Hammergren: We approached these companies because one of us had a relationship with one of them that would facilitate a conversation, perhaps. The other thing is that it showcases the diversity of size and scale. Greenway clearly has a different focus, and athenahealth has a different focus, than Cerner and McKesson do.

Q: Jonathan Bush, CEO of athenahealth, made the point that anyone is invited to join CommonWell – even a vendor of "epic proportions." Are you guys saying that only because you know Epic won't bite?

Hammergren: We'd like them to bite! We want them to bite. I'm hopeful that they will see it the same way we see it. The only reason they weren't at the table, from my perspective, is that we needed speed to get the deal done, and I don't think anyone had as close a working relationship, perhaps, with Epic, as we do with this group.

Q: So, now that you've made this big splash, what's next? What's on your to-do list these next few months?

Hammergren: Hopefully at my level we'll be engaged in trying to recruit more companies into the alliance, and that every day we'll have a more ubiquitous group of people saying, "This makes sense for us, and we want to participate." These guys [points to Malec and McCallie] have to operationalize it.

Malec: Oh, that little thing. [Laughter.] We're planning on quick cycles. We want to come back next HIMSS and say, "This works. We've shown it works. Here's an area where people are excited about this, and we're ready to take it to nationwide scale. If you're familiar with the work we did with the Direct Project, we announced that at HIMSS three years ago. Within three months we had published specifications, within six months we had a working implementation, within nine or 10 months we had first production use, a year out we had 70 organizations that were committed and using it. We're thinking we can do the same – tight cycles, getting it done – which forces a lot of issues to come to the surface and get solved. That's the best way to get these things to happen. And the agreements those people on the stage signed were not trivial agreements. They weren't just words. They were committing organizations to the resources to get this to happen.

Q: What lessons will you bring to this venture from your experiences with Direct?

McCallie: It's the attitude of the Internet pioneers: rough consensus, working code. We want to move forward, and if we have to make some quick decisions, test them out and revisit those decisions if they happen to be the wrong ones, that's better than spending a year in an abstract room designing a protocol and then trying to push people to use it when it's never been tested. It's healthcare. It's patient data. It's complicated. As fast as we want to move, it will still be a complicated process. I think Direct was appealing and successful in some measure because it was simple and straightforward. This is much more sensitive and complicated. The good news is we've learned a lot, and I think we'll go at it with a bit more intelligence than we would have three years ago.