Key thoughts on healthcare interoperability from CommonWell Health Alliance Executive Director Jitin Asnaani

Jitin Asnaani, executive director of CommonWell Health Alliance, discusses interoperability challenges today and where healthcare technology is headed in the future.

Question: What is the current state of interoperability in healthcare today?

Jitin Asnaani: The first step was digitization of health data, which has largely been driven by the widespread adoption of EHR technology due to the Health Information Technology for Economic and Clinical Health Act of 2009. According to the Office of the National Coordinator for Health IT, since 2008, office-based physician adoption of EHRs has more than doubled, from 42 percent to 87 percent, while adoption of basic EHRs has more than tripled from 17 percent to 54 percent. The next step is to drive up the accessibility and volume of data exchange to positively impact caregivers while at the same time ensuring the data exchanged is consumable and useful for those care providers.

As organizations and initiatives similar to CommonWell continue to drive forward services that more easily enable data exchange among disparate systems, we'll continue to get closer to a world in which nationwide interoperability is an everyday utility. However, the reality is the vast majority of healthcare sites are still not connected — particularly, when we look at the volume of data exchange among different regions and different healthcare settings. The future is bright, but the journey to get there is long and, at times, arduous. Success is critical to improving a provider's ability to deliver quality, person-centered healthcare.

Q: What still needs to happen to help make interoperability more ubiquitous nationwide?

JA: At the end of the day, the biggest challenge is overcoming the status quo. The way things have always been done — apathetically or even actively siloing data and perpetuating a world where care is based on a fee-for-service model — is not going to improve healthcare for all. Along the way, the most important indicator of success is ensuring the person is truly at the center of his or her care and feels empowered to participate in critical decisions. This is why CommonWell built a person-centered, nationwide network that enables access to health data regardless of where care occurs.

Q: How is CommonWell working to improve nationwide interoperability?

JA: CommonWell and its members are producing and deploying real-world, cross-vendor interoperability services that will contribute to improved healthcare delivery and outcomes for providers and the people they serve. These services aim to solve the patient linking and identity problem at a national scale, which is why we created a record locator service that allows providers to find all records associated with a patient, no matter where the care is delivered. Like the search engine of the late 1990s, the RLS gives providers and the people they serve the opportunity to find and use patient data that truly impacts the quality and experience of care for the patient and the physician.

CommonWell also works with many industry stakeholders to ensure consistent and complementary results.

• Representatives from our member companies have served on multiple government-sponsored task forces, including many of ONC's Health IT Policy Committee workgroups.
• Many members also work closely with other interoperability initiatives such as The Sequoia Project, The Argonaut Project, HL7 International and more.
• Last year, CommonWell and Carequality announced an agreement to collaborate to increase health IT connectivity nationwide. This includes providing Carequality members access to the CommonWell RLS.

Q: How do CommonWell and its members work together to improve interoperability among different care settings?

JA: CommonWell has more than 60 members, and each brings a unique perspective and skill set to the table. Our membership today includes market leaders and technology innovators supporting care settings such as post-acute care, imaging, perinatal, laboratory, retail pharmacy, oncology, population health, emergency services and more.

Earlier this year, 14 of our members committed to building new Application Programming Interfaces that will enhance existing services and make data exchange even more efficient. The new APIs are anticipated to be utilized for a variety of needs across the "health and care" ecosystem, including for individuals seeking coverage for disability insurance, organizations investing in more effective care coordination and communities seeking to drive public health programs. We see the use of these types of APIs as a stepping stone to exchanging health data nationwide.


Q: What potential implications does the 21st Century Cures Act have on interoperability and the work of CommonWell and its members?

JA: A significant piece of the 21st Century Cures Act is related to network-to-network exchange. This was of interest to CommonWell even before the Act and was another reason why we announced our collaboration with Carequality last year. Additionally, many CommonWell members maintain networks themselves — including athenahealth, eClinicalWorks, Ability Networks, Health Gorilla, four state HIEs and more — so we're also developing models for them to be able to exchange data. This type of exchange will continue to be important in ensuring the CommonWell network becomes even more robust and valuable to end-users.

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