Leaving Your Badge at the Door to Improve Health Data Exchanges: Part 2
Part 1 of our discussion with Jitin Asnaani, the Executive Director of CommonWell Health Alliance, introduces the mission of the Alliance and covers some of the hot button topics that arose from HIMSS19, this past February.
In a continuation of our discussion, part 2 focuses on what actions the Alliance is taking to make interoperability a reality for healthcare providers across the nation. Asnaani also touches on some of the challenges and opportunities facing both CommonWell and the industry as a whole, where they need the most help, and what they are doing to push the topic of interoperability into the government spotlight.
MEDHOST: Integration and partnership seem like key pieces to solving the interoperability puzzle. With such a broad membership composed of organizations who don’t always agree, how does that dynamic work to achieve your goals?
Jitin: CommonWell is a little bit like the Twilight Zone. It is a place where members of the healthcare industry who normally compete come together to work on the joint problems of interoperability. There is no one-way solution to interoperability; you need solidarity and unity to get things accomplished.
We’ve created a culture of sharing. When CommonWell was founded, my colleague, Nick Knowlton, and I were working at two ambulatory EHR companies that go head-to-head. As two of the original members of the CommonWell team, we made a deliberate choice to “check our badges at the door” and work on these interoperability issues.
Nick has continued to be the cultural czar for CommonWell and pushes our members to realize that this is a place for sharing — sharing in the pursuit of a joint goal to solve roadblocks that impede the flow of data from one platform to the next, sharing to have happier customers, better patient care, and better patient experiences.
It’s critically important to maintain that sort of culture within the Alliance. Healthcare vendors and EHR companies will continue to compete, but it won’t be because we can’t interoperate with each other. We are working to collectively solve for the greater good and for the good of all of our customers. People who have worked with other industry associations and alliances and then come to CommonWell comment on how different and bizarre it seems to have such a transparent, collaborative approach. They realize, though, the outcome is going to be good for everyone.
MEDHOST: Do you come across any kind of resistance getting organizations to work together or getting people on board?
Jitin: Occasionally you run into data blocking issues and organizations who specifically say they don’t want to participate because they don’t want to share data. I think a big challenge is building awareness that there is a way—a facilitator—that can help them exchange data.
Interoperability is not a high product development priority for many organizations. There are so many other things that EHR vendors, in particular, have to deliver to their customers. Meaningful Use spurred rapid industry growth. Most EHR vendors have had to respond with more speed to meet those demands and not become irrelevant, sometimes at the detriment to their product. In trying to catch up, for many EHRs building more interoperability healthcare tools has fallen to the wayside.
We continue to push the boundaries with EHR companies to figure out how we can make it easier for them to participate and connect to the Alliance—from making it more affordable and more seamless to lowering the technical lift. CommonWell is incredibly easy because it’s one connection that links you to thousands of sites with no need to build individual connections.
MEDHOST: How do these challenges apply to rural and community hospitals, those facilities facing closures? How do you make sure they are part of the conversation, get the necessary training, easily get on board with interoperability?
Jitin: There are multiple parts in motion when it comes to the rural healthcare and interoperability. Deep down, the value of interoperability for community hospitals, particularly rural hospitals, is how it helps connect them to the larger community where the patient has been. Their patients often receive care away from their community care hospital. Being able to access those tertiary care centers has an impact. That’s where CommonWell has strong effect, especially now that we’ve collaborated with Carequality.
With one connection through CommonWell, these smaller facilities can get access to some of the biggest EHR vendors outside of the rural health space. Once you are able to connect your EHR to other EHRs through a single pipeline, you create incredible value. Even if they’re not using or accessing data themselves, enabling their data to be accessed makes them a more valuable partner to the tertiary care center or community care center. We actually expect the rural market to grow for us now that we have the connection to Carequality.
