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How much closer to true interoperability is CommonWell?

By Kyle Murphy, PhD

- The CommonWell Health Alliance made waves at HIMSS13 in New Orleans when its founding partners announced they would be banding together to solve the challenge of making their EHR and health IT systems and services interoperable. So what did the vendor association have to say at HIMSS14?

In short, it is making headway. “There has been tremendous progress made,” Scott Stuewe, Director of Client Results Executive at Cerner Corporation who heads up the CommonWell Program Management Committee, told EHRIntelligence.com.

That progress fell into three categories or activities that have been crucial in getting a production-ready service into the hands of CommonWell’s pilot provider partners. The first focused on the development of the technology itself with much of the heavy lifting being done by Relay Health. “We all did development of our own to make that technology come together. So that was built in the last year,” says Stuewe.

The second major task was getting all the association’s participating vendors to agree on an organizational structure and operation, which Stuewe claims was no small undertaking.

“We built the organization that didn’t exist prior, and that is not to be trivialized,” he continues, “to get seven — now nine — competing organizations together to agree on a single document to sign, a CommonWell membership agreement. It exists today and now has had two trial runs with new organizations to find out if they will sign it unchanged.”

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The third challenge centered on finding the right vendor partners to take part in CommonWell’s pilot program, which proved to be more difficult than perhaps anticipated.

“Since we can’t share our client lists, it’s pretty hard to figure out where to even work,” Stuewe reveals. “You have to have kind of cagey conversations — Where do you like? I like here — that’s the way we ended up choosing our geographies. Then once we got relationships with a few organizations, they could help us identify referral patterns and opportunities which made life easier once that was the case.”


Colin Walton/Thinkstock


Having rolled out a production-ready interoperability service to these pilot providers, the vendor association has come face to face with just how problematic interoperability can be. The pilot has served as a learning process with the participating providers proving why having health IT systems interoperate is important:

They have shown us mostly that what we’re doing is really valuable because if we can make it easier than it is because today it’s too hard — if the next iteration of this, if the next client I roll out can be done in 30 days instead of 3 months — we are committed as each independent organization to optimize and roll out to our clients. That is an independent exercise by each of us, and at CommonWell we’re committed to making the process of onboarding a new member easier. Those are the things that we learned. There’s more work to do around optimizing both of those things.

Interoperability relies on standards but standards are not as standard as some have come to believe, claims Stuewe. “People believe that the existence of a standard means that things just plug and play,” he explains. “Standards are very helpful, but in the absence of a clear understanding of implementation of the standard you can’t be sure that the part you comply with and the part they comply with is identical.”

Much of that has to do with compliance, which shows wide variation among providers. “No one is 100 percent compliant with the entire standard. That’s mostly because most people can’t be,” Stuewe contends. “Finding that perfect subset of functionality that is always implementable so that this is the kind of thing we can implement the way an ATM company deploys an ATM. You just plug it in and it works.”

CommonWell like the rest of the industry is still short of that. “That’s where we want to be. Where we are is shy of there, but we are way farther along than we were last year in terms of being able to replicate this from client site to client site within each of our independent organizations,” Stuewe admits.

While the vendor association is not where it wants to be at the moment, it has its sights set on being there this year and hopefully demonstrating that service at HIMSS15. “If that is done by next year and we have multiple clients running in this model and have markets where this is actually connecting a lot of places and creating real value in healthcare, that is the goal,” concludes Stuewe.




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