Interoperability 101

Interoperability, in a nutshell!

Our API will enable you to gain access to national networks such as CommonWell Health Alliance and Carequality, as well as connect you directly with FHIR endpoints. We support a variety of use cases centered around treatment, payment, operations, and patient access. Groups that work with us include Payers, Life and Disability Insurers, Clinical Research, EHR's, Digital Health companies. This page explores what all of this means.

From a very basic level, data is available via national interoperability networks using established and new interoperability standards; and data is also available directly from health systems via HL7 FHIR. We do both, and then some.

Interoperability is complicated, and it always has been for a number of reasons that you can read about all over the internet. It takes a long time to get interoperability right. We've been working on this for many years in our consumer platform, learning what works, and what does not work, and adapting our platform to better support integration flows. We have built the technology to make it easy for you to connect.

So not only is interoperability complicated from a basic data transport and content representation standpoint, it's also challenging to determine whether or not the hospitals and practices holding your healthcare data have endpoints available to query, and what type of interoperability those endpoints support. We provide a national directory to support this. In addition, networks often provide their own directories and we support these as well.

In addition to the technology capabilities required to support successful interoperability, a deep understanding of the industry, including direct participation in Standards Development Organizations (SDOs) and interoperability network workgroups and committees, is required to stay abreast of what the right path to take is. We hold positions across many such groups, figuring out not only how to solve today's interoperability problems, but how to future proof our systems, which is effectively future proofing your systems as well.

Thank you for joining us and the opportunity to partner together and collaborate in this area of Healthcare. We look forward to seeing what we can do together!

Want to learn more? Read on!

What are the differences and similarities between "network" and "FHIR" connections?

It is important to first understand that network connections and FHIR connections really are hard to compare as they are not an apples to apples comparison. Network connections today primarily provide document-based exchange using IHE transport and HL7 C-CDA content standards, but tomorrow will also provide HL7 FHIR-based exchange. The networks are mechanisms through which interoperability transactions occur. FHIR is an HL7 content and transport standard that has become an interoperability term in its own right. Because of this it is often compared directly to interoperability networks such as CommonWell and Carequality even though it's really a standard that could be implemented within such networks.

Network connections and FHIR connections are the same in the sense they are both mechanisms that can be leveraged to access medical data. They are both used across a variety of use cases - from provider to provider, provider to patient, payer to payer, and others - not to mention the many sub-use cases inside of these. They also both leverage the internet to exchange information, and they share standards from the same SDOs, but the similarities mostly end there.

The CommonWell Health Alliance and Carequality “network connections” use well-established interoperability paradigms to make data exchange possible. They both use healthcare IT standards that were initially developed over 10 years ago. These standards are now considered to be mature, although they continue to be maintained and updated where and when appropriate.

FHIR-based interoperability presents a new connectivity option to the market focused on simpler underlying technology. As FHIR is a younger standard than the IHE-based standards used in the network connections, its adoption levels are lower across production settings, as would be expected, however that is quickly changing. FHIR has a focus on individual data elements, offering the ability to craft interoperability solutions based on smaller datasets. This means less work for organizations to adopt, less work to validate those flows and datasets, and ultimately faster time to market. There is a caveat, that these smaller datasets still need to be mapped back into larger datasets, and this is where clinical workflows come into play. FHIR is being incorporated into clinical workflows through FHIR Profiles, and various validation solutions are beginning to show up on in the market.

In conclusion, network connections can provide FHIR based exchange AND document based exchange. FHIR is a standard, and can be leveraged at the individual data element level and as part of workflows. FHIR and the standards currently used in network connections will co-exist for quite some time, and so your solution should able to connect to both. We provide you with a simplified version of this through our API.

What are CommonWell and Carequality?

CommonWell Health Alliance is a not-for-profit trade association founded in 2013 by a handful of health IT companies focused on advancing interoperability solutions in the healthcare industry. Today CommonWell supports thousands of provider connections and supplying record location services on top of its document query and retrieval broker. CommonWell continues to add more use cases and is considering additional services to further enhance the network. CommonWell operates as a physical network, providing a set of solutions on cloud hosted servers that every CommonWell Service Adopter has access to after passing the CommonWell certification. This means that CommonWell has the capability to aggregate operational data across the entire network, identifying areas to improve to further advance interoperability.

Carequality is a trust framework that provides point to point interoperability among its implementers. Carequality also connects thousands of provider sites together creating a cell phone type of network. Carequality provides a directory that each implementer has access to that acts as a type of “phone book” that provides endpoint information about each implementer.

Carequality Numbers


CommonWell Health Alliance Sites


What are the differences between CommonWell and Carequality?

Trust framework vs service network
It is important to note that Carequality is a trust framework that specifies policy and operating principles. It is not, technically speaking, a network service. There is no broker or service provider in the middle facilitating transactions. This is a key difference from CommonWell where a service provider does exist and facilitates transactions.

Centralized vs point-to-point
The difference between CommonWell and Carequality is that the former takes a centralized data exchange approach, and the latter follows a point to point exchange model. CommonWell utilizes a centralized broker architecture that facilitates patient matching and data queries across its member base, while Carequality provides a trust framework that participants agree to abide by and exchange data directly with each other. So in both cases data is acquired, but provide different paths to actually get there. Our API supports both and we can help you better understand which is right for you.

Exchange Modalities
These two interoperability initiatives cover a majority of health systems in the United States and provide you access to millions of patient records to support your use case. While document-based exchange is the current supported flow in both CommonWell and Carequality scenarios, FHIR is coming to Carequality soon, and will be included in CommonWell in the future. So whether your desire is to query and retrieve documents providing a snapshot in time of the patient information, or whether it is to query for more specific items using FHIR, or perhaps you wish to query on all channels to provide as much data as possible (while being compliant against your use case), you will be able to achieve this.

How do I query CommonWell and Carequality using the OneRecord API?

By using our API you will be able to connect seamlessly with CommonWell Health Alliance by querying our register patient, document query, and document retrieve flow. You will also be able to connect seamlessly with sites on the Carequality Framework following our document query and document retrieve flow. Even though these interoperability initiatives do slightly differ in their flows (CommonWell has one additional API call), you will call the same methods for document query and document retrieve, and when you make those calls we can configure your calls to hit endpoints on both networks without any additional configuration needed by you. We simplify the connection so you don’t have to!

What is the overlap between document and FHIR exchange?

It’s complicated. While there is overlap in the underlying standards (IHE and FHIR) supporting document exchange, we must look at what is in practice in the real world. Document exchange today happens over IHE standards through CommonWell Health Alliance and Carequality. Documents can also be built and made available with FHIR through the DocumentReference resource, as has been done in the IHE Mobile Access to Health Documents (MHD) Profile but this is not widely available to the general market yet as document availability through CommonWell and Carequality is. This means that you likely need to have the ability to access both documents and discrete data elements. The good news is that our API will provide you with both!

What about Document Responder?

As a participant in the networks or FHIR exchanges you may have a business need to act as a document responder in addition to a document consumer. You may also have a contractual obligation depending on the network in play. We have solutions to meet your needs. If document responder is a need or want for your system drop us a line and let's talk!

How is this all secured?

Authentication, authorization, and security are paramount. Without adequate controls in place protected health information is at high risk of compromise. What this means for us (and you) is that we always place security first. Sometimes this means more complexity that we have to manage in the API, but we manage that for you and provide straight-forward requirements to meet. You can read more in our security and authorization section.

What’s Next

Ready to get busy implementing? Check out our API Implementation Guide!