Leaving Your Badge at the Door to Improve Health Data Exchanges: Part 1

With every EHR (Electronic Health Record) enhancement or platform build-out, healthcare IT (HIT) vendors nationwide are working, sometimes scrambling, to enable interoperability.

These efforts may work on a granular level, even for their local area; however, it also can slow the journey to nationwide interoperability.

CommonWell Health Alliance  is one organization that is making quicker strides to improve health data exchanges across the country. They believe that carrying out this critical task calls for altruistic collaboration from healthcare IT vendors, government entities, and hospitals themselves. In other words, they believe we should all “leave our badges at the door” to help improve patient care coordination.

A member of CommonWell since 2014, MEDHOST interviewed Jitin Asnaani, the Executive Director of CommonWell Health Alliance to learn more about the challenges and opportunities of nationwide interoperability. Part 1 of our discussion offers a quick breakdown on the CommonWell vision for nationwide interoperability. We also get his reaction on some of the hot button HIT items covered at HIMSS19, such as the impact of FHIR (Fast Healthcare Interoperability Resources) APIs and the recent 21st Century Cures Act.

The second part of our dialog with Asnaani focuses on what actions the Alliance’s members are doing collectively to make interoperability a reality for healthcare providers of all types and sizes.  We also explore why participating in interoperability is important, the challenges CommonWell and the industry face, and what needs to happen to drive this important patient-centered care initiative forward.

MEDHOST:  Tell us about your role in CommonWell and your work there.

Jitin: Currently, I’m the Executive Director of CommonWell and have been involved with CommonWell since it was founded back in 2013. I was actually involved in writing the original specifications and also participated in most of its committees over time – Deployment, Membership, Marketing, etc.

CommonWell is a non-profit trade association made up of almost 80 organizations who have come together in a shared belief that wherever a patient goes and regardless of where their care has occurred, their data should be available to themselves and their caregivers. That’s what we stand for, and it’s a lot of fun leading the Alliance in my role as executive director.

MEDHOST: What do you enjoy most about leading the way for CommonWell?

Jitin: There are several aspects that make this such a fun role, starting with the real-world applications.

We’re focused on building a functioning network that is enabling millions of transactions on a daily basis, which ultimately allow data to flow in a healthcare system.  Where data has been historically stymied, we’re enabling movement. The notion that we are enabling action is one of the best things about being a part of CommonWell.

We continuously hear of stories of patients and providers whose care has been positively impacted by the ability to access data they previously could not. That has to be one of the most gratifying aspects.

The other aspect, which particularly makes my role a lot of fun, is the opportunity to work with such a broad diversity of organizations whose collective intelligence far surpasses what any one organization can accomplish. The people bring together so many perspectives, so much innovation into what we’re working on, that it’s just remarkable; you learn so much from different companies.

Not that everybody harmoniously agrees on everything all the time, of course. As a matter of fact, that they don’t always agree adds value. They come up with very different ideas, and we work hard to put those ideas into motion. CommonWell creates a productive environment where people are bringing together great ideas and focusing on getting those ideas implemented in the real world.

Both parts of that equation, who is coming to the table and the diversity of the people, along with the fact that we’re actually making something real are probably the best parts of working with CommonWell.

MEDHOST: Since our HIMSS19 interoperability discussions, what are some new takeaways from that event, and how will they apply to CommonWell moving forward?

Jitin: There were probably three big things. First, at HIMSS we got deluged with a whole bunch of regulations. What was interesting to me was that the regulations pointed in very clear directions: What does information blocking mean? What is the expectation around notification? What are the expectations for the ability to get patient data—for the patients and the caregivers?

It was great to see that a lot of the regulation talk aligned with what we were trying to accomplish, and it gave us a little bit more validity. It’s probably reflective of where the industry was starting to go in the first place.

The second thing was the focus on FHIR APIs. It was quite clear at HIMSS that anything related to FHIR was a sold-out event. It was really exciting to see that a number of us in CommonWell were involved in informing the Argonaut Project. We adopted FHIR long before people had heard about it. There’s now a lot of industry momentum in FHIR, and it’s really exciting. It means that we picked the right pot, and we need to continue working towards satisfying the expectation of FHIR in the long run.

