October 2016

Welcome to 
WISHIN Connections , the monthly e-Newsletter from the Wisconsin Statewide Health Information Network (WISHIN).  We will keep you up to date with WISHIN activities, news on health information exchange (HIE) and new product developments.
Have a WISHIN story you'd like to share? Let us know. 
CommonWell, Carequality and WISHIN
The basics of, and differences between, interoperability options in healthcare
In the October 2015 edition of WISHIN Connections, we outlined the benefits of regional and statewide health information exchanges (HIEs) like WISHIN in enabling collaboration among groups striving for healthcare interoperability. A year has passed and the content of that article is still relevant. But as HIE evolves, questions remain about how all of the options compare and contrast with each other.

If you're confused about all the options, you're not alone.

WISHIN has been hearing variations of the same questions lately from customers:
"What's the difference between Carequality and CommonWell?"
"How is WISHIN different?"
"What is my best option for information exchange?"

At the highest level, WISHIN, Carequality and CommonWell are predicated on the same principle: to enable healthcare providers to securely and efficiently share patient information to improve outcomes. Furthermore, each option is not mutually exclusive of the others.

  • WISHIN is a network of individual organizations and other networks.
    • Supports multiple use cases - queries and notifications
    • Patient data aggregated into one record
    • Connects to government data sources (Wisconsin Immunization Registry, Prescription Drug Monitoring Program, Medicaid pharmacy claims)
    • Network reaches beyond the networks of CommonWell and Carequality
  • CommonWell is a network of healthcare organizations.
    • Query use case
    • Limited vendor participation
  • Carequality is a framework for network-to-network connections.
    • Focused on standards and policy of data exchange
    • No data aggregation
    • Query use case


The   CommonWell Health Alliance (CommonWell) aims to define and promote a national infrastructure for exchange with common standards and policies. It provides a network for patient identity management, record location and data query and retrieval.

CommonWell was founded by Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth, who act as managing members of CommonWell. Membership to the CommonWell Health Alliance is open to EHR vendors, health IT providers, and health systems. Contributing members, such as eClinicalWorks and MEDITECH, have access to the exchange while General members like HIMSS and PointClickCare only serve in advisory positions. CommonWell uses a revenue-based fee model with an additional one-time certification fee to validate compliance with the Alliance Specification and Services.

Unlike WISHIN, CommonWell requires individuals to opt in for patient enrollment. Patients initiate access in person at any of their providers participating in CommonWell by providing identification and confirming specific sites of care. 


Carequality  (pronounced Care-e-quality) is an initiative of the   Sequoia Project , a non-profit, public-private collaborative for advancing nationwide health data sharing.

The biggest distinction between Carequality and CommonWell is that Carequality is not a network; rather it's a network-to-network trust framework.

Carequality was created based on the belief that there will never be a single national network that meets the needs of the entire industry. Therefore, it exists as a standards framework to connect independent networks, including WISHIN and other HIEs, to one another. Carequality, like CommonWell, emphasizes an agreed-upon set of "rules of the road" and technical specifications  (which are compatible with policies and specifications of WISHIN) to make connecting disparate networks easier. Carequality is currently developing implementation guides for use cases one by one. Right now the only use case it supports is record locating for queries.

Carequality participants can include state/regional HIEs, vendor, payer, and lab networks among other types of healthcare networks. Providers such as physicians cannot join Carequality directly; these organizations must be a part of an established network that is a member of Carequality.

There are various levels of Carequality membership. One option is for a network to become an implementer of the Carequality Framework. Implementers are organizations that can provide connectivity into data from a number of different organizations and sources- in other words to act as the connection point for a network and agree to the use cases. WISHIN's technical vendor, Medicity, is a Carequality implementer.

Non-implementer members are not connected to Carequality but play a leading role in the Steering Committee and Advisory Council. Additionally, volunteers and supporters may take certain roles such as on committees and are officially recognized as well.

Carequality also has a workgroup tasked to develop policies and technical features regarding patient consent. Part of the Carequality framework allows for local rules to be followed as long as they don't bar interoperability. For example, if one network connected to Carequality required an opt-in policy and another network had an opt-out policy, both would be able to maintain these rules over their systems without adhering to a new requirement for patient enrollment.

Similar to CommonWell, Carequality has a revenue-based implementation fee that includes membership.

