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Will Carequality Lead EHR Vendors to EHR Interoperability?

"The way we are going to get to interoperability faster is not by having each individual customer try to integrate with other customers."

- The Sequoia Project and Carequality have taken significant steps forward in advancing EHR interoperability by brokering agreements with several health IT vendors to implement its framework for point-to-point health information exchange.

EHR interoperability at Carequality moves forward

Five big names in health IT — Epic Systems, athenahealth, eClincalWorks, NextGen Healthcare, and Surescripts — recently signed on to be the first implementers of the Carequality Interoperability Framework, the legal agreement that streamlines the sharing of health information between these various systems.

Read 10 Biggest Epic EHR Implementations in United States

Three in particular were vocal in calling attention to the significance of being an early adopter of the legal framework.

"The industry needs to evolve from simply exchanging information to meaningfully sharing it and introducing new workflows to access it," Doran Robinson, athenahealth Vice President of Healthcare Transactions, said last week. "We believe that efforts such as Carequality, CommonWell and the Argonaut Project are making marked progress on mobilizing health care information in meaningful and secure ways.

Read Epic, Carequality Challenge CommonWell on EHR Interoperability

His comments were echoed by head of eClinicalWorks, CEO Girish Navani.

"As vendors, we have a responsibility to make information accessible to patients and their physicians," he told EHRIntelligence.com. "The work done as part of the Carequality Framework will speed the time from end user agreements to being able to go live with real interoperability between disparate systems. This initiative will aid our customers in sharing pertinent health data and providing better care."

Matthew A. Eisenberg MD, FAAP, who serves as both the Medical Informatics Director of Analytics & Innovation at Stanford Health Care and Chair of the Epic Care Everywhere Governing Council, championed the announcement as a big win for EHR interoperability:

The Carequality framework is designed to accelerate health information exchange at the network level.  It was developed with guidance from stakeholders across the entire spectrum of the health care industry.  At its core it includes a trust framework that ensures free and open exchange (the non-discrimination requirement) and solidifies the use of common standards for query-based document exchange by spelling out the details in their implementation guide.  Any network, vendor based or not, may participate. Vendors that support robust exchange networks and utilize standards based exchange are encouraged to join.

Read 10 Biggest Cerner EHR Implementations in United States

Any vendor may participate, but noticeably absent from the list of early adopters was Epic's chief rival, Cerner Corporation. In a statement to EHRIntelligence.com, the Kansas City-based EHR company give little indication of its plans to implement the framework:

Cerner supports the free flow of data across the care continuum, regardless of geographic or technological boundaries. To this end, we have supported The Sequoia Project and its Carequality initiative. We are a founding member of Carequality and also provide direct support with leadership from a Cerner senior strategist who serves as vice-chair of the Carequality steering committee and is co-chair of its document query workgroup which was instrumental in developing the Carequality Interoperability Framework.

Cerner's involvement in Carequality mirrors its work with CommonWell Alliance, which numbers athenahealth and several other prominent EHR vendors among its membership. The juxtaposition of Carequality and CommonWell was front and center during a notable hearing before the Senate Committee on Health, Education, Labor, & Pensions a year ago.

At that time, Epic's Vice President Peter DeVault revealed the rationale behind the EHR company's decision not to join CommonWell, which included the cost and signing of non-disclosure agreements on top of other reasons.

"They aspire to be a nationwide network with a record locator service that will tell you where every part of a patient's record is," he stated. "They are not that today. According to their latest report that I have seen, they have four different sites live on their network, fewer than a 1000 physicians compared to a 100,000 thousand in Care Everywhere and almost 10 million records exchanged a month now."

Additionally, DeVault went on to explain how the two networks would eventually work together.

"Carequality is meant to be that fabric that connects all of the networks together," he continued, "so you have health information exchanges, you've got the Care Everywhere network, you will eventually have CommonWell. Carequality then will be the fabric that stitches all of that together. So we hope that they will join Carequality."

Where the provider, patient fit in?

All the talk of EHR and health IT companies, agreements, and connections have their place, but they ought to come second to the role interoperability must play in delivery high-quality, patient-centered care, according to the Chief Medical Informatics Officer at UCLA Health.

"It all comes back to doing what's right for the patient. Every EHR vendor will tell you that they built their system around the patient…Fine," Michael Pfeffer, MD, FACP, tells EHRIntelligence.com. "If the patient is the center of the universe, it shouldn't matter where the patient goes."

"It's all about the patient," he continues. "The idea that owning or protecting data about a patient is going to offer you some level of advantage in the business isn't true. That idea has mostly gone by the wayside in favor of if we provide excellent care and we have satisfied patients, they'll come back. And in order to have that level of satisfied patient as well as excellent clinical care, you need the whole picture of the patient wherever they go."

These comments alone would give the impression that Pfeffer is critical of the Carequality developments, but that's not the case.

"I'm just excited that this is even on the table," he says. "It's really hard for individual sites to do these things. We just don't have the amount of money and resources needed to connect our system to all these different systems, and you can layer things on top of different systems. But ultimately you really need it built in to the system, so when you see the patient it is right there — it's just a click and you can see all the other records from all the other sites that this patient has visited."

For Pfeffer, the proof is in the ability of the Carequality Interoperability Framework implementation to facilitate those connections that will unite entire healthcare communities, not just portions of them.

"Carequality will do nothing for me if it's just Epic because I get Epic to Epic," he argues. "That works great. I need Epic to Cerner, Epic to athenahealth, Epic to Allscripts — I need that level of interoperability. The way we are going to get to interoperability faster is not by having each individual customer try to integrate with other customers, but rather have the vendors work together and link the systems."

The UCLA Health CMIO has his eye first and foremost on connecting clinical sites in Los Angeles County, which are either Epic or Cerner shops on the whole. That being said, Pfeffer views the big picture as most important"

"That is the only thing we should be thinking about in this business — what is the right thing for the patient. The right thing for the patient is that all the EHRs talk to each other in some way, in a meaningful way, not in a regulatory way," he concludes.

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