Commonwell Health Alliance’s Jitin Asnaani on Mission for National Health Data Exchange

Jitin Asnaani

[Music]

Female: Welcome to Conversations on Health Care with Mark Masselli and Margaret
Flinter, a show where we speak to the top thought leaders and health
innovation, health policy, care delivery and great minds who are shaping the
health care of the fut ure. This week, Mark and Mar garet speak with Jitin
Asnaani, Founding Executive Director of the CommonWell Alliance, not for
profit trade association, a health care and technology organizations that are
working together to create universal access to health’ s data nationwide. The
organization has thousands of providers, payers, electronic health entities
and organizations utilizing their platform to share health data and exchange
health information.

Lori Robertson also checks in, Managing Editor of FactCheck. org looks at
misstatements spoken about health policy in the public domain, separating
the fake from the facts. We end with a bright idea that’s improving health
and wellbeing in everyday lives. If you have comments please email us at
[email protected] or find us on Facebook, Twitter, iTunes or wherever you
listen to podcast. You can ask Alexa to play the program Conversations on
Health Care. Now stay tuned for our interview with Jitin Asnaani of the
CommonWell Allia nce on Conversations on Health Care.

[Music]

Mark: We’re speaking today with Jitin As naani, First Executive Director of the
CommonWell Health Alliance a not for profit trade association of health care
and technology organizations working together to create universal access to
health data nationwide. Prior to that he was Director of Athenahealth where
he helped build a cloud based interoperability platform. He also contributed
to the Federal Advisory Committees for Athenahealth and HL7 Argonaut
Project as we ll as serving in the Office of the National Coordinator for Health
IT. He earned his bachelor’s in science at MIT and earned his MBA from
Harvard Business School. Jitin welcome to Conversations on Health Care.

Jitin: My pleasure to be here.

Mark: Yeah. I t hink everybody knows that as the amount of available health data
continues to grow, interoperability of health information systems has also
grown as a crucial issue and problem to solve. I think that’s one of the
founding goals of the CommonWell Alliance. I’m wondering if you can help
our listeners understand how much closer we’ve come to the goal of making
health data readily available to patients and for providers who rely on it.

Jitin: Absolutely. The quests to become perfectly interoperable and have dat a
share so seamlessly across systems that has to actually continue as medicine
itself evolves as the types of data out there evolve in response to kind of
changes in therapeutics and diagnosis abilities and so on. The big first step for
us that we’re tryin g to a ccomplish is to get the spigots running. 10 years ago
when I enter this industry, there was virtually no multiparty data exchange

Jitin Asnaani

happening. There were some point to point exchange exceedingly expensive,
but there was no way to get a whole party to c onnect to each other except in
small localized environments. Now, here we are with things like
CommonWell leading the way, enabling broad scale nationwide cross
community exchange of data in support of patient access and other
purposes.

If you look at a Co mmonWell network we enable more than 11,000 different
sites [inaudible 00:03:24 ] all across the US to be able to exchange data and
that number is just going by thousands every year. We’re working with
others who are trying to enable such goals as well. We really are at a place
now where the pipes are there, our water is running and now we’re working
on making the data that flows for them better. How do we make the insights
from the data more actionable? As we get to that we’d think about turning
them into a ction in terms of better patient care. But now we’ve taken -- the
work is done both within the CommonWell and with partners outside
CommonWell. We’re at a stage where we can say, yes we’re very close to
being at the precipice of stage two where the data is really flowing, so that
providers can use it in a wide variety of contextual situations with patients.

Margaret: Well, we have seen such a dramatic shift in the American health system over
this past decade. Most health systems have gotten off paper and o nto
electronic health records. Many people say that the large EHR entities in the
marketplace have made the interoperability more difficult than it needs to
be. We’re curious about the genesis of the CommonWell Alliance, where do
the idea for this and the identification of the need for a new organization the
CommonWell Alliance to exist. Maybe you could just tell us a little more
about how these entities are building an infrastructure that’s really going to
make for a better flow of health data between syst ems and, of course, to the
patients.

Jitin: Yeah, if you think about EHRs and their adoption, so over the course of 40
years there was a very slow pace of EHR adoption across the industry. Less
than 20% of all health care was electronic. Then came the EHR incentive
programs, out of the High Tech Act and what you had was an artificial kind of
pumping up of this part of the industry where if there was an incentivized
push for our provider organizations to adopt EHRs . On the one hand you
could say, this is gre at, on the flipside having worked at an EHR vendor I can
tell you that was -- because it was an artificial pump, it was -- it was a land
grab . You had to run out into the market with what you had and whatever
you could build on the fly to try to have an op portunity, get part of that
sudden opportunity to electronify these paper based practices in institutions.

