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Setting the Story Straight on CommonWell

by John Moore | April 12, 2013

Arguably, the biggest news story coming out of HIMSS last month was the announcement of the CommonWell Health Alliance – a vendor-led initiative to enable query-based, clinical data sharing. So much has been written about CommonWell that there is little need to rehash what has been said before.

What has not been said, or at least has been sensationalized nearly to the point irrelevance is the whole controversy surrounding Epic and how they were not invited to join the CommonWell Alliance until after the announcement. None other than Epic’s own founder and CEO, Judy Faulkner, has gone on record stating the Epic was unaware of CommonWell prior to the announcement. Faulkner has gone on to question the motives of CommonWell, in an effort to subvert it, in her highly influential role on the Dept of Health & Human Services HIT workgroup committee.

That was the last straw.

It is one thing to moan and groan at the HIT love fest that is HIMSS, where vendors commonly discount the announcements of competitors. But it is quite another thing to be a part of a highly influential body that is defining nationwide HIT policy and make the same claims over again, especially when they are frankly not true.

Is there some truth to Faulkner’s claims that the vendors who have created CommonWell may have had an additional motive, stopping the steamroller that is Epic? More than likely.

But it is also true that founding members of the CommonWell Alliance do wish to lay down the swords of hoarding data to allow higher order services to be developed on top of the CommonWell platform. They all see the market changing rapidly. They know that they, on their own, cannot move fast enough to meet all the needs of the market. They understand that the next iteration in HIT is to move to a platform-based services model – that is where the value will be. As to whether or not CommonWell will ultimately be successful, that is far from certain as there are many rivers to cross before we see the query-based health information sharing that these alliance members envision take hold, if at all, in this industry.

From our vantage point, Epic, with its monolithic strategy that is more akin to Wang Laboratories than it is to Apple’s iOS, is operating on a model that while providing a seamless environment from ambulatory to acute (something other EHR vendors have totally messed up on), will ultimately hinder healthcare organizations’ ability to rapidly innovate and respond to market changes. Epic simply will not be able to move fast enough and their customers will struggle as a result.

As to whether or not Epic was invited to the CommonWell party; we have received confirmation from several sources that indeed Epic was invited to join a couple of weeks prior to the announcement. What likely occurred is that Epic saw that CommonWell’s goals, objectives, and operating structure were already formalized when the invite arrived. Thus, Epic would not have an ability to make substantive contributions to this initiative and rejected the invitation.

It is disingenuous for Epic to state otherwise and if they were a public company, they may have been subjected to an SEC inquiry. But alas, Epic is not a public company and Faulkner can say what she wishes with few, if any, repercussions. Her quite vocal denouncements of CommonWell though do show that she clearly does feel threatened by this alliance.

But a core mission of Chilmark is to cut through the BS to ensure that this industry is informed. In keeping with that mission, we felt it important to let you know what is really happening behind the scenes at CommonWell. Hopefully, we have set the story straight on the CommonWell Health Alliance and Epic saga.

8 responses to “Setting the Story Straight on CommonWell”

  1. Bob Brown says:

    Thank you for the clear and concise post on CommonWell and Epic.

    At this time, the future of CommonWell is uncertain, but they certainly did make an effort to, as you mentioned, publicly “…lay down the swords of hoarding data to allow higher order services to be developed…”. Admitedly, they anticipate those services would be developed on “their platform.”

    At this point, any improvement in the sharing of health data is probably a good thing. But, CommonWell’s approach is just that, an approach. At The CURE Project, we have a different approach; an approach based on the healthcare community’s wants and needs, not the wants and needs of healthcare IT vendors.

    The current generation of health IT systems, especially the standalone EHR systems with which the healthcare community is having so much trouble, are simply not up to the job at hand and will eventually be replaced with a newer generation of health IT systems that will be more efficient, effective, useable and useful. They will be aware of, and incorporate, the many processes, workflows, and informational needs that exist and converge at the point of care.

    We believe the results of our recent research will go a long way to enabling that holistic view of the point of care and the resultant transformation to take place.

