The belief that collaboration is a key part of success is not a new one, especially when it comes to achieving nationwide interoperability in healthcare. We have always been dedicated to working together across the industry to break down the barriers to interoperability, which is why we are excited to share CommonWell Health Alliance and Carequality are increasing nationwide health IT connectivity by providing additional health data sharing options to the over 15,000 hospitals, clinics, and other healthcare organizations actively deployed under the Carequality framework or CommonWell network. The agreement outlines three objectives:
- CommonWell will become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequality participant.
- Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality.
- CommonWell and The Sequoia Project, the non-profit parent under which Carequality operates, will also explore collaboration on other interoperability projects in the future.
This is a big moment in healthcare, and we understand there are likely questions about the collaboration. Details regarding the agreement can be found in the press release as well as answers to more specific questions in the FAQ below.
If you have any additional questions about the announcement or its impact on your health data sharing capabilities, please contact us.
Carequality & CommonWell Health Alliance FAQs:
- Carequality is a platform-neutral, vendor-neutral framework to connect health data networks under a common set of nationwide legal, technical, and policy rules with the goal of promoting trusted exchange. The Carequality Framework is enabling exchange today for patients, providers, and others across vendor networks, as well as Health Information Exchange networks (HIEs), record locator services, clinical information networks, and personal health record (PHR) networks.
- CommonWell Health Alliance offers operational cross-vendor interoperability services that health, health IT, and health data exchange organizations across the care continuum embed into their technology to enable caregivers to exchange data within existing workflows. Today, services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve records for a patient from multiple member systems. CommonWell members span the continuum of care including hospitals, ambulatory practices, post-acute and long-term care, pharmacies and PHRs.
Are terms like member, participant, connection, and implementer interchangeable? No. Below are definitions:
- CommonWell Member: A CommonWell member is a health care organization that believes in the vision and mission of CommonWell and can participate in CommonWell committees to drive forward key initiatives.
- CommonWell Subscriber: A CommonWell member who has subscribed to using and deploying CommonWell services, such as patient ID management, advanced record location, and query/retrieve broker services.
- CommonWell-enabled Providers: CommonWell-enabled providers are those providers who are enabled with CommonWell services via their vendor member or providers who subscribe directly to the CommonWell services.
- Carequality Member: A Carequality member is a health organization with an interest in a national-level common trusted exchange agreement and interoperability framework. Members are engaged in developing and expanding the framework.
- Carequality Implementer: A Carequality implementer is a health data sharing network that has adopted and implemented the Carequality Interoperability Framework, connecting their network (and their members) to other networks that have implemented the framework.
- Carequality Connection: A Carequality Connection is enabled to share health data under the Carequality framework via an existing Carequality implementer. An example would be a health system that is enabled to share health data via their vendor, who is an implementer.
- Carequality-enabled Providers: Carequality-enabled providers are those providers who are enabled to exchange health data under the Carequality Framework via their Carequality Implementer.
- Directed Query: A user- or system-initiated query that is sent to a specific organization to determine whether a specific patient has a record at that location. An organization is defined as any entry in the Carequality directory. The query may be sent directly to the organization or through an intermediary gateway such as the CommonWell gateway.
Questions about Collaboration and Membership
- How did this agreement come about?
CommonWell is a health data sharing network and Carequality is a framework to enable health data sharing between and among networks. Though each initiative approaches the challenge differently and has different intermediate goals, the ultimate goal of both initiatives is to ensure that vital clinical information is available to those who need it, including patients and other relevant players but particularly focused on providers at the point of care. It became increasingly clear as the initiatives matured that their distinct architectures and approaches could be bridged in order to further that shared common goal. The current agreement is the culmination of discussions for over year to address the practical details involved in making the connectivity and future collaboration a reality.
- Why is this important? What are the benefits to patients and providers?
Ultimately both providers and their patients will benefit. By expanding the number of interconnected networks across the country, patients will benefit because they will have more assurance that their providers are able to diagnose and treat them with more and easier to find available information at hand.CommonWell Health Alliance and Carequality through their members represent the overwhelming majority of providers across the country who can exchange health information today. Connecting the participants with this arrangement will expand exchange opportunities nationwide, including for Carequality participating networks that are not vendor-based. While this doesn’t solve interoperability for every provider in the country, it does reduce the complexity of data sharing between providers.
