After McKesson, Cerner, Allscripts, Greenway and athenahealth made news at HIMSS13 this past week with the launch of the CommonWell Health Alliance – putting aside their competitive instincts, for a moment, to pledge their common commitment to interoperability and data liquidity – Healthcare IT News spoke with McKesson CEO John Hammergren about the road ahead.
Joining Hammergren in the discussion were David McCallie, vice president, medical informatics at Cerner, and Arien Malec, vice president, data platform solutions for McKesson's connectivity business, RelayHealth (and, in his former role at the Office of the National Coordinator for Health IT, the driving force behind the development of the Direct Project).
[See also: Six HIT heavy-hitters announce interoperability organization]
Q: Cerner CEO Neal Patterson mentioned that your companies had been working on this collaboration for several months, but that, right up until the eleventh hour, "I don’t think we knew if this was going to happen or not." What were some of the reasons for that? Were there wrinkles that gave you pause?
Hammergren: I think that, philosophically, these two executives were on board with the idea that this is what we need to do, and Neal and myself were on board with the idea that this is what we need to do. I think formalizing it – what is it we're going to do, and how we're going to do it together and how are we going to protect our own strategies and intellectual property and still collaborate and cooperate in this endeavor – is more nuanced than the mere agreement that we needed to do this. Getting through those nuances took some time. But I think there was a meeting of the minds the whole time.
McCallie: Oh, absolutely. We actually looked up the date. The first conversations were in May of last year, and Arien and I exchanged two emails – it was after the Bipartisan Coalition meeting that Janet described where they surfaced these problems and had a room full of both vendors and care providers. Both Farzad and Joy Pritts from ONC were in the meeting, and everyone was sort of complaining to Farzad: "You've got to go solve this identifier problem, it's killing us." And Farzad said, "Look, it's against the law! I can't do it. You guys have to solve it." I came back and literally quoted that – "you guys have to solve it" – I sent an email to Arien and he said, "We think the same thing. Let's talk about it." And within a week, we knew this was what to do. It just was an obvious fit. The process of going from that notion to an agreement that complicated organizations can sign was a long process.
Malec: I'd say governance was the biggest deal. Cerner had been prodding so much on getting the governance right, figuring out a bunch of really tough questions about how our organizations are going to work together, that, when we got agreement among the two of us, and then went to Allscripts, for example, they asked a whole series of questions, and we just rattled the answers off. We had already thought about all those issues. It was all written into the agreement we were signing. That's what took the time.
[See also: Direct Project champion to leave ONC]
Hammergren: But these companies came on very quickly, though. A week and a half.
Q: How did it come about that it was these particular five companies? Did you go around to other vendors to ask whether they wanted in?
Hammergren: We approached these companies because one of us had a relationship with one of them that would facilitate a conversation, perhaps. The other thing is that it showcases the diversity of size and scale. Greenway clearly has a different focus, and athenahealth has a different focus, than Cerner and McKesson do.
Q: Jonathan Bush, CEO of athenahealth, made the point that anyone is invited to join CommonWell – even a vendor of "epic proportions." Are you guys saying that only because you know Epic won't bite?
Hammergren: We'd like them to bite! We want them to bite. I'm hopeful that they will see it the same way we see it. The only reason they weren't at the table, from my perspective, is that we needed speed to get the deal done, and I don't think anyone had as close a working relationship, perhaps, with Epic, as we do with this group.
Q: So, now that you've made this big splash, what's next? What's on your to-do list these next few months?
Hammergren: Hopefully at my level we'll be engaged in trying to recruit more companies into the alliance, and that every day we'll have a more ubiquitous group of people saying, "This makes sense for us, and we want to participate." These guys [points to Malec and McCallie] have to operationalize it.
Malec: Oh, that little thing. [Laughter.] We're planning on quick cycles. We want to come back next HIMSS and say, "This works. We've shown it works. Here's an area where people are excited about this, and we're ready to take it to nationwide scale. If you're familiar with the work we did with the Direct Project, we announced that at HIMSS three years ago. Within three months we had published specifications, within six months we had a working implementation, within nine or 10 months we had first production use, a year out we had 70 organizations that were committed and using it. We're thinking we can do the same – tight cycles, getting it done – which forces a lot of issues to come to the surface and get solved. That's the best way to get these things to happen. And the agreements those people on the stage signed were not trivial agreements. They weren't just words. They were committing organizations to the resources to get this to happen.
