Following a sizable soft launch throughout July, the Carequality network now is live, with 13 participating vendors that offer HIE services.

Software companies working with the project include athenahealth, Coordinated Care Oklahoma, eClinicalWorks, Epic, GE Healthcare, Inovalon, Integrated Data Services, Kno2, Netsmart, NextGen Healthcare, OneRecord, Surescripts and Texas Health Services Authority.

Now, more than 3,000 clinics and 200 hospitals are live on Carequality, with data exchange underway in four states—California, Missouri, Texas and Virginia. Many of the early adopters are supported by three vendors: athenahealth, eClinicalWorks and Epic.

Steven Lane, MD
Steven Lane, MD

For example, Sutter Health is working with athenahealth to support affiliated ambulatory practices in exchanging C-CDA continuity of care documents and anticipates soon also working with eClinicalWorks and NextGen, says Steven Lane, MD, clinical informatics director of privacy and interoperability.

But the C-CDA differs between vendors, Lane says, noting that those differences between supposed standards have been an obstacle for providers trying to conduct health information exchange.

Importantly, standardizing a C-CDA format is a new initiative of Carequality, he adds. “We work with large IPAs, and the providers use more than 30 different EHRs. It’s still tough to do HIE, and we often still use faxes.”

With many providers swapping out their electronic health record systems for new EHRs that better support accountable care, Sutter Health will be educating its affiliated physicians about Carequality and urge them to join the network, Lane says. “We need to get over the notion that interoperability is not possible and start working on it.”

The importance of Carequality cannot be overstated, says Eric Helsher, vice president of client success at Epic. The vendor operates a national network for its clients, called Epic Care Everywhere, a rules-based network that enabled sharing health information among Epic users. Through that approach, there wasn’t a need for individual legal agreements with every Epic organization exchanging data with other Epic providers.

Now, Carequality as it matures will offer the same services to providers across the nation, using a wide variety of information systems, according to Helsher. “Carequality is connecting the circles.”

For the first time, there is a clear path for all vendors and providers to achieve national interoperability, Helsher believes, as the program is doable for even the smallest organizations.

The model is similar to the networks of cell phone companies, he notes. “They have their own pricing models with networks, but got together to let people cross networks and call everywhere they want. Carequality will help us call others.”

In April 2014, The Sequoia Project, an industry collaboration to advance secure health information exchange, convened health information technology leaders to find a way to resolve cumbersome and diverse HIE processes that were impeding progress.

Stakeholders created ground rules for necessary legal terms, policy requirements, technical specifications and governance processes, creating a standardized way to conduct health information exchange called the Carequality Interoperability Framework, which was published in late 2015.

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