"The Alliance intends to be a collaborative effort of suppliers who are focused on achieving data liquidity between systems, in compliance with patient authorizations," a press release said. "The Alliance will define, promote, and certify a national infrastructure with common platforms and policies."
Among the initial participants in CommonWell are Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth, a McKesson subsidiary. Together, these vendors represent 41% of the hospital EHR market and 23% of the ambulatory care EHR market, according to a McKesson spokesman.
[ Read how a handful of health information exchanges in different states are exchanging patient data. Health Data Crosses State Lines. ]
Notably absent from the lineup is Epic Systems, the largest EHR supplier. Some observers have interpreted rumors of the interoperability alliance as an effort to counter the dominance of Epic by making end-to-end integration of applications less important to healthcare organizations.
Nevertheless, representatives of the founding companies, in a press conference at HIMSS, emphasized their desire to include all EHR vendors in the initiative. "We need and want the entire industry to work with us," said Neal Patterson, chairman, CEO and president of Cerner. Later, in response to a question about Epic, John Hammergren, chairman and CEO of McKesson Corp., said, "Everybody's been invited to participate." He added that the founding companies didn't want to wait until all of the vendors were on board before announcing CommonWell.
Nobody from Epic was available to comment at press time.
CommonWell came together only recently. Patterson said discussions had been going on for several months, and it wasn't clear that the competing companies would agree to increase interoperability among their systems until a few weeks ago. Allscripts signed on at the last minute.
If the founders are to be taken at their word, they decided to break down the barriers between their systems to improve healthcare and to optimize the value of those systems to customers. "Our government isn't going to deal with this problem," Patterson said, so the vendors have to take the bull by the horns.
In the press release, Hammergren said, "The formation of this alliance takes health care a step closer to broad industry interoperability. A national and trusted health information exchange will break down the information silos in health care and should dramatically improve the quality and cost effectiveness of care delivery."
That's also the aim of an EHR/HIE Interoperability Work Group (IWG) that includes 19 EHR suppliers, including some of those involved in CommonWell, as well as 15 states and 18 vendors of health information exchange (HIE) software. Last fall, the IWG partnered with the eHealth Exchange, successor to the Nationwide Health Information Exchange or NwHIN, to create plug-and-play connectivity between EHRs and HIEs and between different HIEs.
Asked how CommonWell fits with the IWG initiative and HIEs in general, Cerner executive David McCallie said that CommonWell would build on the IWG effort, especially in the content of data exchange. But he noted that CommonWell was only creating a "framework." Richard Elmore of Allscripts added that CommonWell "just wants to get the patient data." It's not going to normalize data from different sources or deal with care coordination or population health management, he said, so there will be roles for both CommonWell and HIEs.
The alliance plans to start testing early components of its data exchange infrastructure within the next year, including:
-- cross-entity patient linking and matching services;
-- patient consent and data access management; and
-- patient record locator and directed query services regarding recent patient encounters.
Although patient identity management and the record locator will be centralized, the Alliance will use a peer-to-peer architecture that allows users to view data without aggregating it in a data warehouse. The goal will be to allow patient information from outside sources to flow automatically into the EHRs of clinicians when they need it.
Patterson stressed the need for a unique patient identifier, which, he noted, Congress has long resisted. "We're the only country with a major healthcare system that doesn't have a universal patient identifier," he said.
McCallie said that CommonWell would use some kind of "strong identifier" that works across disparate systems. But rather than create a universal patient ID, he suggested, the alliance would let patients choose an ID number they already have, such as their driver's license or passport number or a cell phone number.
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