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Interoperability knowledge hub

Get everything you need to know about interoperability in healthcare and what it means for hospitals and providers today.

National Services

Several third party vendors are stepping in to attempt to address interoperability issues with local software systems and create national interoperability solutions. Such services include Surescripts, DirectTrust, and CommonWell Health Alliance.


Surescripts is the predominant, national third-party network for electronic prescriptions. It is a cloud-based system that uses healthcare IT interoperability to connect pharmacies, pharmacy benefit managers (PBMs), and individual prescribers. Created in 2001 by pharmacy associations that wanted to connect pharmacies with doctors, Surescripts grew quickly, and in 2013 processed more than 1 billion e-prescriptions.11  But how did Surescripts achieve this success? First, it identified a market demand for a service that connected entities whose interests did not always align, such as PBMs and pharmacies. Then, after several attempts, PBMs were brought into the Surescripts system in 2008. This merger was pushed along by Medicare bonuses for e-prescribing, established in 2008, as well as provisions of the HITECH act in 2009 that subsidized the purchase of EHR systems. 


DirectTrust is a nonprofit consortium that supports the exchange of electronic health information as required by Stage 2 of the MU program. Members of the consortium are healthcare IT interoperability vendors that collaborate in supporting the trusted exchange of health information using a secure email model. This model connects over 40,000 healthcare organizations and 760,000 accounts, providing a secure, bi-directional exchange between providers, clinicians, laboratories, pharmacies, health plans, and patients. 

DirectTrust exchange transactions numbered nearly 23 million in 2014. DirectTrust faces numerous interoperability obstacles, including lack of clear standards for information exchange, inconsistencies in EHR technology certification and, perhaps most problematic, information blocking by vendors tied to fee-based EHR systems.

In testimony before the Senate Committee on Health, Education, Labor, and Pensions, Dr. David Kibbe, MD MBA, President and CEO of DirectTrust, stressed that resolving these obstacles "must address the unwillingness of some providers… to share and exchange data…" Kibbe postulates that "this unwillingness originates in the current business models… wherein fee-for-service payment creates disincentives for sharing of health information and rewards information hoarding, or at least the delay of timely information exchanges."12  Such actions by fee-based providers leave practitioners and health care systems stuck in the middle with no leverage to motivate their providers toward a more interoperable system. 


Carequality is a framework to connect health data networks under a common set of nationwide trusted exchange, legal, technical, and policy rules. The Carequality Framework enables exchange today across vendor networks, as well as Health Information Exchange networks (HIEs), clinical information networks, and personal health record (PHR) networks13

CommonWell Health Alliance

The CommonWell Health Alliance offers real-world, cross-vendor interoperability services that health IT organizations across the care continuum embed into their technology enabling providers to maintain existing workflow. Services include patient ID management, advanced record location, and query/retrieve broker services, allowing a single query to retrieve records for a patient from multiple member systems14 .

For Carequality and CommonWell End User Terms, click here




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