In terms of distribution to the rural hospital, it may be most effective coming through the EHR vendor. There can be a lack of messaging to rural hospitals as to the availability of things like CommonWell. Typically, there are even fewer resources helping them on the technical side with the ability to connect to things like CommonWell. The EHR vendor is a critical linchpin. EHRs have both the ability to access the rural hospital as well as the technical resources to enable access.
You also need to be able to train rural health hospitals on how to make the most of something like CommonWell. That’s a harder problem, actually being able to utilize the data that can come through CommonWell for their patients. Here I see a few different efforts happening:
There is support from the EHRs themselves. We’ve also had discussions with a number of state HIEs (Healthcare Information Exchanges). I met with the Massachusetts state HIE recently, and they’re specifically thinking about offering training programs for local providers. Not just the urban areas around Boston but also the expansive rural areas across the state. These training programs will help get people to adopt and utilize CommonWell in their settings. This type of participation solves the distribution to those places and at the same time provides training.
Between the EHR vendors, the state and local authorities, and industry associations like NRHA (National Rural Health Association), I’m hopeful that rural and community hospitals will be able to find the right set of resources to help them utilize CommonWell and its services more effectively.
MEDHOST: In terms of cost, what is happening to make the transition to interoperability financially feasible for the rural healthcare community?
Jitin: CommonWell only charges the EHR or technology vendor for access to our services.
For this example, let’s say it is mainly EHR vendors. The EHR vendor charges whatever they feel is appropriate back to the customers. My mandate is to drive down those costs as low as possible. This is a non-profit run by mostly EHR companies in the first place. We’re charging them for a service at as low a price as possible because they’re the ones who want it. This is one of the main reasons they specifically invest in the Alliance.
Over time, expecting the cost of interoperability passed to the EHR vendors goes down, the expectation is that same decrease in cost will be passed on to the hospitals. At some point, it might even be free.
In the meantime, we’re going to try to drive down costs as low as we can. On a facility basis, the cost is already less expensive than a couple of individual, point-to-point connections.
My hope is that it truly becomes like the water bill or the utility bill. Not that you won’t notice it, but it’s not something that makes you not run the dishwasher or take long showers.
MEDHOST: Where do you need support the most and from whom?
Jitin: Number one support comes from the EHR vendor community. Hand-in-hand with that is government support in the terms of CMS and ONC regulations and guidance. We would like to see all those aspects fall in line with what CommonWell is trying to do.
At CommonWell, we have built something that we know works and is utilizable. We know it’s not perfect, but we know how to make it better overtime. My hope is that in trying to make this a reality, we get wind in our sails from government regulation. Hopefully, policymakers will see what we’ve done, see that it actually works, and make it so more people want to do it
EHR vendors and the government—those are the sources of support I really think about today. The EHR community is on the hook for enabling interoperability and trying to make it work. The government community needs to ensure that regulations reflect what we’re learning about enabling interoperability at the ground level.
MEDHOST: How closely does CommonWell work with the government?
Jitin: First, we have several government agencies who are members of CommonWell. Those agencies participate with us in various committees just like private sector members. The second way in which we work with the government is with healthcare industry regulators like the ONC and CMS.
In terms of those who regulate our landscape, they’re not inside the Alliance for obvious conflict of interest reasons. However, we do collaborate with them and share what we’re learning, what we’re doing, where we’re struggling, and where they can help us be more successful. In response, they reach out to us to understand what we’re working on. Healthcare regulators ask for our feedback on certain pieces of legislation and we do our best to help guide them in their mission. It is a lot of collaboration.
It helps that we’re non-profit trying to contribute to the collective good. Our positioning gives us an opportunity to be more open with the government as well as to get more guidance from the government.
There’s still a good amount of ground to cover when it comes to solving for interoperability, and the journey is not for healthcare facilities to take alone.
No single entity or government policy alone can offer a completely viable solution to nationwide interoperability. What it will take is full participation across the entire industry. In CommonWell Health Alliance, we have found a valued partner who shares this same ideal.
Contact CommonWell to learn more about how to make your EHR interoperable.