8 Health Information Exchanges Lead The Way

Greenway Medical Technologies, one of the oldest independent electronic health record (EHR) vendors in the United States, has recently placed its chips on promoting what it calls "standards-based interoperability." In doing so, the ambulatory care EHR vendor has joined the leading edge of a movement to break down barriers between disparate systems and reduce the need for expensive interfaces.

Greenway users already are exchanging Continuity of Care Documents (CCDs) -- standardized clinical summaries -- with other providers that are using the Cerner and Epic inpatient systems, Justin Barnes, VP of marketing, industry and governmental affairs for Greenway, told InformationWeek Healthcare. An announcement involving interoperability with a major ambulatory-care vendor is expected by early December, he added.

Other EHR vendors have demonstrated the ability to exchange CCDs in interoperability showcases, Barnes stated. "But we're not aware of where they're using standards-based interoperability in a deployed setting," such as a hospital campus or a healthcare community, he said.

Providers with disparate EHRs can, of course, exchange CCDs via health information exchanges, he said, but that requires costly interfaces. In contrast, he says, Greenway's approach, using "cross-platform exchange between different systems could reduce interoperability costs in America by 80%-90%. That's what we're trying to do."

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Greenway has already gone beyond CCD interchanges, employing standards created by the Integrating the Healthcare Enterprise (IHE) industry workgroup. For example, Greenway and Epic have both adopted IHE's Cross Enterprise Document Sharing (XDS.b), a Web services profile that facilitates the sharing of clinical documents between unrelated organizations.

This approach is strikingly similar to that of the Interoperability Work Group (IWG), a consortium of states, vendors and health information exchanges that has developed plug-and-play standards for sharing health information. IWG recently partnered with Healtheway, which operates the eHealth Exchange (EHE), to implement these standards by testing and certifying vendors and health information exchanges.

Greenway, a founding IWG member, expects to have little difficulty in meeting the certification criteria, Barnes said, partly because Greenway and IWG are both using IHE standards.

Meanwhile, he pointed out, the cross-platform interoperability with Epic and Cerner could be replicated in healthcare systems across the country. In addition, Greenway is the first ambulatory care vendor to be certified as part of the Cerner network, Barnes noted. That would make it easier for hospital-owned physician groups to adopt Greenway if their hospitals use Cerner, he said.

Greenway is also working with providers and payers in Austin, Texas, to build the infrastructure for a "healthcare community" committed to supporting new models of care delivery and payment, Barnes noted. While admitting that that will require cross-platform registries, analytics and care management tools, he said that it won't necessarily mandate a "full-blown" health information exchange. The information exchange could be done through standards-based interoperability among disparate systems, he said.

In the long run, he predicted, some healthcare communities might decide to work only with EHR vendors that meet certain interoperability criteria. "That will help drive the market faster by creating the demand for interoperable products."

Greenway, which received a cash infusion from an IPO last year, has also been expanding its relationship recently with retailer Walgreens. Having supplied a version of its EHR to the worksite clinics of Walgreens' Take Care Clinics, Greenway is now doing the same for Walgreens' pharmacies, according to an August announcement. WellHealth, a Walgreens EHR based on the Greenway product, is now in 200 pharmacies and will be rolled out to all 8,000 Walgreens outlets by next summer, the press release said.

The introduction of the EHR is part of a corporate initiative "that supports the transformation of [Walgreens'] traditional drugstores to health and daily living destinations," according to the release. "The WellHealth EHR will deliver to Walgreens pharmacy staff a single patient view capturing their immunization and health testing history with their prescription profile."

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