Third, just before HIMSS, we made an announcement regarding the CommonWell ConnectorTM program that would allow intermediaries to connect to CommonWell. It was very exciting to see the number of organizations who came to talk to us at HIMSS about that program. That means CommonWell has an opportunity to continue its reach and really ensure that no matter where patients go, we’re able to help them and their caregivers get a full picture of their clinical history.

MEDHOST: You mentioned a growing FHIR API landscape. What do you attribute to that growth?

Jitin: The notion that we should be able to easily exchange targeted healthcare data is an idea which time has come. We’ve been living in a world that’s akin to PDFs – so static, and it’s time for us to get past that dogmatic view.

A FHIR API will allow you to ask specifically for the data you care about in a well-defined format. That is incredibly helpful. It allows for a wide range of applications to successfully connect into the growing healthcare ecosystem. The drivers of FHIR growth are one-part technology and one-part powerful political forces that have decided to join the FHIR bandwagon.

It’s like any other technology. Once you have enough momentum, when you have critical mass, it just becomes the industry expectation and the industry standard. I think that’s what we see happening in FHIR.

MEDHOST: Speaking of politics and federal regulations, give us your take on 21st Century Cures Act. What does that mean for promoting interoperability?

Jitin: 21st Century Cures has done two things really, at the super high level. First, there’s a growing notion that data cannot be hoarded or selectively shared in any sort of way. The regulations are very clear that any selectivity or hoarding is going to be met with consequences. That is important because it means organizations who have either sat on the sidelines of interoperability or specifically not engaged in broad-based ways are going to have to rethink their role. They will have to rethink how they approach data management for their institutions. EHRs and providers have been served notice that they need to participate or be left behind.

There are lot of descriptions that have gone into what information blocking is and what it means to be a facilitator of exchange. There are even technical descriptions on what an API is and how it needs to be exposed. All this creates clarity for the technology community in terms of where we need to go. It also creates some amount of freezing because in the short term, until these rules become final, you don’t know where they’ll really land.

21st Century Cures will create an acceleration effect of interoperability. In the short term, it may cause some people to hold back until they know where the industry is going. When these rules become final, everybody will have to take the plunge, much as they did for Meaningful Use and the adoption of EHRs.

MEDHOST: What are your thoughts about the coordination of payment of care between payers, providers and patients. What is the impact of interoperability in that trend?

Jitin: Back when I was a director of interoperability at an EHR vendor, I had two conversations. I’d talk with people who would go into excruciating detail to explain what the burden is going to be for them to be able to connect. Then, I’d have other conversations with ACOs (Accountable Care Organizations) where the details of interoperability were taken for granted.

Now we have provider organizations asking us to bring the payers into the fold. They want to do this to enable a higher value exchange of data and better coordinate care and payment of care.

It’s interesting that the dynamic has changed. I got this impression as well, from payers at other data exchange organizations like Carequality and eHealth Exchange. At those places, the gulf between payers and providers seems to be shrinking. The notion that there will be a little bit of cooperation between them seems not as alien as it was seven or six years ago when we formed the Alliance.

I don’t know what the end state is, but it’s clearly a progression towards higher integration between those parts of the industry. You can see why CMS (Centers for Medicare & Medicaid Services) is pushing for that through their own actions, motivating the community towards joint standards development with payers, providers, and the like.

Joint actions and partnership are a common thread in our conversation. No discussion about interoperability can ignore the fact that there is no single solution to the problem. It is an intricate challenge that requires participation from every player: providers, payers, vendors, and policymakers.

Stay tuned for part two where we talk about what actions the Alliance is currently doing to promote interoperability nationwide at both the healthcare industry and government levels.

Join the Alliance and learn more about interoperability with CommonWell.

For more information about MEDHOST, contact us at 1.800.383.6278 or inquiries@medhost.com.

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