In some ways got a little bit backwards, the jump to electronification without
thinking about the interoperability or as interoperability is follow o n. What
they are driving was the adoption of EHRs which were not design for
interoperability. When you’re living in a paper based world you’re
interoperability solution is a fax machine. Interoperability was great in a

Jitin Asnaani

paper based world for paper based int eroperability. I’m being a little to ngue
in cheek there, of course. But the reality is that that was not a problem, it
suddenly became a problem in a very quick timeframe artificially, because of
meaning for use. What happened in 2012 and 2013 timeframe wh en the
EHRs started realizing, hey, this is the way the world is going, we’re all going
to have electronic records whether mine or my competitors.

The reality is to have these records be able to exchange with each other.
Given kind of the knowledge of how federal regulation tends to act coming
from top down as in from the federal government on down to the EHR
vendors, is just found not be as good a solution as if the industry had just
taken with themselves. We took it upon ourselves, that time when
CommonWe ll was just founded it was just five substantial vendors,
Athenahealth, Greenway Health, Sonar, Allscripts and McKesson. Those five
got together and said, hey we believe that data exchange is going to be
critical. We should be enabling caregivers across th e country to be able to
find the patient’s data regardless of what EHR record the current or previous
providers have used.

We came together and decided we create basically a shared services
platform which included a record locator service and a patient ind ex so that
we really could tell where the patient has been regardless of what EHR
they’re using. It allowed us to be able to exchange data amongst each other
without having to build point to point connections. That was the genesis of it,
it was this notion that we know where we need to go as an industry, we
know how we can get there, let’s build something that we know works
because we are -- EHRs are going to be on the hook to build them. Then let’s
open it up so that the entire industry can join us, the go vernment can join us,
and we really can take care of the patients across the care continuum.

Mark: I love the notion that you think we’re on this precipice of having the data
flow and certainly to make that happen we need to sort of understand the
standar ds that are required to facilitate the building of this infrastructure.
There’s this growing enthusiasm for something called FHIR and that’s not the
flame but rather this is a fast health care interoperability resources
technology. That was developed by th e folks at HL7 of the global authority for
interoperability and health information technology and through the Argonaut
Project. I’m wondering if you could tell us more about the role of FHIR and
why it’s so vital to scaling up innovation in the health info rmation technology
arena.
st
Jitin: So, what is FHIR? It is based off of much more modern 21 century internet
protocols to share electronic data. It represents -- it did a format for
exchanging what an industry luminarian name Wes Rishel likes to call
mole cules of data. In other words, just the data I’m interested in, not
necessarily the entire patient chart. The ability to work with modern
protocols means now you can attract into this industry a younger and newer
generation of participants from Silicon Val ley, folks from technical colleges

Jitin Asnaani

and universities across the country. Developing innovations without requiring
a lengthy participation in the industry in the first place to really understand
how these old ancient protocols that we use typically in this i ndustry that
have been the ministry of the industry these last 40 something years. If you
get it right and everybody implements the same modern protocols
everywhere, in other words actually standardize it. Then that means that
somebody who’s building a sta rtup can work with several different EHRs,
then that second part about the data being available in molecules means it
can participant in other types of exchange.

The fact that you can kind of pick and choose the type of data you want to
exchange, it should be a game changer. You should be able to create
innovations that are very, very focused on particular things people need like
being able to find immunizations for your child or something. If you’re going
to take them to soccer camp and they need all of th at. Things like
CommonWell who provides the ability to go and find where the data is to
correlated to a single individual, become even more useful in this scenario. In
fact it reduces our cost, because right now we do entirely document best
exchange with t hese old legacy systems and our ability to participate with
those participants became cheaper because everybody is now using much
more modern protocols as directed by the Argonaut Project.

Margaret: Well, just recently I think there was a fair amount of an ticipation leading up
to this year’s HIM SS Global Conference. It was marked by some big
announcements from the Centers for Medicare and Medicaid, services from
the Administrator Seema Verma and others within HHS who I understand
announced some pretty bold new rules for advancing health data liquidity. I
understand that this rule says that by 2020 no patient should have to wait
more than 24 hours to gain access to their own health records electronically
and at no cost to them. This is huge, it signals a new incentive certainly for
health systems to improve health information sharing. This is a radical shift.
Tell us why you think these new CMS rules are so significant.

Jitin: If you just think about what the experience is today for an individual
participating health care. We’ve heard stories from our neighbors and our
friends, and then we’ve heard it from very high profile individuals like Seema
Verma and the care of her husband or former Vice President Biden and the
care of his son. If you think about all the se scenarios, underlying theme is
there just a lack of empowerments. As an individual in this country when you
are participating in your health care, whether your outcome is good or bad
you are a victim of the health care system here, that’s the issue. Whe n
CommonWell was formed our notion was the caregiver should really get the
data no matter where the patients receive care.

