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.