Electronic Health Reporter

Guest post by Jitin Asnaani, executive director, CommonWell Health Alliance.

For decades, the use of paper medical records was the “norm” and the sharing of those records with another provider typically involved a photocopier and a briefcase for the patient to carry them to the next doctor. Today, electronic medical records are becoming the standard, but the exchange of health data between disparate networks and software systems has remained elusive.

While some data exchange is taking place in health care today, it’s only occurring in isolated pockets, typically within one region or health system, making it largely ineffective. Solving this challenge requires transparency, collaboration and innovation for continued success–attributes CommonWell Health Alliance embodies.

Transparency across the Industry

Competition in almost every sector thrives on keeping information separate and technologies proprietary. However, for many industries – like banking, telecom and internet, working across competitor lines to exchange data has enriched and expanded their reach. Health care needs to take a lesson from these industries.

Working in data silos will not improve the exchange of health data; rather, it will create friction in the industry. Patients expect their doctors to have the information they need to provide them with the best treatment. Doctors struggle to access this important data outside their four walls. The industry has an opportunity to step up and make it possible for providers to access a three-dimensional view of the patient’s health history, and in turn, create a new wave of opportunities for the health IT industry.

Collaboration among Health IT Industry Players

Collaboration throughout the IT industry is essential to creating a ubiquitous nationwide interoperable Health IT Infrastructure. This focus on infrastructure will drive standard adoption and open up the gates to national record sharing. Electronic health record (EHR) vendors offering services across the healthcare continuum are a key piece of this puzzle, which is why CommonWell formed to join forces with all health IT stakeholders dedicated to the vision that patient data should be accessible no matter where care occurs.

Collaboration with the public sector is also crucial. The government plays a strong role in narrowing the technical standards in health IT, but the bar must be raised on leveraging real-world data exchange. Additional ONC activities are complementary to the existing Federal Advisory Committees (FACAs) as noted below:

• Bipartisan legislation known as the 21st Century Cures Act—which passed in the U.S. House of Representatives this past July—includes mandates that systems be interoperable by the end of 2017 or face reimbursement penalties.
• In early October, the Office of the National Coordinator for Health IT (ONC) released its final draft of “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.” The three overarching themes of the roadmap including:
  • Giving consumers the ability to access and share their health data
  • Ceasing all intentional or inadvertent information blocking
  • Adopting federally-recognized national interoperability standards.
• The ONC has also formed a Health IT Policy Committee and Health IT Standards Committee which each include smaller workgroups that meet to ensure ongoing collaboration among the private and public sector. In fact, many members of CommonWell and other private-sector interoperability initiatives participate and/or lead these committees and workgroups.

Innovation Necessary for Future Success

Interoperability governance is not suited by a one-size-fits-all approach. The government must create a space for two key industry-driven activities to occur: (a) innovation, and (b) collaboration. Together these two activities create an “innovative ecosystem” that can take the healthcare experience to new levels. This is akin to fundamental technology explorations, such as the Internet, which transpired as a result of the government allowing the private sector to innovate and to collaborate in ways that created powerful sources of value to users – think of the search engine, online reviews, social networks, airbnb, and so on. The same approach is necessary for nationwide interoperability.

The emerging CommonWell ecosystem is a textbook example of this phenomenon. While CommonWell is the first HIT vendor-driven interoperability initiative focused on building a national capability for person-centric health data exchange, it collaborates with several other industry organizations. For example:

• Health Level Seven International (HL7)—a not-for-profit, ANSI-accredited standards development organization focused on healthcare interoperability—is developing standards for the exchange, integration, sharing and retrieval of electronic health records. CommonWell and its members have driven adoption and refinement of several HL7 content standards for data and document exchange.
• Integrating the Healthcare Enterprise (IHE) – not-for-profit also focused on interoperability. CommonWell has leveraged and refined several IHE transport and security “profiles” for simplifying and standardizing health data exchange.
• The Argonaut Project – an industry-led initiative to accelerate the adoption of HL7 Fast Healthcare Interoperability Resources (FHIR) – is helping to provide more mature health IT standards for discrete data exchange. CommonWell has been leveraging and contributing to FHIR since before the inception of The Argonaut Project, and has avidly contributed back to this industry initiative as well.

While there is more work to be done, the ongoing efforts of the private and public sectors are a significant step in the right direction. It is high time that consumers are made first-class citizens in health data exchange, and that providers have and use built-in capabilities to share individual health information for care. One day, access to health data without boundaries or restrictions will be a national utility and healthcare delivery as we know it will never be the same.