The caregiver was always broadly defined to be -- it could be the clinical
provider, it could be the patient themselves, it could be the parents, the
teachers whoever. We expected to the bulk of the exchange would be driven
by clinical providers, physicians, nurses and the like, and that has borne out

Jitin Asnaani

to be true. But from the very beginning it was all about enabling it for
whoever in ne eds to have authorize access to take care of that patient. As
CMS [inaudible 00:12:52 ] two things, they have said that yes the individual
must be empowered, and they are focused on the individual. Even though
I’m not sure the immediate volumes will come fr om the individual, although
you can certainly argue that over the next three to five years. We expect
more health care to be driven by individuals themselves.

Not only are we moving in the direction of more interoperability, we are
really moving in a direc tion of greater empowerment. That’s what I really
love about the rules that have come out. The second thing is this notion that
they have really forcing adoption off this FHIR APRs. To the extent that we
know everywhere that the same set of APRs are going to be utilized for the
majority of the health system that participates with CMS as their peer, that
enables higher interoperability. Not only will it become utilized for the
purposes of enabling patients to get their care, but it’ll also be utilized by
oth ers who want to participate in the care.

What CommonWell has done in the past, we already have patients to
connect to us. In fact, we’ve enabled this for the last three years, and I think
this I think will inserts the kind of confidence that a EHR or patie nt app
developer is going to feel that, hey, if I participate here I know for sure that
other people that participate will have the data, will have it in a format that I
can reliably build software, I can build innovations on top off. We’ve already
done so me parts of it in CommonWell, but the fact that CMS is really going to
drive the industry to standardize and to accept the patient has a right to their
data, I think will be a big boon for all of us who are just trying to make
interoperability ubiquitous .

Mark: We’re speaking today with Jitin Asnaani the First Executive Director of the
CommonWell Health Alliance a not for profit trade association of health care
and technology organizations working together to create universal access to
health data nationwid e, and was one of the founders of the Argonaut Project.
Jitin you say that we’ve reached an interesting pivot point where we’ve gone
from not having enough data to all of a sudden having too much of it. It
seems that there’s just increasing demand for info rmation, we at our health
center engage with the All of Us Project, paring together genomic
information, health information, social determinants. There’s just an
enormous amount of new streams of data flooding into the system. What’s
the next five years lo ok like in terms of synthesizing this information?

Jitin: If you just think about the different pieces you need in your health data
puzzle as a provider, you know you had disparate data sources. You have the
clinical chart data, the social determinant data , the genomics data and the
like, right? You have a system that feeds this to you, right, an actual EHR
other HIT system, you don’t touch and feel CommonWell that sort of like the
Version Network. It’s somewhere in the background doing its thing. You need
to know where these data sources are and get them connected at the time

Jitin Asnaani

you needed for the patient you needed for. Here’s what I see happening
Mark, as folks realize that there is a lot more data that they need in their
locality in order to be able to exch ange data, I see them making a lot of point
to point connections. Let me just connect to that local state agency that has
the housing information for these patients who have socioeconomic issues.
In the meantime I’m going to connect to CommonWell because I ’ll be able to
get the clinical chart data on the patient. Then it’s going to come up here into
my EHR, my EHR provided by X, Y, Z vendor for the patient for whom I really
need that information, I will utilize it.

I see that bearing not given right now, Ma rk, because the participants on the
CommonWell network who immediately started using the service to a great
degree were actually PCPs who are seeing brand new patients, because they
were so desperate for any data that even if their data came across from so me
location and was not in a well formatted. They would still at least skin
through it so that they had something. Overtime as the data become better
we have more and more use cases where people are utilizing it in more and
more situations. I think this is the big transformation. As EHRs make the
transition from enterprise software systems that have interoperability as a
feature towards interoperable web based systems that have user facing
functionality that makes you more intelligent. The experience of use rs is
going to get better. As the goal post moves from, hey do I check the box on
functionality to how am I creating an experience that’s so good in light of the
fact that I’m seeing more and more data coming into my system. As we make
that transition, I t hink the experience for providers and caregivers is going to
dramatically improve.

My sense is that CMS has already seen this and they are trying to drive more
usability related regulation. My sense is that EHR vendors investing more and
more in this space . Some of the newest EHRs on the block kind of really think
of themselves as interoperable to platforms that have EHR functionality build
on top of it. I think as the world moves in that direction the realization that all
these other data sources out there , it’s just going to be table sticks. If you
cannot figure out how to deal with all the different types of data out there
and present it in a friendly way to your users, you have illimited shelf life. I
see our role to be very specific service role there, right, and it’ll take us a long
time to get all the data sources connected because some of them are kind of
locked away in these government agencies. As we start getting there, EHR
vendors also getting there, and in the meantime people really are already
s tarting to tap into those valuable sets of data. Geno mic data is probably
going to be a critical piece of this whole puzzle, but it’s subject to all the same
constraints and force with the evolution.

