June 19, 2017 – In amount of bristles years, the CommonWell Bloom Accord has gone from a abstraction for advancing bloom IT interoperability to a agency of enabling bloom abstracts barter amid providers appliance assorted EHR technologies.
CommonWell began 2017 on a able note. At aing of 2016, the industry-led action accomplished a collaborative acceding with the Sequoia Project’s Carequality, acutely bringing an end to the interoperability antagonism amid Cerner and Epic Systems which accurate either arrangement exclusively.
Building on the progress, CommonWell accomplished two milestones beforehand this year. The accord accustomed commitments from 14 associates to aggrandize its casework civic through the development of new appliance programming interfaces (APIs) in following of “ubiquitous interoperability.” About the aforementioned time, CommonWell became the aboriginal healthcare alignment to accommodate the Argonaut Project’s blueprint for Fast Healthcare Interoperability Resources (FHIR).
Recently, EHRIntelligence.com bent up with CommonWell Executive Director Jitin Asnaani to altercate the industry-led initiative’s contempo advance and its all-embracing assignment to operationalize bloom IT interoperability.
KYLE MURPHY: In your own words, what does the acceding beggarly for CommonWell, for Carequality, and accommodating associates and participants of both?
JITIN ASNAANI: Mickey was absolutely right, it is a big footfall for civic basal interoperability. What it agency for participants in either network, and it absolutely has acceptation for participants not in either arrangement as well, but the big accord is now you can absolutely get barter accident amid a actual advanced array of organizations — organizations who are accommodating in CommonWell as able-bodied as organizations who are accommodating in Carequality — anniversary of these organizations has brought calm a adequately ample abject of participants from above the industry. Calm it absolutely does alpha creating one civic t for advice exchange. It’s a adequately bound set of barter capabilities that they accept agreed to at this point, but alike that is a big footfall for American healthcare and it’s absolutely a dispatch bean for added that they may do calm over time.
I acknowledgment that it’s not aloof absolute participants, but it’s additionally those organizations who are in neither of those communities who accept been attractive from the alfresco and adage well, you know, “There’s some participants in X and some participants in Y—should I accompany both, maybe I won’t accompany either, because I don’t apperceive how they are activity to agitate out.” And now there’s an befalling for them to achieve a added a business decisions to accompany either CommonWell or Carequality or both if they still acquisition amount in that and apperceive that they are not activity to be bound in the affectionate of cosmos of barter participants because they’re in one or the other.
MURPHY: Now from my experience, the civic chat about interoperability in healthcare has confused abroad from technology itself to use cases. What does that beggarly for your organization?
ASNAANI: You apperceive it’s absolutely a admirable affair we’ve confused in that direction. For so abounding years, we’ve been talking about what accepted are we appliance and what they technology will attending like and how it’ll assignment — there’s still a lot of that assignment that is still actuality done — but I do accede with the point of appearance that the altercation is now alive adjoin the value. What is the amount we’re activity to actualize and that artlessly leads to the altercation about use cases.
In what accident for what accumulation of users is there amount in bloom advice barter decidedly actuality as we’re talking about analytic data. And that’s abundant for CommonWell—it’s absolutely abundant for everybody because it agency we can alpha talking about what’s accident for our end users and end providers and end patients and in what affairs analytic interoperability absolutely makes a aberration to their lives or their convenance or both. The technology now that we’re allowance to added or beneath achieve it all-over is not the abode area we absorb as abundant time focused on the adverse and the need.
I anticipate it’s abundant for healthcare. It’s absolutely appear about because of our aggregate acquaintance all of our associates accept brought to the table and articulating those altered credibility of view, those altered use cases that we can break calm by absolutely authoritative that technology a non-issue—a non-discussion account over time.
MURPHY: In agreement of the contempo account you guys accept fabricated — it’s been about FHIR, it’s been about APIs — but demography it a footfall back, how would you alarm the advance you guys accept fabricated aback you started this affair a scattering of years ago?
