HIT Policy Committee debates CommonWell Alliance

The unveiling of the CommonWell Health Alliance at HIMSS in early March by six EHR vendors sparked a lot of buzz, not only for their lofty goal of fostering healthcare data interoperability nationwide, but due to the noted absence of EHR giant Epic System Corp.

On its website, McKesson, RelayHealth, Cerner, Allscripts, AthenaHealth and GreenWay’s alliance describes itself as an independent not-for-profit trade association organization working for the common good to improve healthcare data liquidity.

The HIT Policy Committee’s April 3 meeting examined CommonWell, with committee members applauding industry focus in coming up with solutions to interoperability challenges while at the same time distancing themselves from active support. In one notable moment, Judith Faulkner, CEO of Epic, stated outright that Epic never was formally invited to join.

“We ran into this just as HIMSS opened, because the original keynote speaker scolded us in front of the whole group for not being part of this group,” she said. “We were not aware of it at all.”

Business entrepreneur Paul Egerman and Charles Kennedy, CEO of accountable care solutions at Aetna, cleared up some matters on the nature of CommonWell in a special report, for which they conducted numerous interviews with CEOs involved in the alliance.

“This is very much a start-up enterprise, they are just in the early stages of getting organized,” explained Egerman. Through the alliance, providers could unambiguously identify patients through a HIPAA-compliant national file and locate patient records through targeted peer-to-peer queries. The information would be integrated into EHR workflow.

“This is basically a pay-to-play concept,” Egerman said of the alliance’s business model, explaining that participating vendors must pay an annual fee and acquire certification to use the CommonWell logo. The alliance would incorporate a governance model with a board of directors including vendors, consumer advocate groups and patient representatives, but he stressed that everything is still in its formative stage.

Kennedy said interest in the CommonWell Alliance in part stemmed from vendor focus on providers who want to form ACOs but need interoperability at a more acute level. “I do believe some of the motivation for this is customer-driven,” he said. Overall, CommonWell CEOs expressed commitment to openness and greater data liquidity, according to Kennedy.

Committee members both lauded the effort to tackle the interoperability challenge but expressed concern about whether a private collaboration is appropriate to implement and manage interoperability nationally. Some worried it would not coordinate well enough with existing state and regional information exchanges.

“For me, the question is will it work?” said Farzad Mostashari, MD, ScM, national coordinator for health IT. “Will it help us move forward with any initiative that doesn’t encompass everybody? There have been many efforts to be the network and any [initiative] adds little value until you near 100 percent.” Epic's Faulker also tallied off some of her questions on CommonWell. “Is it a business? A competitive business? A public service? …We know it’s expensive to participate if you are not one of the originals,” she said. “What components of business will be in it? Will it favor those who start it? Will it sell the data? Will there be patents? Those are some of the questions I asked.”

Kennedy and other committee members wondered if commercial interests in such an undertaking could tarnish the ultimate goal of nationwide interoperability.

“We have to wonder, would they maintain that commitment to the free flow of information regardless of where the care occurs or would commercial interests start to find their way inside--I just don’t think we know,” said Kennedy.

On the topic of whether a commercial, piecemeal approach is appropriate, Joshua Sharfstein, secretary of health & mental hygiene in Maryland, also asked, “Are you taking a step closer to where you want to go or are you putting barriers to where you want to go?”

“Even if well intentioned, it can create barriers,” echoed Marc Probst, VP and CIO of Intermountain Healthcare, who urged that the policy committee create a national solution to solve these problems. “We ought to come up with concepts and standards in place to really make this happen.”

According to the CommonWell website, the alliance is working on a proof of concept over the next 12-18 months, after which time it will be formally established.