Margaret: We’ve been speaking today Jitin Asnaani, First Executive Director of the
CommonWell Health Alliance a not for profit trade association of health care
and technology organizations that are working together to create universal
access to health data nationwide. You can learn more about their exciting
wor k by going to CommonWell Alliance.org or on Twitter @CommonWell or

Jitin Asnaani

follow him @Jitin, that’s J - I - T - I - N. Jitin thank you for your incredibly
important contributions to health data interoperability for being such a great
communicator about the work that you’ re doing and for joining us today on
Conversations on Health Care.

Jitin: Thank you so much for having me.

[Music]

Mark: At Conversations on Health Care we want our audience to be truly in the
know when it comes to the facts about health care reform and po licy. Lori
Robertson is an award - winning journalist and Managing Editor of
FactCheck.org a nonpartisan, nonprofit consumer advocate for voters that
aim to reduce the level of deception in US politics. Lori, what have you got for
us this week?

Lori: In a po litical rally in El Paso, President Donald Trump falsely suggested that
fact checkers didn’t hold then President Barack Obama accountable for his
false promise that if you like your health care plan or your doctor you can
keep them under the Affordable Car e Act. We wrote as far back as 2009 that
Obama couldn’t make that promise to everyone. Trump said, “You can keep
your doctor, remember that?” Then he called out the fact checkers saying,
“Hey, where are the fact checkers? You know, some of the most dishone st
people in the media are the so called fact checkers.” In August 2009 we
wrote under the Health Care Bills been debated at the time some employers
might have to change insurance plan to meet benefit requirements and
others could drop coverage and pay a p enalty instead. The nonpartisan
congressional budget office estimated that three million people with
insurance through their employers would not be offered coverage. We
si ghted that report and explained in detail how the different versions of
health care l egislation could affect the ability of some to keep the same
insurance plan.
th
Obama had made the claim and in August 15 2009 town hall event as he try
to garner public support for his health care overhaul plan. He told the crowd,
“If you like your health care plan you keep your health care plan.” When
asked about the claim in a 2009 press conference, Obama said he meant,
“The government is not going to make you change plans under health
reform.” But we noted that’s not exactly the claim he continued to mak e.
Obama repeated his talking point over the years and we repeatedly wrote
about it. His claim made our list of health care whoppers in 2010 and a
roundup of Obama Care myth in September 2013. In October 2013 reality
caught up with Obama’s claim when many Americans who bought coverage
on the individual market began getting letters from their insurance
companies saying they’d have to buy a new policy because of the ACA’s
minimum benefit requirements. The fact is we held Obama to the same
standard that we hol d Trump. That’s my fact check for this week, I am Lori
Robertson, Managing Editor of FactCheck.org.

Jitin Asnaani

Margaret: FactCheck.org is committed to factual accuracy from the country’s major
political players and is a project of the Annenberg Public Policy Center a t the
University of Pennsylvania. If you have a fact that you’d like checked email us
at chcradio.com, we’ll have FactCheck.org’s Lori Robertson check it out for
you here on Conversations on Health Care.

[Music]

Mark: Each week Conversations highlights a b right idea about how to make
wellness a part of our communities and everyday lives. Fitness trackers have
become all the rage, but another trend has emerged in the age of wearable
devices. After a few months about a third of user simply stop using them. Th e
reality capture the imagination of Tufts University School of Medicine,
Professor Dr. Lisa Gualtieri.

Lisa: I thought what if you could take all of these abandoned trackers and give
them to the people who could benefit most from them.

Mark: She thought w hat if we could get disinterested owners to donate their used
fitness trackers to be repurposed and donated to underserved populations.

Lisa: A lot of the work that we’ve been doing has been with older adults, racial and
ethnic minorities. For a lot of peo ple the cost is precipitate so I think that
that’s a barrier.

Mark: In 2015 she launched her nonprofit enterprise Recycle Health an online social
media campaign which seeks donated wearable devices to provide these
expensive devices for free to those in ne ed. She partnered with organizations
working with low income adults, seniors in fall prevention programs and
veterans as well.

Lisa: What we do is talk to people about how access, how sedentary they are in
coming up with a reasonable and achievable goal. T hey might start off with
2000, 3000 steps as their goal, but they know how to make that higher when
they’re ready to.

Mark: Recycle Health, a simple repurposing of personalized wearables providing
these tools for free to vulnerable populations empowering t hem to engage in
activities that can improve their own health. Now that’s a bright idea.

[Music]

Mark: You’ve been listening Conversations on Health Care I’m Mark Masselli.

Margaret: And I’m Margaret Flinter.

Mark: Peace and health.

Female: Conversations o n Health Care is recorded at WESU at Wesleyan University,
streaming live at chcradio.com, iTunes or wherever you listen to podcast. If
you have comments please email us at [email protected] or find us on

Jitin Asnaani
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