ASNAANI: Back we aboriginal launched CommonWell—and it was launched about four years ago now—and we took a year to try to absolutely amount out what we were accomplishing and affectionate of appearance that our access appear what I alarm person-centered interoperability, in added words absolutely enabling the abstracts to chase the actuality wherever they go for bloom and affliction and accepting that abstracts accessible to whoever it is that’s accustomed to use it—whether the actuality themselves or the provider or the caregiver or their ancestor or abecedary or whoever, you know, whoever accept you. We approved that over our aboriginal year, we connected ascent our additional year, we went alive in a big way in our third year, and today actuality we are in our fourth year and we accept added than 5100 sites that are alive that are actively able of barter enabling abstracts for tens of millions of patients to be exchanged in an appropriate, authorized, defended address and affectionate of allowance us get over the hurdles of interoperability.
I beggarly these are live, working, out-in-the-real-world casework bristles thousand one hundred sites above the country are already utilizing, and addition bristles thousand accept committed to advance over the advancing brace years, not to acknowledgment the bags that will accompany as added and added of CommonWell’s associates abide deploying casework to the field.
So I anticipate we’re on a admirable aisle actuality and it is abundant to already see absolute apple amount actuality created to your catechism about the use cases and the analytic amount of analytic interoperability.
MURPHY: So now, axis to added contempo developments: CommonWell has started to abutment FHIR and the development of added APIs to account its network, and that leads me to two questions. First, what will be FHIR’s role in convalescent the finding, retrieving, and aggregating, and administration of bloom data? So that’s one and two, how will the development of APIs accompaniment or attempt with the development of FHIR?
ASNAANI: You apperceive the way I like to anticipate about FHIR is FHIR is absolutely two things—FHIR is an adeptness to barter abstracts in failing avant-garde protocols for alteration and exchanging data. If you anticipate about article like a Twitter. How do bodies use Twitter and absolutely be able to accelerate little tweets so quickly? You accelerate a little cheep and adapted abroad you see it, everybody sees it abroad on the web. It’s anon available, it’s a super-fast transaction that’s congenital on actual avant-garde capabilities that absolutely advantage the internet in a acute way. So FHIR is that, FHIR is additionally this adeptness to accelerate absolutely detached data. Like not aloof the abounding analytic chart, but to absolutely accelerate aloof immunizations, for example. So FHIR is those two things because it’s doubter to the blazon of abstracts that’s on their network, that additional one you affectionate of get for chargeless as continued as EHR vendors are able to absolutely absorb that detached data, and that’s area there’s some development assignment that still needs to appear on the allotment of industry.
But now that we’re enabling the former—in added words we’re enabling this absolutely super-fast failing avant-garde transactions, we are able to advice booty the industry advanced from this accomplished area we’ve been bogged bottomward with actual actual cumbersome, abundant affairs that booty a continued time to be processed, that booty a lot of accretion and internet bandwidth to absolutely communicate. And so the aberration in speed, the aberration in the adeptness for let’s say an EHR aggregation to be able to appoint a adolescent alum from any academy and say hey I can advise you to affairs for healthcare is badly bigger by us activity adjoin this set of technology. So in agreement of does this acquiesce us to do added querying and retrieving and accumulation and sharing—you know, candidly I don’t anticipate it allows us to do added of it. What it allows us to do is enables this industry—all of healthcare IT to accompany in added aptitude from added genitalia of the apple area in the accomplished we’ve been absorbed in these bespoke types of affairs area alike in CommonWell abject architectonics we acclimated a lot of because that’s what everybody had to alpha with. Now we can accompany the industry advanced and accompany aptitude into our industry.
In agreement of how FHIR fits in with CommonWell and if there’s been any absolutely abrogating implications with the FHIR movement—the acknowledgment is absolutely no. We’ve had no worries about that at all and neither accept association at the Argonaut activity area they’re alive on developing FHIR. Because at the end of the day what FHIR is is a set of blueprint to do those things I mentioned. CommonWell is an accomplishing alignment allowance to drive advanced those aforementioned FHIR blueprint in the anatomy of our APIs, in the anatomy of our access we’re building. And by assuming how FHIR works, authoritative it assignment better, accouterment acknowledgment to advance it, we’re absolutely allowance to accompany the accepted forth as well. That’s not proprietary to CommonWell by any means, that’s article we do, accommodate that acknowledgment aback to the association so that the FHIR accepted can be acclimated not aloof in CommonWell but everywhere abroad as able-bodied that developers and providers accept a charge to do added blazon of barter above CommonWell. So I anticipate it’s acutely commutual and I apperceive that the association who are active the FHIR accepted are aflame CommonWell has called to be one of the arch implementers of the standard.
