In an unprecedented move in the U.S. Healthcare IT industry, competing health information technology CEOs from Cerner, McKesson, Allscripts, athenahealth, Greenway Medical and RelayHealth took the stage on Monday to announce the CommonWell Health Alliance an independent not-for-profit organization that will support healthcare interoperability. 

The company executives stated that the U.S. government can’t solve the problem of healthcare interoperability, so they decided to form their own initiative.

A prepared statement provided by the companies noted that CommonWell’s first three priorities include:

1. Cross-entity patient linking and matching services to enable patients and their data to transition between facilities, independent of the software system the data resides in.
2. Patient consent and data access management that fosters HIPAA compliance and simple management of data sharing by the patient.
3. A patient record locator and directed query services to help providers deliver a history of recent patient care encounters, and, with appropriate authorization, a way to provide patient data across multiple providers and episodes of care.

The event was kicked off by McKesson executives. J. Walter Reid, vice president of strategic planning and marketing at McKesson introduced the event, flanked on stage by unlikely partners from fiercely competitive healthcare IT companies. "Developing the interoperability to connect the silos will be important,” said John Hammergren Chairman, CEO of McKesson Corporation. “This is competitive disruption.”

"Healthcare is a very personal business because it deals with patient data. Our government is not going to deal with this problem and this meeting is a milestone after much work over several months. We need the entire industry to participate in this data liquidity issue,” continued Neil Patterson, co-founder, chairman, CEO and president, Cerner. “What is going on in healthcare regarding lack of interoperability is immoral. Today patients have to interoperate the data themselves.”

Jonathan Bush, CEO and Chairman of athenahealth took the stage as well. "All of the services that we sell are part of 'the trade'" Bush said. "We trade all of the [expletive deleted] grunt work that you don't want to do in healthcare and we do it for you for a fee. The only way this vision is accomplished is if we connect to all of the other players in the Cloud. To get that ball rolling we need to build an information backbone because healthcare today is not an expression of our humanity. While cost is important, patients just get shoved a set of services whether they like it or not. The CommonWell initiative offers an opportunity for [patient] shopping for services," Bush explained. “We don’t need opacity and lack of interoperability to jack up prices for healthcare IT products.”

Paul Black, president and CEO of Allscripts said in a prepared statement, "The alliance provides a framework that will enable patient identification and record sharing for providers across the nation."  Greenway CEO Tee Green added, “This is good for patients and good for healthcare.”

Noticeably absent from the announcement was Epic, one of the leading vendors of electronic health records. After the event, Stirling Martin, SVP of Acute Care at Epic said, “this is an exciting time in healthcare. We think we will need to see how this plays out over the next 12 to 18 months, which is what the group stated on their web site. The announcement seems timed for the HIMSS trade show. We were not invited ahead of time to participate. However, we already exchange records today with Cerner and have been doing the Epic to non-Epic information exchange for years. We see a great deal of interoperability in the market place, and we exchange with more than 350 vendors today.” However when asked about the Epic business model for interoperability, Martin acknowledged that while there is no fee between Epic systems or sites to share data, Epic requires its customers to pay a ‘nominal fee’ which he declined to disclose, to interoperate with systems outside the Epic world.

Cerner’s sales leader had his own comment about Epic and the initiative. "It is an industry led group that is about interoperability," said Zane Burke executive vice president client organization for Cerner. As head of sales for Cerner, I would like this to be an all Cerner world, it simply isn't. We believe that interoperability is key for healthcare," he continued. "Epic is not part of this announcement today but they are welcome to participate.”

Anyone, in fact, can join. 

“Some might be concerned we are creating another proprietary network, what makes this different?” asked Judy Murphy, deputy national coordinator for programs and policy at ONC. Neil Patterson from Cerner gave a wry smile and joked, “We are all competitors, and this isn’t the group I would get together for a private network that blocks competition.” Patterson stated after the event, however, that the initiative is intended to draw a bright line in the industry. “Either you’re for interoperability or you are not.” Patterson said.

A spokesperson for GE Healthcare IT, who did not participate, said in a prepared statement, “Interoperability and exchange are among the top priorities for the industry and GE Healthcare remains committed to standards base interoperability for both EHR and departmental data. This requires the ability for all providers and vendors to engage.”

Architecturally, the CommonWell Health Alliance is open to both government-backed standards from organizations such as ONC and the Common Document Architecture (“CDA”) as well as other innovations. “In the end, we want to make interoperability the focus so that the transport mechanisms, though important are not the most relevant part,” stated David McCallie, Jr. MD, vice president of Medical Informatics at McKesson. A Cerner executive added that the intent was to make this interoperability real-time.

McKesson started the initiative first, with the development of a ‘platform as a service.’  While McKesson were anxious to go to market alone, they realized that they needed leading industry partners to make the vision a reality. “There are all kinds of ways to add value and innovate. The market for HIT is huge. And we can’t get that market place to work without such an initiative. It used to be that banks used to brag that they had more ATMs than anyone else.  Now that doesn’t matter because the ATMs are interoperable. The banking industry no longer competes on the basis of proprietary ATMs, because they concluded interoperability was good for the customer,” Hammergren concluded. 

Dr. Robert Jesse MD Ph.D., liked what he heard about the announcement. The principal deputy under secretary for Health and leader of clinical policies and programs for the Veterans Health Administration (VHA), Dr. Jesse is the nation’s largest integrated health care system. “Once patients understand that personal health records belong to them, they will demand more interoperability,” Jesse said. He disagreed somewhat that the federal government isn’t working to solve the interoperability issue. “The iEHR initiative is a program that enables cooperation between the VHA and the Department of Defense and it has enabled 30 million patient records to be stored with the constructs to enable patients to own and interact with their own data.” 

In the end, Jesse said, corporations should not own patient data, it should be owned by the patients themselves. Jesse also believes that real-time information will be essential for improving care delivery in the future. He led the RTLS initiative in the early stages at the VHA (see GovHealth IT article “Real-time location and mobile health solutions gain traction, show ROI.”  Jesse asked, “Why is it that CMS takes two years to report data about patients? We know more about how many refrigerators and couches we manufacture in the U.S. than we do about U.S. patients.”

While Dr. Jesse believes the VHA has an excellent health record system, he believes that no E.H.R. today supports the future vision of how care will be delivered. “Team medicine must be a part of the future E.H.R.  This includes system facing, clinician facing, and patient facing modalities designed for the specialists who will use the E.H.R. in various settings.” 

When asked about the governance of the CommonWell Alliance, a McKesson executive responded that the CommonWell Health Alliance is designed to be a level playing field with no inside deals for any participant. The CommonWell headquarters location has not been determined yet, and according to executives who briefed the press, it has not been incorporated yet. Executives said it will probably be structured as a Delaware not for Profit. The spokesmen for their companies acknowledged that they weighed waiting longer to announce the initiative until they had more members and more structure, but decided the time was now to make the announcement to build momentum for it.

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