Building on Existing Collaboration for True Interoperability

Connectivity, interoperability and seamless information exchange are necessities in today’s data-driven environment. And though there are many different approaches and initiatives underway, we are still waiting to see quality drastically improved and disparate networks truly connected.

In December 2015, the Sequoia Project’s Carequality collaborative released its Interoperability Framework. The overarching mission of Carequality is to enable health information exchange, improve patient safety and make nationwide interoperability a reality, all accomplished by giving data sharing networks across the country the ability to communicate using the common Framework.

At Surescripts, along with athenahealth, eClinicalWorks, Epic Systems and NextGen Healthcare, we are proud to be among the first implementers of the Framework. Dave Cassel, current Carequality director, spoke with Surescripts about what sets Carequality’s Interoperability Framework apart--how it aims to build on, not replace, existing collaborative initiatives--and what’s to come in the future.  

• What makes the Sequoia Project’s Carequality’s Interoperability Framework different than other industry data exchange collaborations?

Carequality is unique in that the Framework is used by other data exchange collaborations, building on their important work. We’re not trying to supersede them or otherwise compete with them.

Cell phones provide a helpful analogy. In order to make calls, you have to sign up with carrier, like a Verizon or AT&T. Once you do that, though, you can make calls to anyone, regardless of who they’ve chosen as their carrier.

Existing data exchange programs and platforms are the cellular carriers of our model. A physician practice, hospital, patient, or other relevant stakeholder might work with an HIE, their EHR vendor, PHR, or another type of service provider – an “Implementer” of the Framework, as we call them – to get their connectivity. Once they do that, they can exchange with the customers of all the other Implementers. Our inclusive approach to health data sharing means we’ve got the entire healthcare ecosystem--providers, payers, and patients--all working together. You can see a partial list of the diverse Carequality community on our website.

• How does the Framework, work?

The Carequality Interoperability Framework consists of several key elements. First and foremost, it provides a legally-binding governance structure that allows every participant at every level to have confidence in the fact that all other participants are playing by the same, known set of rules. The rights and policy obligations are clear. 

Once you have that governance, you also do need to speak the same technical language, so we specify technical specs for connectivity under what we call a “Use Case” – basically a type of content, married to a technical architecture for exchanging it. Our initial Use Case is Query-Based Document Exchange – the prototypical HIE use case in which information is collected, in the form of clinical documents like a CCD, from disparate sources when needed. The final piece to the puzzle is a directory of the participants, so you can make sense of the many connections available.

All of this together, we think, will enable a quantum leap in health information exchange and interoperability, by greatly magnifying the power of the individual data exchange programs and platforms already serving patients and providers.

• What does the future of data sharing look like under this construct?  

There’s a lot of work to be done in health IT interoperability. Right now, there are working examples of interoperability across the country, but these tend to be restricted to particular geographies or technology platforms, and there is a lot of variability in the functionality provided. We see these pockets of connectivity being united as we accelerate and eventually blanket the nation. We also see significant advances in functional capabilities. Right now a lot of exchange is in the form of sharing clinical documents, which is certainly valuable but doesn’t meet all the needs of care coordination, population health analytics, and other key uses. One of the great features of the Carequality Interoperability Framework is that its governance aspects are technology independent. As a new technology emerges, we can publish an implementation guide for it so that it can be enabled under the governance structure.

Ultimately, the goal is to make interoperability an after-thought one day. Providers and patients will expect data when and where they need it, without having to think about the different platforms and geographies.

• What are the “Principles of Trust” and why are they so vital to enabling nationwide health information exchange?

The Principles of Trust were the outcome of our initial discussions in 2014 that focused on executing our vision, much of which was based on establishing and gaining trust. We came together as an industry – including competitors and stakeholder groups that are wary of one another’s motives – and reached agreement on what a trusted structure would look like. The Principles formed the foundation for the Carequality Framework, which basically implements their tenets in contractual form.

The Principles range from relatively mundane requirements like needing to comply with identified technical standards, to more revolutionary concepts like our Non-Discrimination Principle. That principle states that you must exchange with others who abide by the rules and are similarly situated. You don’t get to pick and choose your individual exchange partners.

• With HIMSS fast approaching, what is the number one takeaway about Carequality that you’d like attendees – and the industry at large -- to be aware of, and where can people go for more information on becoming involved?

When you stand in the overcrowded exhibit hall with folks hawking all kinds of products and services, just remember we are all pulling for the same thing: to help patients and providers by making care effective and efficient. Carequality, and our parent organization The Sequoia Project, wants to convene everyone in that room to tackle interoperability and our unique comprehensive, inclusive approach can actually make that a reality.

You can see Carequality in action at The Sequoia Project’s HIMSS Booth, #454, where we will run a live demonstration with Surescripts and other Carequality adopters daily.

Please stop by the booth and introduce yourself. I look forward to meeting as many folks as possible. We can chat about how your organization can benefit from engaging in Carequality and all The Sequoia Project’s latest activities to make nationwide, industry-wide health data interoperability a reality.