- What is the connectivity that will happen between these two organizations?
There are many types of interoperability required to support care delivery. Some of these information exchange capabilities are already widely adopted, such as electronic prescribing, electronic lab results delivery and electronic public health reporting. Up until now, however, the industry has not had a consistent nationwide approach for a provider to electronically request and retrieve a medical record from another provider. This agreement changes that.CommonWell and Carequality will work together in the following ways:
- CommonWell will become a Carequality implementer on behalf of its members and the provider organizations they serve. This gives CommonWell subscribers the option to engage in health information exchange through directed queries with other Carequality participants, and vice versa.
- Carequality will work with CommonWell to make a Carequality-compliant version of the CommonWell record locator service available to any provider organization participating in Carequality. This enables non-CommonWell-enabled providers to utilize such a service from CommonWell.
- CommonWell and The Sequoia Project, the non-profit parent under which Carequality operates, will collaborate on this endeavor and expect to collaborate on other interoperability projects in the future.
Specifically, the two organizations are enabling query and retrieve of CCDAs and the option for a record locator service that can help improve the likelihood of finding a patients’ record via a distributed process. This type of exchange is important in many critical health care situations, such as when a patient shows up in the emergency room or in any other situation where a provider is making a diagnostic or treatment decision but needs to know key medical information to avoid adverse events such as allergic reactions.
- Which organizations are covered by this arrangement?
This new connectivity agreement impacts the health IT organizations, and their clients, who already share health data via either Carequality or CommonWell. Known as Carequality implementers and CommonWell subscribing members, these organizations come from across the healthcare eco-system. The members of CommonWell Health Alliance can be found at the CommonWell website: commonwellprod.wpengine.com. The participants in the Carequality framework can be found at the Carequality website: www.sequoiaproject.org/carequality.
- Does this mean that any CommonWell-enabled provider will be able to talk with any Carequality-enabled provider?
With this new agreement, any CommonWell-enabled providers that agree to the Carequality Connection Terms via their participating CommonWell subscriber will be able to exchange information for treatment purposes with any Carequality-enabled provider.
- Why did CommonWell and Carequality enter this agreement?
Both organizations saw an opportunity to work together following demand from Carequality and CommonWell end-user providers for additional data sharing options. Ultimately, the two organizations entered this agreement to expand nationwide interoperability, giving their end-user providers easier access to more health information so they can make better informed care decisions.
- Does this mean that CommonWell and Carequality are merging?
No. While Carequality and CommonWell have a shared interest in expanding connectivity, they will continue to have distinct missions and approaches, and will continue to provide different value to their respective communities.
- I’m connected through Carequality, through my vendor or another implementer. What does this mean to me?
You will be able to find and exchange with any CommonWell participants who choose to participate in exchange via Carequality. These CommonWell participants will be available in the Carequality Directory and will be query-able like any other participant. In addition, current Carequality participants can choose to use the CommonWell record locator service, just as they would any other record locator service that supports the Carequality Framework.
- My vendor is a subscriber of CommonWell services. What does this mean to me?
CommonWell-enabled providers will continue to have access to their existing CommonWell services, such as record locator brokered queries that automatically fetch data from multiple locations. Now, additionally provider organizations served by CommonWell Subscribers will have the option to engage in directed query with all organizations that are enabled by Carequality Implementers. CommonWell Subscribers can incorporate directed query functionality into the existing specifications and infrastructure. Of course, CommonWell will continue to innovate on the set of services that it offers to its members across the care continuum, including those that are not covered by the Carequality implementer model. (For a more detailed explanation of how the connectivity will work, see question 14.)
- My vendor is both a Carequality implementer and a CommonWell subscriber. What does this mean to me?
Providers with vendors in this situation will continue to have access to all existing connectivity that their vendors have enabled. Vendors that subscribe to the CommonWell services and that are a Carequality implementers will choose whether to enable all connectivity via CommonWell (for record-locator brokered queries and directed queries for organizations that are enabled by Carequality implementers) or whether to continue to use CommonWell for record-locater brokered queries and to use the Carequality framework to engage in directed queries with organizations that are enabled by Carequality implementers.
