As CommonWell continues to expand the services and reach of its interoperability network, the concept of a real person at the heart of different representations of a patient’s healthcare across different systems remains core to CommonWell’s mission to create a vendor-neutral platform that breaks down the technological and process barriers that currently inhibit effective health data exchange. From the onset of discussions within the CommonWell Health Alliance there was a clear requirement to conceptually connect all the instances of care to meet the goal of providing a complete picture of an individual’s healthcare in a timely fashion wherever they received care. As the service provider for CommonWell, RelayHealth helped solidify these principles and built the core services around the fundamental concepts of a person, representing the holistic individual, and a patient, representing specific points of care throughout a person’s life.
Architecture
One of the key components driving forward this vision of exchanging needed clinical information was the initial architecture of the services. CommonWell wasn’t formed to be a standards body or write white papers around interoperability theory; CommonWell members wanted a network that they could utilize to solve many of the challenges around the real-world exchange of critical healthcare data. Early on in the technical discussions within CommonWell the member representatives realized that existing technologies and service definitions should be used wherever possible to allow for speedy adoption. Utilizing PIX transactions for patient registration and SOAP IHE transactions for document location and retrieval fit perfectly into what the vast majority of CommonWell’s members were already doing.
FHIR and Level of Link Assurance
The technical representatives soon realized that if CommonWell wanted to facilitate sharing clinical data from all sources, across all encounters the Alliance needed to utilize some newer frameworks and extend those new frameworks with unique CommonWell concepts. CommonWell Health Alliance soon embraced an early version of FHIR to create a set of services built around managing a complete record of a person, their encounters (patient records), the links connecting these patient records to the central person and finally a measure of the quality of those links, our ‘level of link assurance’ or LOLA. These critical new resources enabled RelayHealth to construct the core services to manage a person across settings of care, provide an up to date picture of where that person received care and protect data privacy by presenting high-probability matches to clinicians but only enabling clinical data sharing once that link was confirmed through either a strong ID match or human intervention. Soon patients will be able to manage these connections themselves.
Record Locator Service and Document Querying
The strength of the service design is complimented by centralized services built and maintained by a service provider like RelayHealth with a history of supporting exchange of healthcare data at scale. Without CommonWell services a member needs to create connections point to point, implement and test security with each party and negotiate nuances of transactional interpretations. With the CommonWell services a member connects once to CommonWell, implements and tests security only once and communicates with any member similarly without fear of an interpretation of a query parameter breaking connectivity. Additionally, CommonWell members have the benefit of a continually maintained record locator service and a document query service that automatically queries for documents from all confirmed settings of care in parallel with one request. The brokering of these requests also provide for a single point for logging, auditing and reporting.
Without the engagement and willingness of the members to collaborate and design a set of services and resources that enables data sharing across all settings of care the infrastructure built for the Alliance would simply be another set of endpoints that didn’t actually contribute to exchange across the traditional silos of data. Without a service provider like RelayHealth that could innovate, build and maintain the services that support a representation of a person’s healthcare across all of their settings of care and broker the transactions between the members the Alliance would just be another standards body. The Alliance, the members and the service provider working together to define and construct a network to facilitate nationwide interoperability has been a game changer within healthcare IT with the person at the center of it all from the beginning.
Chas Fuller, Director of Product Development, RelayHealth