    From our research, we now understand that the underpinnings of the healthcare ecosystem thru which health information is transported is a dynamic adaptive distributed network of heterogeneous nodes that communicate. Health IT vendors who understand that will lead the way in designing and delivering the next generation of health IT systems.

    We also feel it is inappropriate to continue relying on the health IT vendors and federal regulators to be the de facto specifications setting group for health IT. It hasn’t worked very well. We believe the healthcare community, and only the healthcare community, can coordinate the development and dissemination of the specifications for the next generation of health IT systems. That is an essential component of The CURE Project’s approach.

    In time, we believe the approach favored by CommonWell and the approach championed by The CURE Project will merge. And the healthcare community will be better off because of that merging. Data will be able to be easily shared, across platforms, across different vendor’s systems, and across state lines. That data will be available for the higher order services we all know we need in order to truly improve the delivery of health and wellness care and achieve the triple aim.

    We invite you and your readers to learn more about The CURE Project at www dot TheCUREProject dot org.

    – Bob Brown

    • John says:

      Thanks for your comments Bob and introducing us to The CURE Project.

      While I like the idea of the CURE Project and agree, it is time that we do something as an industry to address interop & info sharing across a heterogeneous ecosystem, I’m not sure exactly who should lead the charge. Federal mandates rarely work long-term as they tend to stifle innovation over time. Passing responsibility to the HIT vendors is also a little like handing the keys to the liquor store to the local college kids.

      Problem is, the healthcare community (hospitals, physicians, IDNs, etc.) are culpable in all this current morass as well for they have not been very forthcoming in trying to create interop linkages among themselves due to competitive reasons. If these entities had demanded interop from the start from their EHR vendors as the condition of a sale, they would have received it. And can we hold providers fully accountable when we have created incentives in the form of reimbursement models that encourage providers to compete?

      A fine mess we’ve created and in time I am hopeful we’ll dig ourselves out but it won’t happen today, nor tomorrow, nor next year. We have a long journey ahead with an uncertain end point.

  2. Check out Extormity’s “Oh Well” initiative – promising to make Extormity applications interoperable with each other at distances up to 65 feet.

  3. […] Moore is an IT Analyst at Chilmark Research, where this post was first published.  Email This […]

  4. The Epic / CommonWell saga you describe in such detail is irrelevant. See my comments to your post on The Health Care Blog for the reasoning.

    What is important is for ONC and HHS to make sure doctors and patients and policymakers get the transparency and mobility we all need to bend a cost curve dominated by a vendor and institutional lock-in business model.

    From my perspective, Epic and CommonWell are allied and timed to undercut the introduction of Direct messaging and View / Download / Transmit messaging as part of Meaningful Use Stage 2. These powerful and standards-based interfaces adopted by state health information exchanges and Blue Button+ respectively need to be heralded and protected.

    CommonWell and Epic should not be allowed to undercut open, standards-based and free interfaces under physician and patient control. If Chilmark and others continue to see EHR vendor initiatives through rose-colored glasses of hope instead of the power grab they actually are, then the HITECH incentives will continue to increase the pricing and political leverage of the vendors and hospitals. The result could ruin the US economy. See http://thehealthcareblog.com/blog/2013/04/07/onc-holds-a-key-to-the-structural-deficit/ for my reasoning.

    • John says:

      I agree and disagree with your arguments here and on THCB.

      First, where we agree:
      !) Ideally, full interop as a part of HITECH should be a condition of the tens of billions of dollars we are spending in taxpayer money to digitize health. Quite awhile back I actually wrote a post stating that the feds should just forget this piecemeal approach to interop via State HIEs, bite the bullet and create a health information sharing network model on what Eisenhower did to create the interstate highway system. Unfortunately, no one in Washington today has the guts to actually make this type of commitment.

      2) Open standards should be supported, promoted across all systems to achieve what is stated above.

      3) Leaving something as important as this for the vendors to address is far from ideal.