- I’m not connected to either group today. How can I participate?
Together, Carequality and CommonWell represent a significant majority of the electronic health record marketplace, and connectivity through your EHR vendor may be a possibility. Regional or state health information organizations (HIOs) may be an option as well. If you don’t have a clear option from your vendor or an HIO, you can encourage your vendor or your HIO to pursue connectivity through these interoperability initiatives, or contact the initiatives to explore other possibilities.
- Will this change the roles of CommonWell or Carequality in the future?
No. These and other interoperability networks and initiatives will continue to grow and evolve the services that they offer to their respective participants. Connecting the two organizations with this arrangement allows them to connect their participants regardless of platform, which will provide value to all providers and patients.
- Is this the only way that participating vendors will connect to other vendors and other networks in the future?
It isn’t the exclusive way EHRs and other networks connect today, and will not be the only way in the future. EHR systems, networks, and other health IT systems and devices are using a variety of standards, interfaces and tools to exchange data. The market continues to evolve and will continue to provide a variety of interoperability options to meet the needs of all customers.
- What actually needs to happen in order for this connectivity to work?
Once the technical implementation is complete, each CommonWell subscriber will determine if they will utilize CommonWell to enable their Carequality connectivity. Provider organizations will need to specifically agree to the Carequality Connected Agreement (CCA) to enable connectivity through their CommonWell subscriber.
- What does this mean for state health information exchange organization?
Regional and state health information exchange organizations (HIOs) are health data sharing networks serving particular geographies or markets. Often these networks provide additional value to local communities, such as public health reporting, that is not offered by nationwide initiatives such as Carequality and CommonWell. These national initiatives do provide opportunities to expand the reach of these regional networks for some use cases, and thus provide additional value to their members. A number of HIEs and HIOs currently participate in the Carequality and CommonWell organizations, and others are welcome to do so.
- Is this aligned with the ONC Roadmap?
Yes, the work of CommonWell and Carequality independent from each other are aligned with the ONC RoadMap, as demonstrated by their pledges of support last year. The new arrangement furthers our respective commitments to supporting collaborative governance, implementing nationally-recognized interoperability standards, addressing data blocking, and easing consumer access.
Questions about Technology/Services
- How technically will CommonWell become a Carequality implementer on behalf of its members and their clients work to enable directed queries?
CommonWell will provide a gateway between CommonWell subscribers and Carequality implementers. The gateway enables support for directed queries. This will allow a Carequality participant to request and retrieve medical records from any CommonWell subscriber listed in the Carequality directory using the same technology that they already use to talk to other Carequality participant. Each CommonWell subscriber who chooses to participate will be listed in the Carequality directory just like any other Carequality participant.
- How technically will Carequality members be able to access a Carequality-compliant version of the CommonWell record locator services?
CommonWell will provide a record locator service that conforms to agreed-upon standards for record location through the Carequality Framework, and this will enable those who choose to subscribe to the CommonWell record locator service to use their platform’s Carequality implementation to access CommonWell’s record locator data.
- Is this based on standards? What standards are being used?
Yes, document query and document retrieve transactions will continue to follow the ITI-38 and ITI-39 standards already in use by both CommonWell and Carequality. CommonWell will also support ITI-55 and ITI-56 transactions as part of the communication layer between CommonWell and Carequality members.
- Why isn’t this based on FHIR and OAuth?
Today, CommonWell already utilizes FHIR in order to enable some of its APIs, while Carequality is already working on using FHIR to enable provider directory management. However, note that FHIR is still a draft standard. As these standards mature, each organization will incorporate them more broadly.
- As a provider, how much will this cost me?
Neither Carequality nor CommonWell can determine pricing charged by vendors/service providers, please contact your CommonWell subscriber or Carequality implementer for specific pricing details.
- What is the timing for this connectivity? When will it go live?
Completion of the technical aspects of the Carequality specifications and CommonWell gateway are expected in the first half of 2017. Connections will be enabled between participants of the two initiatives as members agree to deploy the services and as CommonWell-enabled providers accept the additional connection terms required under the Carequality framework.
By Jitin Asnaani, Executive Director, CommonWell and Dave Cassel, Director, Carequality