How is WISHIN different?

WISHIN is the state-designated entity for HIE that connects healthcare providers and approved stakeholders, like payers, throughout Wisconsin. In addition, WISHIN connects Wisconsin participants to national organizations via the  eHealth Exchange , another initiative of the Sequoia Project. The eHealth Exchange is a group of federal agencies and non-federal organizations with connectivity that spans across all 50 states. Your one connection with WISHIN means you're connected to the largest HIE network in the United States.

Both the eHealth Exchange and Medicity, WISHIN's vendor, are in talks with Carequality to sort out the technical requirements and timelines to establish connectivity that will allow WISHIN to spread its network even further.

Fortunately for all Wisconsin providers, WISHIN is making great progress in onboarding the state. WISHIN Pulse has an established network of more than 1,400 sites of care including data for more than 4.3 million patients.

Furthermore, while CommonWell and Carequality have query-only methods for record location, neither supports all of the use cases and services that WISHIN offers to help providers achieve meaningful use requirements and improve care overall.

WISHIN Pulse queries for records and also aggregates data. That means you don't have to query any number of separate facilities to get patients' information nor do you need to know where the patient has previously been seen. WISHIN provides it all at once. Pulse also includes access to Medicaid prescription data, patient immunization status from WIR as well as Prescription Drug Monitoring Program data.

WISHIN also created a Patient Activity Report which provides push notifications to payers and providers of patient hospital or ED visits. The report, which includes admission, discharge, transfer (ADT) and demographic information, was created to help payers and providers follow up proactively and timely with members who have visited a hospital or ED. The PAR can help to assure compliance with care plans, avoid preventable re-admissions, prevent duplicative testing and procedures and connect patients with medical homes or appropriate follow-up care.

In addition to its query-based exchange network, WISHIN offers secure direct messaging for enhanced opportunities for providers to communicate with one another and improve transitions of care.

WISHIN prides itself on providing the most comprehensive patient view to physicians and clinical staff on-demand and within the workflow.  Health information exchange is all about better information for better outcomes to help patients and caregivers alike.

WISHIN's goal is to support and complement your organization's mission to provide superior healthcare services through increased utilization of healthcare interoperability.

With connections to regional and national networks and providers, a patient-centered query system, extensive use cases, and secure direct messaging, WISHIN is the clear choice for organizations looking for an easy route to superior interoperability.

We know it's complicated and confusing. WISHIN is at the Carequality table by extension through Medicity and we are connected to numerous points inside and outside the CommonWell network. So it's not a question of "either/or"- WISHIN can be the best of both worlds.

Please, send us a message or give us a call if you have further questions on healthcare interoperability or how WISHIN could help your organization.

WISHIN Client Tip: 
When to Notify WISHIN Support  of Changes

Please let us know if:

- Any of your organization's interfaces will be down for an extended period of time

- Your organization is making changes to interfaces that may impact WISHIN Pulse, such as adding new codes for patient demographic fields, modifying results/report status codes, moving data to different HL7 fields, or adding new HL7 event types

- Your organization has EHR system upgrades or server changes

- Your organization is adding new facilities to your interfaces

Test connections are available for when you want to test any types of changes to your organization's interfaces. 
Wisconsin Medicaid EHR Incentive Program Accepting Applications
The Wisconsin Medicaid Electronic Health Record (EHR) Incentive Program is now accepting Program Year 2016 applications. For more information see the Program Year 2016 ForwardHealth Updates for Eligible Hospitals and Eligible Professionals.

WISHIN encourages the meaningful use of CEHRT to foster continuity of care and improve health care quality. Please visit the Wisconsin Medicaid EHR Incentive Program website for more information on provider eligibility, incentive payments, and the application process.

As an early reminder: The last day to submit a Program Year 2016 Wisconsin Medicaid EHR Incentive Program application is currently  March 31, 2017

If you have any questions or want more information about the Program, please contact Program staff at the following email address: dhsehrincentiveprogram@dhs.wisconsin.gov. Take advantage of this funding and apply for Wisconsin Medicaid EHR Incentive payments! 

Wisconsin Statewide Health Information Network | Company | (608) 274-1820 | wishin@wishin.org | www.wishin.org | PO Box 259038 | Madison, WI 53725-9038