Q: What lessons will you bring to this venture from your experiences with Direct?
McCallie: It's the attitude of the Internet pioneers: rough consensus, working code. We want to move forward, and if we have to make some quick decisions, test them out and revisit those decisions if they happen to be the wrong ones, that's better than spending a year in an abstract room designing a protocol and then trying to push people to use it when it's never been tested. It's healthcare. It's patient data. It's complicated. As fast as we want to move, it will still be a complicated process. I think Direct was appealing and successful in some measure because it was simple and straightforward. This is much more sensitive and complicated. The good news is we've learned a lot, and I think we'll go at it with a bit more intelligence than we would have three years ago.
Malec: When I was at ONC and we were trying to get this thing, I had this notion that it doesn't matter who agrees that Direct is the best thing since sliced bread. If HIT vendors don't have the commitment to build this into their products, it's not going to matter for providers. That's one of the biggest lessons: If the vendors don't step up to get this job done. nobody else can solve that problem. If you look at how this work gets done in other industries, it's not government and standards organizations browbeating the WiFi vendors to adhere to the standard, it's the device makers saying, you know what? If this stuff just works, we're going to sell a lot more of it and it's going to be a lot more useful for the customers we serve. That's where we need to be in healthcare. We have an obligation to make sure that we're not making interoperability a barrier to making the U.S. healthcare system more IT-driven.
Hammergren: That evidence and that philosophy will help drive people to the solution that may otherwise have said, I don't know if I want to participate with those people because we compete with them. I think if you take the view of the patient and the view of the provider, and what's in their best interest, our customers, having access to the right data, a patient with an assured identity, is critical.
Q: Have you heard from your customers? Did you give any of them a sneak peek?
Hammergren: We were pretty careful about what we said publicly.
McCallie: We previewed this over the last couple of weeks with folks at ONC – Farzad and Claudia Williams and others. We previewed it with Deven McGraw, the privacy advocate and with Jamie Ferguson, who is driving the Care Connectivity Consortium with some of the larger IDNs, so they were not surprised by this. And, much to our delight, the feedback from them was uniformly positive. There was not a negative word raised. It really sort of surprised me a little bit.
Q: Farzad has seemed increasingly exasperated lately about lack of progress on interoperability, and has begun calling out vendors for not being more proactive on that front. What has he had to say about this?
McCallie: We shouldn't speak for him, but we can say that he was very encouraging. Arien spoke earlier today about the need to have the market pull with the government push. Without a little bit of both of those, it's not going to work.
Malec: I'd say a market where the government has to do all the pushing is fundamentally a broken market.
Q: You've emphasized over and over that, even with this new alliance, these five EHR companies are still competitors. Talk about threading that needle between competition and collaboration.
Hammergren: I think winning is going to be on the same dimensions that we've always won or lost, in the application space, at least from our perspective. To think that you can win by having a data strategy that is not ubiquitous, and not "everyone in" is, from my perspective, shortsighted. We provide technology to retail pharmacies and health plans ... everybody and their brother. All of those people will be better off if we can move information between them. That's not what we've done as an industry. I don't think we as a company – or any company – would ever have a complete data set on a patient. So this is not something that strategy officers in the IT industry sit back and say to their CEOs, "We should not do this, and here are the following competitive reasons why. There may be some people who make money on the movement of data, who say, "This is also moving data, and so it's competing with me." But it won't be the typical application vendors that will have that point of view.
McCallie: The other thing is that the market has really changed around where this data needs to go. A lot of it is because of Obamacare and the focus on accountable care organizations. When IDNs were trying to consolidate all the information within the walls of the IDN, there wasn't really a push for interoperability at this kind of scale. But nobody can survive if that's all they do now. Because they don't have enough people. All of a sudden, every conversation starts with, "We gotta have the data." We wanna get the plumbing discussion off the table so we can talk about the applications.
Hammergren: And the analytics tools and the population health tools. Even the more sophisticated systems that have had this closed environment kind of view are beginning to recognize when they take risks, "Oh, that patient is in Florida two months out of the year, and I don't have that data in the Mayo Clinic system." And if they don't get it, they have a real problem.
