After McKesson, Cerner, Allscripts, Greenway and athenahealth made news at HIMSS13 this past week with the launch of the CommonWell Health Alliance – putting aside their competitive instincts, for a moment, to pledge their common commitment to interoperability and data liquidity – Healthcare IT News spoke with McKesson CEO John Hammergren about the road ahead.

Joining Hammergren in the discussion were David McCallie, vice president, medical informatics at Cerner, and Arien Malec, vice president, data platform solutions for McKesson's connectivity business, RelayHealth (and, in his former role at the Office of the National Coordinator for Health IT, the driving force behind the development of the Direct Project).

[See also: Six HIT heavy-hitters announce interoperability organization]

Q: Cerner CEO Neal Patterson mentioned that your companies had been working on this collaboration for several months, but that, right up until the eleventh hour, "I don’t think we knew if this was going to happen or not." What were some of the reasons for that? Were there wrinkles that gave you pause?

Hammergren: I think that, philosophically, these two executives were on board with the idea that this is what we need to do, and Neal and myself were on board with the idea that this is what we need to do. I think formalizing it – what is it we're going to do, and how we're going to do it together and how are we going to protect our own strategies and intellectual property and still collaborate and cooperate in this endeavor – is more nuanced than the mere agreement that we needed to do this. Getting through those nuances took some time.  But I think there was a meeting of the minds the whole time.

McCallie: Oh, absolutely. We actually looked up the date. The first conversations were in May of last year, and Arien and I exchanged two emails – it was after the Bipartisan Coalition meeting that Janet described where they surfaced these problems and had a room full of both vendors and care providers. Both Farzad and Joy Pritts from ONC were in the meeting, and everyone was sort of complaining to Farzad: "You've got to go solve this identifier problem, it's killing us." And Farzad said, "Look, it's against the law! I can't do it. You guys have to solve it." I came back and literally quoted that – "you guys have to solve it" – I sent an email to Arien and he said, "We think the same thing. Let's talk about it." And within a week, we knew this was what to do. It just was an obvious fit. The process of going from that notion to an agreement that complicated organizations can sign was a long process.

Malec: I'd say governance was the biggest deal. Cerner had been prodding so much on getting the governance right, figuring out a bunch of really tough questions about how our organizations are going to work together, that, when we got agreement among the two of us, and then went to Allscripts, for example, they asked a whole series of questions, and we just rattled the answers off. We had already thought about all those issues. It was all written into the agreement we were signing. That's what took the time.

[See also: Direct Project champion to leave ONC]

Hammergren: But these companies came on very quickly, though. A week and a half.

Q: How did it come about that it was these particular five companies? Did you go around to other vendors to ask whether they wanted in?