The vision for healthcare interoperability is simple: patient data should be easily accessible and readily exchanged to promote care coordination. For anyone with an eye on the healthcare industry, however, it’s clear that this simple idea requires complex processes that often depend on collaborations between IT systems, healthcare professionals, and specific regulatory requirements.
In 2013, six top healthcare IT vendors — Cerner, McKesson, Allscripts, Athenahealth, Greenway Medical Technologies, and RelayHealth — came together to promote interoperable structures across healthcare organizations. Together, they formed the CommonWell Health Alliance — a not-for-profit body poised to solve some of the most pressing healthcare data exchange challenges.
As of 2019, this alliance has grown to accommodate 80 members, with around 13,000 participants from single-physician offices, to multi-hospital systems, EHR companies, and data exchange vendors. Read on to learn how CommonWell is transforming healthcare and driving nationwide interoperability.
The CommonWell Health Alliance is a national network of organizations committed to providing patients and providers with access to health data, regardless of where care occurs. With the what covered, let's examine why an alliance of rival IT organizations was necessary to promote data exchange across health systems.
At the time of the Alliance’s formation, interoperability was on a gradual, but complicated path to nationwide connectedness. For starters, patient identification was a confusing landscape to navigate. With inconsistent patient identification methods across systems, it was often difficult to match records, leading to fragmented data and incomplete exchanges across systems. This was because most hospitals used multiple systems for clinical, administrative, and specialty services, coupled with inconsistent formats for storing names and addresses.
According to a 2014 Office of the National Coordinator (ONC) report, 1 in 5 matches within an organization could be incorrect, with the number going up to half when providers sought data from other facilities. This lack of standardization was also reflected in the different coding vocabularies and proprietary formats adopted across EHR systems and healthcare organizations, limiting interoperability between systems that spoke different languages. Coupled with privacy concerns when sharing health data, these factors often made data access challenging for patients and relevant care providers.
The CommonWell initiative encourages EHR vendors and other relevant partners to adopt standards that make it easy to exchange health data at a reasonable cost.
From the CommonWell perspective, a patient should be free to switch between healthcare providers, care settings, or hospital departments without fear of losing their valuable patient data. If that sounds familiar, it’s because previous interoperability efforts have aimed for the same goal.
By leveraging the efforts of past health IT initiatives like HIMSS, The Sequoia Project, DirectTrust, HL7, and eHealth Initiative — the Alliance has the stage set for creating a nationwide data-sharing infrastructure. However, coupled with these initiatives, key efforts of the Alliance set it apart from other interoperability efforts, solidifying its position as a health information exchange. These include:
Using this feature, relevant providers in the care continuum can identify every patient registered in the CommonWell network. Patient enrollment is made possible through Edge Systems that send Admission Discharge and Transfer System (ADT) data to CommonWell, creating individual patient records. Through Change Healthcare’s Patient IDLink application, patients registered within CommonWell are linked to documents creating an identifiable individual within the network.
The Record Locator Service (RLS) is the shining star of the CommonWell Network. Through this feature, patient data is located within the network and shared with providers, patients, and other authorized users. Providers need to make only one request to the network to retrieve multiple records for a patient. This feature is used as a table of contents to identify where a patient’s health records may be situated within the CommonWell network. Very importantly, this central database limits costs for EHR access between relevant stakeholders.
As a participating provider, you can initiate a query from your organization’s EHR system to the CommonWell network. The network then helps to retrieve these records from another participant’s EHR system, no matter where in the country they might be. After receiving a query request, the receiver will locate and process the inquiry through internal systems, before transmitting the retrieved information through the CommonWell Network and back to the requesting provider.
This information is then integrated with the requesting provider’s EHR system to give a fuller picture of the patient’s health records. In these cases, data transfer is made possible through query-based document exchange and FHIR-data exchange. CommonWell supports the exchange of structured chart and encounter data, formatted as Consolidated-Clinical Document Architecture (C-CDA) documents. This network also facilitates the sharing of clinical narratives and notes.
In 2016, CommonWell made a major move to enhance connectivity by becoming a Carequality implementor. This bridge was a significant event, as both organizations control the lion's share of providers across the United States involved in data sharing.
For quick introductions, Carequality is a vendor-neutral framework, promoting information exchange by connecting health data networks through a network-of-network approach. In simpler terms, Carequality acts as the epicenter, a meeting point where a provider on one network can exchange data with another provider participating in a separate health data network without either needing to join multiple data-sharing networks. This diverges from the CommonWell approach where data exchange is made possible by participants adopting a shared infrastructure and framework to access and retrieve information.
Under the CommonWell-Carequality connection, CommonWell serves as an implementer of Carequality on behalf of its members. This team-up achieves the following objectives:
At the end of this week, the CommonWell network would have exchanged close to 30 million documents, connecting thousands of healthcare organizations, with close to 200 million individual patient records now within easy reach.
These qualifications have made the Alliance a shoe-in for Qualified Health Information Networks (QHINs) status. QHINs are a creation of the Office of the National Coordinator (ONC), set up to implement Trusted Exchange Framework and Common Agreement (TEFCA) and support nation-wide healthcare interoperability. In February 2023, CommonWell got the green light to become one of TEFCA's first QHINs.
CommonWell is on track to become one of the first government-sponsored efforts at a nationwide network-of-networks. Removing the need for stakeholders to join several networks to achieve this goal, the CommonWell Health Alliance is poised to usher in the next generation of data exchange in healthcare.