      Where we disagree:
      1) Providers are just as much to blame as vendors. If they wanted true interop across systems they would have been far more savvy in their purchases. Unfortunately, they had their own reasons under a FFS reimbursement model to not have interop as then patients would not be as tightly bound to a given health system.

      2) The CommonWell/Epic saga is worth reporting on as there is a lot of mis-information being passed around in the market and someone had to come out and clear the air – we did where others feared to tread thereby keeping to one of our core tenets: To bring clarity to the market.

      3) Direct, which you promote so highly is actually a concept first developed by David McCallie at Cerner and Wes Rishel of Gartner. McCallie is now very much involved in CommonWell. And guess who actually led the effort at HHS to develop Direct? Yup, Arien Malec of RelayHealth/McKesson who is now working with McCallie and others to stand-up CommonWell. I can’t think of two better individuals to lead this effort, can you?

      4) In my conversations with CommonWell and what I have alluded to in our research note to clients is that CommonWell is not about creating high barriers to information sharing, it is about lowering them. The last thing CommonWell wants to do is to tack on onerous transaction fees – that is not where the value/opportunity is. It is pretty silly to even think that way. The longterm play here is platform services to support care within a given community.

      Does CommonWell have challenges, you betcha! This initiative has a long and challenging road ahead. But I do have faith in McCallie and Malec for if duo can pull this off it is them.

      But one question keeps coming up over and over again Adrian as I write this response: What about the vendor led initiatives of the Wifi Foundation, the Bluetooth SIG, Continua and the list goes on. Today, you are happily enjoying the standards that these industry/vendor-led organizations have created (certainly on your smartphone) – is everything that they have accomplished suspect? Should we have left it to the regulators to create the necessary standards and services to enable that smartphone you are holding? If that is indeed the case, you would still be using a land line.

  5. John,

    We seem to agree on a couple of more things and disagree on the big one.

    1) We agree that providers are as much or more to blame than the vendors. The vendor lock-in business model is well worth the expense the providers incur if it serves to increase their pricing leverage. Siloed EHRs prevent patient mobility and restrict physician referrals. In many regions, the ability to dominate a market has given the most integrated delivery system a 30% price benefit over less integrated competitors. Epic dominates these markets today and it’s conceivable that CommonWell could reduce physician and patient lock-in if it drives the Epic providers to adopt CommonWell protocols.

    2) We agree that the CommonWell / Epic saga needs to be reported, but does it really matter what happened in the month before and after the announcement? The clarity you seek might come only when Epic and CommonWell agree on protocols and governance regardless of who shot first. Even then, Chilmark should analyze what would be the impact on the market and provider pricing leverage if Epic either stays out or joins the CommonWell protocols. My amateur analysis says that it would make no difference at all if the vendors’ protocols undercut state health information exchanges and patient-directed Blue Button Plus exchange. The important thing is protocols and governance that increase patient and physician mobility relative to the integrated providers.

    3) We agree that McCallie and Malec are as honorable and prolific as anyone in this business and I have worked with both of them over many years. I say this publicly every chance I get, so here it is again.

    4) I have not seen any statement from CommonWell about free interfaces. DICOM works for decades and has no transaction or interface fees. So do WiFi, Bluetooth and Continua, to cite your examples. Epic charges high interface fees for external transactions. Let’s hope CommonWell will be like DICOM and not like HL7.

    Your final “question” and example are inappropriate and do not apply to the CommonWell initiative. WiFi, Bluetooth and Continua operate in Markets. Real markets where consumers purchase the technology they use. EHRs do not operate in a real market. Both doctors and patients are forced to use whatever EHR is imposed on us by the Provider (sounds like a Star Trek, episode, doesn’t it?). There is no substitutability and, as a result of the HITECH incentives so far, much less competition and massive consolidation. I’m no fan of regulating technology, but in healthcare the market has clearly failed and state action for transparency, portability and privacy is required before health care costs swallow the rest of our economy.

  6. Notably absent from the lineup is Epic Systems, the largest EHR supplier. Some observers have interpreted rumors of the interoperability alliance as an effort to counter the dominance of Epic by making end-to-end integration of applications less important to healthcare organizations.

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