OP-ED

The #CommonWell Open Discussion Forum

The EHR vendor lock-in business model is under attack by frustrated physicians and patients and the reality that health care cost and quality are more opaque than ever. Doug Fridsma of ONC politely talks of the need to move from vertical integration of health care services to horizontal integration where patients can choose with their feet. Farzad Mostashari calls for moral behavior and price transparency. The Society for Participatory Medicine says “Gimme My DAM Data” and Patient Privacy Rights asks HHS to allow physicians to prescribe health IT without interference from the institution or the vendor.

The vendors’ response is a charm offensive called CommonWell Health Alliance with a pastel .org website. The website is presumably the official source of information about CommonWell and it lays out the members’ strategy to preserve the vendor lock-in business model for a few $Billion more. Ok, maybe more than a few.

The core of the CommonWell strategy is to avoid giving patients their data in a timely and convenient way.

To maintain the vendor lock-in premium, CommonWell proposes yet another version of institutional control. Compare their vision with Direct Project that enables physicians and patients as first-class citizens or Blue Button+ .

To maintain an industry that derives 60% of revenues from interface and installation costs, CommonWell is designed to overlap and undercut the efforts of state Health information exchanges.

To ensure that the vendor lock-in mission stays on track, membership is restricted:

“The CommonWell Health Alliance is for healthcare information technology vendors. Other health system participants – such as payers, health systems, etc. – will realize the benefits of the Alliance’s efforts through their technology vendor’s participation.”

Nonetheless, CommonWell does want to tackle 5 important problems. Reliable patient IDs, centralized authorization management, convenient accounting for disclosures, support for health record locator services and timely access to all clinical information are also the goal of patient, state and federal initiatives. These will be achieved through open discussion and limited regulation. ONC must use the tens of $Billions of incentives, CMS must use its leverage on state HIEs and Medicaid practices, and the massive Federal Health System (VA / DoD) must use the power of the purse to solve these problems in a sustainable way.

A sustainable solution to the 5 problems requires open discussion. CommonWell’s .org website does not have an open forum or a wiki. I propose #CommonWell as a good place to start the conversation around the 5 important problems that CommonWell has articulated: T1: PatientID; T2: Authorization; T3: Auditing; T4: Locator; T5: Clinical.

Beyond Twitter, where should the #CommonWell forum be hosted?

Adrian Gropper, MD is Chief Technical Officer of Patient Privacy Rights and participates in Blue Button+, Direct secure messaging governance efforts and the evolution of patient-directed health information exchange.

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13 replies »

  1. A little late to the party but here are my thoughts:

    CommonWell is a mix of business objectives and desire to improve the state of interoperability. Since it is partially business, what they intend to do is really no different than what the Wifi consortium did, or the Bluetooth SIG, or the Continua Alliance. All of these efforts were industry vendor led where vendors saw a larger opportunity on the horizon then what exists today. While I have some reservations, overall I am quite pleased to see the vendors lay down their swords and allow query-based exchange across those systems that are a part of the CommonWell Alliance.

    What they are proposing to do is, to some extent, is being attempted by public HIEs. Unfortunately, the vast majority of these public efforts will fail due to a multitude of reasons. These vendors see that but also see the need for interop in a heterogeneous EHR environment, thus are stepping in to solve the problem since standards alone cannot do it (you actually need services).

    CommonWell is being led by some top notch people who have the creds to pull this thing off. I know many of them personally and truly believe they want to make a positive, societal impact. I trust them, their hearts are in it.

    All the moaning and groaning about the patient is frankly unwarranted at this time. No part of this industry, in my brief time studying it, has started with the patient first – it has always been: Let’s get the clinicians using this stuff first and then will on-board patients/consumers. Seriously folks, you are barking up the wrong tree on this one. For example, despite all the hundreds of millions of public $$$ that went into public HIEs, none of these HIEs consider the patient engagement side of things till recently. I personally have been pushing from the other side to get the vendors to support the Blue Button, which they by and large do now, but not a couple of years ago. Bottom-line, they’ll get to the patient, but they’ll address clinician needs first.

    Lastly, the future of CommonWell is far from certain. Yes, the five vendors claim to represent about 40%+ of all patients in the US but I don’t believe we’ll see broad adoption till that number is close to 75%. If Epic, despite their protestations finally joins the alliance, then it will be game over. Till then, we’ll all have to wait and see.

  2. Having used a patient portal and messaging with my patients since 2006,
    patients love it. Extremely valuable to them and to our practice.
    Patient’s have access to their entire medical records, progress notes, results etc.
    We write and document notes for them.
    The records are ours, but they are also theirs.

    http://www.HRFP.net
    ThinkTankATFalkoffblogspot.com

  3. Thanks for this leadership and tracking, Adrian. My own post on Commonwell during HIMSS completely drank the Kool-Aid and didn’t see what you’ve seen.

    What to call the shadowing forum? CommUnwell?

  4. In last night’s Tweetchat, we had participation from 3 of the 5 founding companies, including two key architects of BlueButton+, a lawyer, and many Society for Participatory Medicine members.

    Here’s my summary:
    — The people involved in CommonWell are top-notch, honorable and experienced
    — CommonWell does not consider “Gimme My DAM Data” or patient engagement a priority
    — CommonWell says they will involve patients in governance but this is meaningless if it’s not an open standards process
    — CommonWell will not use an open standards process – this means there’s no open forum for us
    — CommonWell is “going for results” with provider-to-provider communications as their priority
    — Even though they helped create BlueButton+, CommonWell is not committed to using it

    For now, the bottom line is that we need an open forum that shadows everything CommonWell does and adds the e-patient perspective for all to see. This forum therefore needs to be open to the world.

    This is how open standards evolve.

  5. Bob,

    Your T6 is the core of the proposed Open Discussion Forum. The process I’m proposing is similar to the established S&I Framework that the architects of CommonWell have been incredibly generous to support in the past. S&I has set the standard for open governance in health IT and this is an opportunity for the private sector to adopt and run with the S&I methodology.

    Your T7 is most welcome. The immediate need of state HIEs and federal procurements is for consensus and policies. The health reform clock requires them to issue RFPs in the coming months. An architectural reference model would be a great addition to the Forum but it needs to be done in parallel with the broad consensus and running code that our community needs today for exactly the 5 points raised by CommonWell.

  6. We would like to add T6: Community-based specification, in which the specs for health IT are actually based on the wants & needs of clinicians and team members, not regulators or vendors,and T7: Architectural reference model. We have identified the healthcare ecosystem as a dynamic, adaptive distributed network consisting of heterogeneous nodes that communicate. Health IT apps should accommodate that fundamental model in their design. Visit us at http://www.TheCUREProject.org to learn more.

  7. The benefits of this are over hyped. Most patients do not want it and doctors often want updated data, so the notion that there will be fewer tests ordered is meaningfully flawed. This way to the egress.

  8. “Beyond Twitter, where should the #CommonWell forum be hosted?”
    __

    Uh, Linkedin, Facebook

    They’ve declared common Law Trademark on the word “commonwell,” btw, so using it might incite some “cease and desist” pushback harrassment.

    Butm there’s a “commonwell.org” NGO that long predates them, so, …

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