CommonWell's Jitin Asnaani: There's no excuse for providers not getting data

Since its inception in the spring of 2013, the CommonWell Health Alliance, which enables data exchange for vendor members at healthcare organizations nationwide, has grown to more than 40 members, including founding organizations Cerner, Allscripts, athenahealth, McKesson, Greenway Health, Evident and Sunquest. While Executive Director Jitin Asnaani is optimistic for the potential of future growth, he's also realistic about the alliance's expectations going forward.

"What I've learned is that [membership growth] is very lumpy," Asnaani told FierceHealthIT. "A few weeks ago, we announced that seven members joined us. Before that, though, I think we had a drought of around two or three months where nobody joined us. And last summer, a whole bunch of organizations joined us. I'm going to guess based on the rate at which people are calling us and saying that they want to be part of it, that we'll be around 50 members by the end of 2016, but it's probably not much better than just a guess."

More important than rapid growth, Asnaani said, is ensuring real-world usage and deployment of services to improve patient care.

In an exclusive interview at the Healthcare Information and Management Systems Society's annual conference in Las Vegas last week, Asnaani also shared his thoughts on the Department of Health and Human Services' (HHS) data sharing pledge (which CommonWell signed), current and future CommonWell initiatives and the use of the Fast Healthcare Interoperability Resources (FHIR) standard.

FierceHealthIT: There have been many criticisms of HHS's recent data sharing pledge, most notably, that it does not employ a carrot or a stick. You signed the pledge; what is your take on the effort and such criticisms?

Jitin Asnaani: I'm honestly not sure how [the Office of the National Coordinator for Health IT (ONC)] wants to utilize that pledge to do something meaningful in the industry. I'm not a critic of it, but I'm also not sure I see [the endgame] either.

When the pledge came out and we looked at it, we thought "this is fundamentally about patient-centered care." It aims to give power and access to data without creating any excuses. And as far as the use of standards, they help us to execute our plan. We looked at this pledge and thought that while we're not too sure this is going to be super helpful for the industry, we do know this speaks to things that we completely believe in.

FHIT: CommonWell recently announced an effort to offer post-acute care services. The Centers for Medicare & Medicaid Services announced recently that it was going to make it easier for these kinds of providers--mental health, behavioral health, long-term health--to acquire technology. What progress is still needed to improve post-acute care efforts?

Asnaani: When I was at ONC I started a standards initiative around long-term post-acute care. One of the things that struck me about post-acute care is the organizations that deliver such care to a population that really needs it are typically lower margin than many care providers. They don't have the money and they were not funded by Meaningful Use, making the money they have available to buy into technology sparse.

The beauty of the CommonWell model is that you can build access via APIs into our platform. Even if you are as thin as an app, you can get the data. There's no excuse anymore for not getting the data.

You don't need to build an enterprise system to be able to take care of that area; you should be able to get things easily. We live in a world where a little widget sitting on top of your browser has more power than an enterprise system of 10 years ago. We're in a place now where you don't have to have tons of money to get some pretty good value.

We have an opportunity to cover thousands of sites in the next couple of years that are still underfunded.

FHIT: Talk about FHIR and your thoughts on its place in the industry. Obviously, CommonWell deploys FHIR in some settings.

Asnaani: FHIR is being overbuilt in terms of what it can do. The reality is that if you look at the FHIR standard, it has some of the same issues current standards have. Everything is optional. That means you can send a legitimate FHIR-based piece of data, which has virtually nothing comprehensible in it, and it would be completely legitimate. So there's work that needs to be done by the entire community.

I don't see it replacing much of what exists already. In some places it will, but in some places, you need things like C-CDA (consolidated-clinical document architecture), where you need a document and a flow chart. And the job there is not done yet, either; C-CDA is rife with errors and issues, and those need to be fixed. FHIR will enable you to do all sorts of cool things C-CDA could never do, and that will also be managed and worked on.

I always think of FHIR as sort of the visionary "here's where we're going." We can get there very quickly, but we have work to do.

Our EHR vendors have implemented tools from the past. They can interoperate now, and we just need to make sure they're agreeing on the same parts of the same standards of the C-CDA. But a lot of our members are not EHRs. In fact, more than half of our members are not EHRs. A lot of those non-EHRs have never implemented the C-CDA, or any of these legacy standards, which actually are relatively heavy lifts. FHIR is a lot smaller lift. There are other standards you can use in conjunction with FHIR that make it easier to connect. But if you do those things, then you can have all these other parts where patients go along. Long-term post-acute care is one we talked about.

Other places where they've never had to think about: What about telemedicine? What about imaging? Imaging vendors are not necessarily implementing the same standards, either. We have around 10 care settings within CommonWell; a lot of them just don't have the legacy technology, and I don't want them to build tools they don't need. Why not build to the future if we're going to do that?

Let's just bring the future a little ahead, because we can get far this year, easily. The vendors just have to agree that they're going to do it. It's not hard. It's about herding cats, but the funny thing about CommonWell is that the cats herd themselves, because they know that if they want to succeed, others need to succeed. That's one of the beauties of this initiative; we all use our collective experience to make it better.

Editor's Note: This interview has been condensed for clarity and content.

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