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Sequoia and CommonWell: Paths to Health IT Interoperability

Regardless of high-level similarities, it’s important to recognize what makes these two organizations unique.

By Frank Irving

- The Sequoia Project and the CommonWell Health Alliance travel on separate tracks, but move in the same direction — facilitating and inspiring progress toward nationwide health data exchange and health IT interoperability.

The Sequoia Project and the CommonWell Health Alliance facilitating progress toward nationwide health data exchange and health IT interoperability.

Their respective missions reflect elements of that broadly defined mutual cause. Sequoia’s declared vision is “to make the right health information accessible at the right place and time to improve the health and welfare of all Americans,” while CommonWell states that “health data should be available to individuals and providers regardless of where care occurs.”

Regardless of high-level similarities, it’s important to recognize what makes these two organizations unique. HealthITInteroperability recently spoke to Sequoia Project CEO Mariann Yeager and CommonWell Executive Director Jitin Asnaani about differentiators for their respective entities and what they hope to accomplish moving forward.

Sequoia Project

Previously known as Healtheway, Sequoia took over management of the eHealth Exchange health information exchange (HIE) network in 2012. The Office of the National Coordinator for Health IT (ONC) had previously operated the Exchange, which has since grown to become the largest HIE in the country, according to Sequoia.

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Sequoia also supports Carequality, a public-private collaborative developing a common interoperability framework for data exchange among networks.

HealthITInteroperability (HITI): What’s the status of the eHealth Exchange at this point?

Mariann Yeager (MY): This month the Exchange will celebrate seven years of production, with substantial growth in connectivity each year. It is completely federated, so there’s not a single connection point, but connects 40 percent of U.S. hospitals with a standardized and secure way to exchange health information over the Internet.

HITI: Where does Carequality fit in?

MY: Carequality provides a neutral forum to bring together industry and government to come to agreement on a common set of rules of the road to enable networks to share data amongst each other, and to map out the requirements.

HITI: How does Carequality enable separate networks to interconnect?

MY: In order for networks to trust one another, there has to be a common agreement on the policies and privacy/security and appropriate use of data — a common set of expectations and behaviors that can be relied on. The policy part of that has been memorialized in a legal agreement that all of the networks agree to.

In addition, there has to be agreement on which specific transaction types of data they wish to exchange so that it actually will be conveyed in a manner that works, and so the data received are usable across those networks. It’s essentially establishing a baseline set of expectations to make sure that the connection is trusted, that it will work, that there are accountability measures in place.

HITI: Are there areas for possible collaboration among health industry interoperability initiatives?

MY: Working independently of one another may create a message that much of this work is either duplicative or that it somehow overlaps, or that one approach or issue that somebody is working on is better or not than another. The reality is that these efforts are largely complementary.

From a Sequoia corporate perspective, we want to be a good steward of interoperability, and we want to be a champion to bring things together. And so we’ve spent a considerable amount of our focus last year and again this year on working very collaboratively and openly with the groups in partnering up on certain initiatives and trying to be more cohesive in the collective messaging. I think it’s important to establish clarity and show that there is a lot more harmony than one might assume in light of the separate initiatives.

HITI: Where do you anticipate seeing significant progress in interoperability through the remainder of this year?

MY: I think 2016 will continue to be a year of establishing connectivity on a wide-scale basis. To really capitalize on that and accelerate further, we believe incentives need to be aligned. We have seen evidence that alternative payment models can really drive progress because there’s business impetus to do it. Interoperability is achievable, but sometimes the endeavor is not given the highest priority with all the other competing needs that an organization has. But when those business incentives align, it is a tremendous influence in fueling progress.

Overall, the three elements that are high on our radar are to improve the matching of patient identities across organizations; to improve the completeness and consistency of the clinical summary documents that are being shared on a broad-scale basis; and to come up with a national strategy for developing a provider directory.

CommonWell Health Alliance

CommonWell launched in 2013, inspired by a challenge from former ONC chief Farzad Mostashari, MD, for health IT leaders to build connections across patient health records.

Forty members have since joined CommonWell in its effort to facilitate secure health data access and exchange nationwide. Those members commit to implementing CommonWell’s core services, which include person enrollment, record location, patient identification and linking, and data query and retrieval.

HITI: CommonWell is building a scalable infrastructure that enables health data to follow the patient wherever he or she may be. What are the components of that infrastructure?

Jitin Asnaani (JA): There are three distinct pieces. The first is a centralized set of services — things like patient matching identification, finding patient records and brokering the exchange of the data that’s required for the patient. It’s a combination of hardware, software, the right policies, and the right APIs such that those services can be utilized.

Vendor health IT systems make up the second component; those are the founders and members of our alliance. They are building access to the centralized infrastructure deeply in their software and workflows.

The third component is a connection between those systems and CommonWell. If you are a provider working in a hospital, for you to get data from anybody else on the CommonWell network, you only have to work with that one connection between your system and CommonWell. If you then want to get data from a different hospital, you don’t have to build another connection.

HITI: What is unique about CommonWell’s approach?

JA: First, we’re primarily a development shop that is actually building an infrastructure and services that can be utilized. Second, the centralized services that we’ve built are patient-centered. That’s an important distinguishing characteristic about what CommonWell is trying to solve relative to the rest of the industry: Our entire focus is on patient-centered transactions.

Additionally, as I described, there is a single connection between every endpoint and CommonWell that provides access to everybody else on the network. The fact that this is built into the IT vendor’s platform — and not something bespoke each time — is very different from any multi-vendor collaborations. There are some individual companies who do parts of these things, but we’re doing all of them.

Because our vendor members are building access to our services into their products, we can get very high scalability at a much faster rate than turning one provider live at a time — which is what the industry historically has done.

HITI: Do member companies allocate resources to building the infrastructure or do you have in-house people devoted?

JA: We don’t personally have dedicated resources, but we do have a subcontracted service provider who is on the hook for building, maintaining and scaling those services. The member companies on the other hand, actively dedicate resources to determine what those services should be. They help determine the specifications and standards and how they should be coded. And, of course, they are the ones building the connection into their products.

The beautiful part about that is that they come up with some fantastic ideas. We are benefiting from the ability to bring together the best thinking from across the industry in creating the right set of services and specifications.

FI: What are some of the key priorities for CommonWell moving forward through the next year or two?

JA: We’ve made great strides in deploying CommonWell’s services to members and their clients to date. We’re at the beginning of a wave that needs to continue gaining momentum over the next couple of years.

There are standards issues that we need to work through to make the experience of interoperability better — no matter what part of interoperability we’re trying to solve. CommonWell is helping to improve the experience of interoperability for members’ customers by working through gaps in standards that right now inhibit the exchange of data that doctors and other caregivers really want.

A third priority is related to the fact that more than half of our members’ EHRs are in the post-acute space — pharmacies, labs, EMS, perinatal, radiology, for example. One of the focus areas of CommonWell will be getting into some of those other spaces. Care occurs in the hospital and clinic, but it also occurs at home, and at pharmacies, labs, etc. All of those locations should be able to have access to patient data.

We won’t be able to turn it on all these capabilities at once, but we need to start making those big steps this year.




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