CommonWell controversy resurfaces in HITPC meeting

A coalition of five electronic health-record developers created a buzz and a controversy last month when they announced they were forming the CommonWell Health Alliance to promote health information exchange.

It was much the same reaction at the Health Information Technology Policy Committee meeting this morning, when a study group tasked with looking into the proposed alliance reported back to the full committee. The HITPC was created by the American Recovery and Reinvestment Act to provide an advisory panel with members drawn from across the healthcare industry to advise the Office of the National Coordinator for Health Information Technology at HHS.

Allscripts, Athenahealth, Cerner Corp., Greenway Medical Technologies and McKesson Corp. launched the not-for-profit CommonWell consortium with fanfare on the opening day of the Healthcare Information and Management Systems Society's annual convention in New Orleans, touting it as a vehicle to create a shared, centralized standards-based platform for patient and provider identification and authorization, and information exchange.

The controversy came the following day when keynote speaker Dr. Eric Topol rhetorically asked a packed convention hall, “Where's Epic?” He was referring to Epic Systems, a rival developer of EHRs, and its non-participation in the coalition.

Study group and policy committee members Paul Egerman, a health IT entrepreneur, and Charles Kennedy, head of the Aetna health insurance company's aligned care solutions unit, interviewed leaders from the founding companies and gave their report.

For now, Egerman said, the tangible elements of the initiative are a website and a Twitter account.

“They're just in the early stages of getting organized, so what's presented is their plans,” Egerman said.

The concept, Egerman said, is to create a national record locator service that won't hold patient records, but will contain information about where those records are located. That way, when a provider using a CommonWell member's EHR wants to obtain copies of those records from another provider of one of his or her patients, that provider will be able to send a query to the record locator, and then directly to that provider for copies.

The plan also won't create a national patient identifier, which has long been controversial. “They're using existing identifiers,” Egerman said, such as cellphone numbers, insurance numbers and e-mail addresses, to match patients with their appropriate records, he said.

In addition to ideas about technology, CommonWell planners also have a business model, the lack of which has been a problem that has plagued health information exchanges. “Basically, the EHR vendors are going to pay for it,” Egerman said. “Vendors will have to pay an annual subscription fee to use the service.”

Egerman said people involved are “working hard on it and there is a lot of enthusiasm,” but CommonWell is one year to 18 months out from having a commercially available product.

Kennedy said his questions focused on whether a private collaboration such as CommonWell is “a workable structure to manage interoperability nationally,” likening it as “fairly analogous” to a similar effort more than a decade ago by several top health plans to form MedUnite, a national claims interchange, that was sold after three years.

Kennedy said the leaders he spoke with told him the goal was to improve data liquidity. A second aim, he said, was to respond to customer demand for interoperability for accountable care organizations.

Policy committee member Judith Faulkner, founder and CEO of Epic, noted the controversy generated by the announcement and Epic's non-participation, saying, “We ran into this just as HIMSS opened” and that the keynote speaker “scolded us for not being a part of this. We had not been asked.”

Faulkner asked her own rhetorical questions at the policy committee meeting.

“What is it? Is it a competitive business? Is it a service? Will it be favoring those who started it and using those who did not start it as the means to feed the business? What components of business will be in it? Will it sell the data? Will there be patents? Those are the sum of the questions I asked myself.

“The real question is then, if it is a business, what is the appropriate role of the HITPC and ONC in working with it?” Faulkner said.

ONC head Dr. Farzad Mostashari said, “I think for me, in general, the question I asked myself is, will it work? Will it help move us forward, if any initiative doesn't encompass everybody?

“There have been many efforts to be the network,” Mostashari said, his inflection emphasizing that past attempts were to create an exclusive network. “Anything that adds little value until you get to near 100% (participation) and then the valued is accrued, that doesn't work so well. If it comes at the price of inhibiting other good activities, then I think it creates a different policy driver. I think that is the key thing for us to figure out.”