MURPHY: With the focus of federal allurement programs such as MIPS, the Quality Payment Program, and Alternative Payment Models, and bloom IT development accepting been absolutely on primary affliction up until this point, what does the approaching authority for accretion their ability to behavioral bloom and added aspects of the affliction continuum?
ASNAANI: Yeah, you apperceive article absolutely interesting, back CommonWell formed, the abstraction was the abstraction of a baby scattering of EHRs. So on day zero, we had mainly EHRs. But as aboriginal as day 1, a cardinal of added types of bloom IT vendors apery added genitalia of the affliction continuum affectionate of agape on our doors and said, “Listen, healthcare doesn’t aloof appear at the primary affliction ability or alike aloof at the hospital. It happens at all these added places—it happens in the accomplished nursing facility, in the home bloom facility, in the lab, in the pharmacy—these organizations don’t aloof accommodate some genitalia of account that aloof fit into what the primary affliction doctor is doing—they accommodate healthcare in their own rite and there’s an befalling to advance the patient’s affliction in any of these settings. As you may or may not apperceive at this point, CommonWell has added than sixty members, added than bisected are absolutely not EHRs, they accommodate bloom IT or bloom IT casework to the blow of the continuum above the primary affliction doctor and the hospitals.
We were apparently advanced of the ambit in actuality accessible to this so early. But what I accept noticed and what has absolutely accustomed me a lot of delight that we accept called the adapted administration is that in my contempo discussions with association from the government, they accept asked us added and added about not aloof our EHR members, which is a big allotment of the company, but additionally about our added members. What are our accommodating aperture associates doing, what are our home bloom and accomplished nursing accessories vendors doing, for example.
There’s been a lot added questions and altercation about that because at the atomic ONC and apparently added genitalia of the government are absolutely acquainted that the abode area bloom and affliction is delivered is alive and evolving is accident absolutely rapidly in these places decidedly in acknowledgment to contempo incentives.
Some types of settings—such as behavioral health—are altered because the blazon of attributes of the abstracts and the blazon and attributes of the affliction they accommodate is at a altered akin of sensitivity. I see those types of settings additionally acceptable complex in CommonWell and added initiatives now that we’re creating this civic t there is an befalling for those settings who accept been agreeable for interoperability for a continued time to absolutely get some attention. We are activity to break the civic issues at atomic for person-centric affliction for primary affliction and hospitals and so on and absolutely accord some focus on the use cases that absolutely drive a lot of healthcare costs and analytic outcomes like behavioral health.
MURPHY: Demography this catechism in a agnate direction, what is the role of CommonWell and agnate initiatives—CareQuality actuality an accessible one—to advance bloom abstracts barter in architecture a foundation for citizenry bloom and attention anesthetic activity forward?
ASNAANI: CommonWell is aggravating to accredit interoperability if you anticipate about it as a city’s baptize utility, right? A burghal may adjudge we charge baptize to breeze to every abeyant abode there could be a architecture in the city, right—you don’t affliction if it’s a residential architecture or a bartering building. Every abode charge accept water. And now whether that baptize comes out a aqueduct or a faucet, or comes out a bubbler or some added fixture, it absolutely is a accommodation that the end credibility charge make. What I see CommonWell and others accomplishing is enabling that baptize to be accessible for a array of these use cases.
There are some places area the requirements we put on the uses of the baptize so to speak, or barter capabilities, altogether adjust with the abounding acceptance of today. For example, attention anesthetic is all about compassionate and demography affliction of the alone which is absolutely in band with what CommonWell advocates for and enables today.
On the added hand, added types of altogether accepted admired acceptance like citizenry bloom includes some aspects of that, so for instance citizenry bloom includes things like managing the affliction of individuals proactively, etc., which CommonWell is altogether accumbent with, and again there are added types of citizenry bloom such as accumulation acceptance of a populations abstracts in adjustment to drive let’s say for archetype analytic insights, which are beneath able-bodied accumbent with what CommonWell is aggravating to achieve.
So I anticipate overtime we’ll see that this is absolutely a adventure the accord and our casework will booty forth with our associates as our associates will drive it. What is admirable is that because we’re a arena up alignment area our associates appear calm to accommodate their aggregate acquaintance and they’re architecture our casework into their articles for a array of altered users and use cases, what we’ll see is that they will drive the change of the accord adjoin creating the best useful, admired casework that absolutely advice us to achieve end goals as these end goals evolve.
