Value of Carequality-CommonWell Interoperability Agreement

December 28, 2016 - The health data exchange agreement between The Sequoia Project’s Carequality and vendor-driven CommonWell Health Alliance warrants a second look, according to the President & CEO of the Massachusetts eHealth Collaborative.

In a guest contribution to Life as a Healthcare CIO, Micky Tripathi put into the Carequality-CommonWell interoperability agreement in context, particularly in terms of its impact on healthcare providers.

As noted in a joint statement earlier this month, the health data exchange agreement consists of three important provisions.

First, CommonWell has agreed to implement the Carequality Interoperability Framework, which comprises legal terms, policy requirements, technical specifications and governance processes. Second, Carequality and CommonWell will develop a Carequality-compliant version of the latter’s record locator service to be made available to users of Carequality-equipped health IT systems. Third, CommonWell and The Sequoia Project have agreed to pursue future collaborations.

But according to Tripathi, there’s much more to the story especially as it concerns providers. For starters, the agreement signifies a monumental step forward for healthcare interoperability.

“This agreement is a significant step toward basic nationwide interoperability – for most of the major EHR vendors, you will be able to electronically request and retrieve a medical record from any other provider in the country from within your EHR,” he writes.

While the agreement is a positive in this regard, it is far from being a panacea for healthcare interoperability, Tripathi adds.

For one, common restraints in the way of efficient health data exchange remain.

“The agreement is constrained right now to a single type of transaction – query for an individual CCDA patient record for treatment purposes,” he explains. “It does not cover high volume aggregation of multiple patient records for analytics or population health or research, for example. And it doesn’t cover other types of data such as images, or genetic information.”

Additionally, Carequality-CommonWell interoperability agreement does eliminate data normalization activities or provide support for file architectures and types beyond C-CDAs. Nor does it eliminate the value of Direct secure messaging and exchange. “This doesn’t replace Direct Messaging – it is an additional interoperability option that enhances certain clinical use cases, such as when a patient shows up and records have not been sent in advance,” he notes.

Lastly, Tripathi identifies two implications of the agreement that could have a negative impact on health information exchanges:

This also does not replace state and regional HIEs.  Any HIE can join either CommonWell or Carequality (or both), allowing them to offer nationwide service to their customers (kind of like FTD does for florists).  It does mean that some HIEs will have to refine their business models if they rely on basic query/retrieve.  With basic query/retrieve now effectively commoditized, these HIEs may need to focus more on higher value services such as payload normalization/improvement and population health.

Any organization that is investing in HIE capabilities should pause and evaluate before investing any more time and money. This agreement doesn’t “solve” interoperability, not by a long-shot, but it does solve a lot of the daily headaches that plague CIOs and providers today, and it’s worth taking a hard pause to reevaluate your strategy before proceeding.

Plenty of work remains needs doing before health data exchange between Carequality and CommonWell members becomes a reality and many more details need to be hammered out by the organizations behind the two interoperability initiatives. That being said, the juxtaposition of the two as competitors is becoming less tenable. 

Tripathi’s post contains many more specifics about the Carequality-CommonWell interoperability agreement worth noting, such as what is means for Cerner and Epic EHR users and the two record locator services supported by the initiatives.

Dig Deeper:

Solutions for Addressing Health Information Exchange Challenges
Breakdown of Health IT Interoperability Standards, Organizations