Carequality: Improving patient care coordination by advancing interoperability

In an industry that is increasingly value-based and quality-focused, care providers must have the right patient information in real time to make the best decisions possible. It is critical that patient data is accessible to everyone who is a part of a patient’s care journey and has a say in how care is delivered.

Dave Cassel, director of the Sequoia Project’s Carequality collaborative, shares his perspective on where data exchange is happening today, and how Carequality’s Interoperability Framework, along with crucial services like Surescripts National Record Locator Service, are arming care providers with the information they need to make better decisions based on timely, accurate patient data.

Q: What are some of the top priorities that Carequality is focused on in 2017-2018?

We’re excited about a couple projects that are kicking off over the next year, one of those being extending the Carequality Framework. While the current Framework is enabled for widespread, query-based document exchange, we are expanding that to cover the open API and FHIR-based ecosystem. There is a similar role that the Carequality Framework can play in providing an overarching governance structure for all these different connectivity initiatives going on as well.

Another high-priority project is focused on how we can deliver conceptually similar services—in terms of connecting existing hubs, service providers and data sharing networks—when following the patient. Whether it’s providing an event notification, referral visit information, flagging test results, or many other possibilities, how do you make that notification and related information available to those who aren’t part of the immediate network where that event occurred? That is a challenge we have started to work on in certain areas of the industry. It is also another area that is a great fit for a Carequality governance structure to be applied, providing an operational way for other networks, services and programs that offer these types of notifications to come together under the Carequality Framework.

Q: Carequality continues to grow with new partners and new connections. What does this mean and what is the impact on health data sharing?

It’s important to first understand what Carequality is and how it fits into the bigger picture of health information exchange. Carequality provides the Framework that connects different health data sharing networks and services. This is similar conceptually to how the telecom industry has a framework that allows cellphones to connect to each other, regardless of the carrier.

Once connected to the Carequality Framework, a physician practice, hospital or patient can work with their EHR vendor, personal health record (PHR), or any other “Implementer” of the Framework, as we call them, to exchange information with the customers of all the other Implementers. This approach to health data sharing covers the entire healthcare ecosystem—including providers, payers, and patients.

The Carequality Framework is unique because it is used by other data exchange collaborations and organizations to build on their important work. Previously, providers had to join all the different organizations separately to have access to the participants on each network, but this is no longer the case.

Now that CommonWell is a Carequality Implementer, any Carequality-participating provider or patient with a participating personal health record (PHR) will be able to connect to CommonWell participants, for querying health records, just as seamlessly as they can exchange with the providers or patients served by any other Implementer.  The reverse is also true, of course; CommonWell participants will be able to access all other Carequality participants. What this means for the larger community is that caregivers have more options for locating patient records and sharing data in a secure, standardized way.

It’s great to see so many participants realizing the value of sharing information between disparate networks. With the continued growth of, and access to more and more health records, Surescripts sees the National Record Locator Service playing an integral role within Carequality. When a record locator service can tell the provider where their patient has been seen, instead of relying solely on the patient to recall an accurate and holistic picture of their health history, the provider can more fully focus on the treatment plan and relationship with their patient.

Q: How do you see record locator services fitting into Carequality to improve patient data access and enable better care decisions?

A Record Locator Service (RLS) with a national scope can play a major role in advancing interoperability, and ultimately supporting more informed, safer care. The Carequality Framework was designed to allow participation by RLS providers for this reason. The value of a record locator service is greatly enhanced when you have both the location of the records, and a reasonable expectation of getting them that doesn’t involve calling or faxing.

The Carequality Framework makes RLS, like the Surescripts’ National Record Locator Service (NRLS), more valuable and vice versa. A record locator service and connectivity through Carequality are both valuable, but when put together, they become significantly more powerful and enhance each other’s capabilities.

Q: Improving population health is a crucial component to better outcomes and achieving value-based care. How is Carequality enabling better population health management across the industry?

Once you’ve identified the highest priority patients—those in need of the most care—that’s where you get into the care coordination aspect of the Framework and where Carequality is the most powerful.

Good population health management has several aspects. One of them is doing detailed analytics, which relies on access to large volumes of discretely codified data. While clinical documents are primarily optimized for user consumption, they usually contain key elements of codified data, allowing Carequality connectivity to play a role in supporting analytics. Where Carequality likely can make the biggest difference in the short term, though, is in facilitating care coordination for the sickest patients. These are the patients who are going to see multiple doctors and specialists and the ones who are struggling to keep track of all of their information. It’s essential that all of those who are caring for these high-priority, often chronically-ill patients, have access to their information so that their care doesn’t slip through the cracks.

Q: How is Carequality improving coordination for communities most in-need of better data sharing and interoperability, like behavioral health, and long-term care?

It is so important that physical and behavioral health aren’t siloed from one another. We need to make sure information can be shared—with appropriate security and protection of patient privacy, of course—across behavioral and physical health lines. Netsmart, a behavioral health solution, went live recently, and will help bring this previously underserved community into the fold under the Carequality network.

In the long-term care space, there is a significant push to improve interoperability.  Since  these EHR systems were not under the same Meaningful Use certification requirements that other vendors were, their systems historically haven’t provided support for current interoperability standards.  We’re seeing this situation begin to change, as vendors in the long-term care space work on their own and with interoperability service providers to get connected.  Stay tuned, as there should be some exciting progress in this area over the coming months.

Learn more about Surescripts National Record Locator Service and how it is giving care providers the ability to locate and access clinical records nationwide, here. Also read our latest whitepaper, “All Healthcare Is Not Local: The Human Cost of Disparate Health Data.”