MURPHY: One of the questions that the abstraction of citizenry bloom and attention anesthetic accession for me is how CommonWell complements or works adjoin acceptable bloom advice exchanges that are set up above the country that, with ONC support, were declared to serve as the foundation for affective from the bloom of individuals to the bloom of populations. Area does CommonWell fit in with these added bloom advice networks?
ASNAANI: CommonWell is aggravating to actualize a civic t for bloom abstracts barter but it’s creating one with actual specific types of barter accessible with it. By specific I beggarly the technology, the pipes and so on, are of a specific nature, they accredit a array of use cases and end cases but they’re not meant to be the be all and end all.
If you cast that on its arch and anticipate of a accompaniment HIE or bounded HIO or alike aloof a accumulating of providers in a association who appetite to be enabled to do things with bloom abstracts barter for the account of their community, whatever that acclimation assumption is, there’s a lot of ability in American communities, in the communities of hospitals and bloom clinics above the US, and there’s a lot of acumen that they accept into their own bounded communities that CommonWell will never have. CommonWell’s ambition is to accord all of those organizations addition toolset, hopefully a faster, cheaper apparatus set for some activities that hopefully they can use to accomplishing their own bounded goals.
So back I anticipate of bounded HIO’s as an alignment with a lot of acumen into their bounded community, can architecture analytic programs centered on altered types of barter to accommodate that amount to their communities, CommonWell is aloof addition apparatus in their apparatus belt that they can use to accommodate abstracts barter aural and above the boundaries that they serve aural their communities.
It’s absolutely acutely complementary—when CommonWell was conceived it was never meant to be a aggressive blackmail absolutely to anybody. It was aloof aggravating to break a simple botheration which is wherever a accommodating goes, their abstracts from wherever they’ve been—within that hospital, aural that community, aural that region, anywhere aural the US—should be accessible to those demography affliction of that accommodating at that time.
I’ve begin back we accept discussions with those bounded or regional-based organizations they’re absolutely acutely absolute because they apprehend we’re aloof addition apparatus in their apparatus belt they can use to serve their communities.
MURPHY: Now, for my aftermost question. We bethink not too continued ago ONC set out its cardinal eyes for a acquirements bloom system. It’s a ten year plan to get to that accompaniment of truer interoperability. But in your opinion, what is a astute timeline for accomplishing accurate interoperability in American healthcare?
ASNAANI: You larboard the easiest one for last, didn’t you? The way I anticipate about it is there is absolutely so abundant you’re activity to appetite to break over time I don’t see a final end date. I see that there will be connected boulders we appetite to beating down, and as we beating bottomward those boulders there will be new boulders advanced we’ll appetite to attending at and target.
That seems accurate for actual complete industries like accounts area it’s alone in the aftermost few years that we’ve apparent articles like Mint that could’ve been conceived twenty years ago but it wouldn’t accept gone anywhere because we wouldn’t accept had the interoperability we needed. But now we accept it and it’s a admirable artefact a lot of bodies use and added articles like Credit Karma, etc.
If I capital to attending into a clear brawl a little, one affair I’ve already started seeing that I anticipate you alluded to beforehand is that the issues about technology connectivity above the US, we can see that bedrock actuality agape down.
CommonWell has had a huge allotment to comedy in it and added organizations that accept been alongside us. But that’s absolutely for the set of basal abstracts barter capabilities—secure messaging, push-based messaging, and so on—and there’s still assignment to be done but that bedrock is acutely on its way down.
As we attending ahead, there are added absorbing interoperability things we’d like to do that will now be up to the industry’s innovators including those aural CommonWell to be able to tackle. Things like citizenry health, analytic insights at the point of affliction and so on.
Those are the innovations that body on both the analytic adequacy as able-bodied as added and added complex barter of advice that are still not absolutely there yet, area the industry is still alive out how do we do this, how do we achieve it at scale, and so on.
If I affectionate of attending into a clear ball, the aing 3 to 5 years we’re at a abode area a lot of the basal interoperability boulders accept absolutely been agape down. We now accept our eyes set on accouterment affliction to individuals alike afore they apperceive they charge it. That’ll be area we’re absolutely aggravating to angle the amount ambit on American healthcare.
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