperability is playing a role in helping fight the current pandemic. Wilder also offers a comparison of how integrated delivery networks (IDNs) work at the urban and rural healthcare settings along with some insights on the role of CommonWell when it comes to reducing information blocking.

MEDHOST: Have you heard from your membership or any other healthcare organizations about ways access to the CommonWell network has helped them find some wins during the pandemic?

Paul Wilder: A big one has been faster access to lab and other clinical data. There are a fair amount of COVID patients starting in one setting and moving to another. I’ve heard of facilities doing rapid tests where if someone tests positive that data will flow into the next facility.

Facilities understand it’s important to have access to shared patient data. You can’t get a history and physical from a patient when the person is intubated. Historical data, access to procedures, prior diagnosis, it is all helpful. By accessing clinical data on CommonWell, some providers have had access to a fuller picture of a patient’s medical history when it truly matters, and in some cases that can be life-saving.

MH: Taking everything into consideration – present and future – where is the biggest need now for interoperability?

PW: We are seeing a lot of momentum outside of the traditional large EHRs. As things have moved towards more accountable care and shared risk systems with different financial and clinical models, we are seeing secondary and tertiary vendors pop up.

For example, in the last couple of months we signed on a physical therapy specific system. We don’t often think of physical therapy outside of episodic care, but for a lot of people it’s not. It’s related to previous diagnosis. Shared data helps these providers see chronic conditions or if there are other places to focus.

Telehealth is also huge right now, especially with the spread of COVID. We’d like to see this gain traction. I think telehealth will be the future response for other pandemics moving forward.

MH: Why is interoperability necessary for telehealth to reach its full potential.

PW: Of all the things out there right now that are super critical, telehealth is at the top for both patients and providers. What’s different now is that a lot of the available telehealth comes from existing providers. It isn’t just telehealth vendors – it’s my PCP offering me services through Skype. There are traditional providers that need access to data, but when you add on telehealth there is a real disconnect.

A provider may not have a full history of the patient. After diagnosis, that record needs to go back to the PCP. It amplifies the need for a query-based network that providers can use to see a full history of the patient.

The average person in the US doesn’t realize that healthcare is in trouble right now. They think because of the pandemic healthcare is flooded. The reality is we are only flooding the most expensive care settings – ICU beds. But the what about other services? The reality is PCP offices are closing just as fast as restaurants.

I’d like to make sure we make sure telehealth is an active participant in record exchanges—especially as we re-open the economy—so we don’t lose all that data.

MH: How is the mission of CommonWell in line with the needs of rural hospitals in smaller communities, or in places where there may be only one practicing PCP or less reliable communication infrastructures as compared to a New York or Hoboken, New Jersey?

PW: New York City and North Dakota have a very similar problem – it’s just in a very different geographical setting. When you have a large geography of spread-out facilities or a really dense setting with a lot of options, you tend to have people that go between healthcare systems because it’s necessary.

Rural has always had this problem because there tends to be facilities with more limited access to services. When you start to see that even the big guys have these gaps, it highlights the need for PCPs to do what they do very well. But as you go through different care settings – particularly in rural areas where you have to travel so far in between services – there’s naturally fragmentation in your record.

The solution is not necessarily for IDNs to be bigger, but I believe access – allowing one provider to access data from another – is the ultimate democratization of healthcare. It allows a smaller provider to act a lot bigger. A rural hospital doesn’t have to be owned by the IDN to have access to that data. It can be a competitor and cooperator at the same time by being on the same network. I’ve seen that in many respects, and both rural and urban areas seem to be a lot more similar in how healthcare is being delivered.

MH: Improving the delivery of healthcare by reducing information blocking is a big focus for healthcare regulators. How do those requirements impact CommonWell and its services?

PW: Right now, CommonWell is looking at how we can help our partners and future partners be non-information blockers. I think in general, most of the facilities out there today are not trying to block information. In many respects, they’re trying to do what HIPAA says to do which is maintain the privacy and security of the patient’s record.

What the information blocking rule is doing is giving some template to the things you need to figure out anyway. Patients do have a right to access their data and yes healthcare facilities do own the data, but they also have the responsibility to give it to that patient up-front. I think there are a lot of productive conversations going on right now about how a facility solves information blocking as quickly as possible.

CommonWell has always been a great resource for good access to data at a reasonable price. And that reasonable price point is embedded in the reduction of information blocking and so we are thrilled to already be making this as low-cost as we can, while also maintaining security and privacy. I think it challenges the whole industry to catch up.

Of all the issues facing healthcare in the U.S., the COVID-19 pandemic has highlighted the need for a more interoperable healthcare system. As Wilder stated, interoperability could not come at a better time – for both rural and urban providers as well as their communities.

As a partner with CommonWell Health Alliance and with healthcare facilities across the nation, MEDHOST is dedicated to helping providers get access to the data they need, when they need it, where they need it.

To learn more about MEDHOST’s interoperable healthcare solutions, email us at inquiries@medhost.com or call 1.800.383.6278.

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