Finding the future of interoperability with Redox: Part 3 - How Carequality can solve disconnected data for digital health

In this series, I am exploring how Redox can fill the gap between things one would think should be possible and what actually is possible. In the first two posts, I covered how Redox is overcoming current limitations with bulk FHIR and translating data between HL7^® v2 and HL7^® FHIR^®. Let’s dive in.

What is Carequality?

As someone who sells products to innovators, speed to go-live and value come up on nearly all my sales calls. To that end, when I talk with prospective customers of Redox, I often describe Carequality as the fastest way to go live with meaningful interoperability— measured in days rather than weeks or months. 

Carequality is a nonprofit organization that has developed a framework for trusted, standards-based data exchange between healthcare organizations. Practically, what this means is that Carequality allows you to exchange healthcare data with more than 70% of U.S. healthcare providers via a network approach—with one business relationship and one integration go-live—as opposed to building many BAA-driven relationships and integrations with individual healthcare organizations and their EHRs.

Redox is one of the largest onramps or resellers of Carequality access. We have been a Carequality implementer since 2018 and more than 6,000 organizations are connected to Carequality via Redox Network Onramps. Our customers turn to us for Carequality access because of our developer-friendly onboarding and broad experience and product offerings that allow us to provide more holistic advising on interoperability that’s not limited to just Carequality. 

Carequality considerations

As with anything that seems too good to be true, there are a few considerations when determining if Carequality is a fit for your organization:

1. Carequality is great if you want to get a general clinical snapshot of a patient (in the form of a CDA). But if your data requirements are more like, “I want to be able to retrieve every past A1C for my patients,” Carequality may not fit the bill. 

2. The most widely-adopted part of Carequality is a query-based network, which is ideal if you’re looking to retrieve a summary of a patient’s care when they visit a clinician  or need to make your data available to another treatment organization. Carequality is less than ideal if you want to be notified as things occur with your patients (e.g. new test results) or you need to be able to write data back to their charts in EHRs. 

3. Carequality requires reciprocity. If you’re querying for data, you have to make any new clinical data that you generate available to others on the network (which Redox makes easy via our Responder functionality).

4. Finally, perhaps the most important consideration is who is allowed to use Carequality and how. Before you can exchange data with other Carequality organizations, you must be granted approval from Carequality under one or more predefined purposes of use describing how you will use the data that you retrieve. Currently, organizations are only required to respond to queries for the Treatment purpose of use, as defined by HIPAA. While you can operate under other purposes of use, including Payment and Operations, the likelihood that you will get meaningful value is near zero, because you will not get responses to your queries for patient data from most healthcare organizations on the network. Making Carequality and similar networks, such as TEFCA/QHINs, more useful for non-treatment use cases is a hot topic in the healthcare integration world right now, but there isn’t a clear timeline for when this will meaningfully change.

The “On Behalf Of” designation

Historically, consideration #3 has presented a roadblock for many healthcare software vendors. Although their software is sold to healthcare organizations and used by people who treat patients (e.g. physicians or nurses), most software companies do not have any clinicians on staff or provide any care in-house. Previously, this would have meant that they were not a good fit for Carequality and would need to pursue BAA-driven integrations with each healthcare organization they want to retrieve data from. While this is also something that Redox is great at and has done thousands of times, it’s a very different approach.

After years of turning willing prospects away and crying myself to sleep because I had to tell people “no,” a big change happened in the summer of 2023: Carequality introduced a new pathway for software vendors and other companies to be able to meaningfully use Carequality, even if they don’t employ clinicians.

This new designation called “Treatment On Behalf Of (OBO)” allows organizations to apply for and use Carequality on behalf of healthcare organizations that are on the network and providing treatment. The caveats:

• Any new clinical documentation must go into the member healthcare organization's system for querying by other network participants. 

• The healthcare organization(s) the software vendor is querying on behalf of approves the arrangement.  

An example

Let’s say your AI telehealth application has been purchased by a virtual urgent care clinic for use by their clinicians. Your application wants to display clinically relevant alerts (e.g., potential medication allergies and interactions) as their AI monitors a telehealth session. To do this, your telehealth application needs as much information about the patient from all past care settings, not just the clinical information the virtual urgent care clinic currently has. With the Treatment OBO designation, your application can query the Carequality network for patient records on behalf of the virtual urgent care clinic. As the clinician at the virtual urgent care clinic conducts the visit, she will document her notes and any other details in her existing EHR, which is already connected to Carequality. In this scenario, Carequality Treatment OBO would allow your telehealth application to provide an integrated, data-rich experience for the provider, without necessarily having to integrate directly with her EHR.

This may sound like an edge case example, but as a company that sells to hundreds of software vendors, it’s extremely relevant for many Redox customers. We have already had several customers go live with this pathway and expect to see more in the coming months. I love being able to offer Carequality OBO via Redox Network Onramps as an interoperability option, especially to software vendors that are new to integration and want to prove out value quickly. And, as a software vendor’s integration needs grow, Redox can provide additional products such as BAA-facilitated integration via the same set of APIs.

There’s still a tremendous amount of work to be done to make healthcare data more accessible while protecting patient privacy, but Treatment OBO is a major win in unlocking more use cases for innovators in health tech.

I’d love your feedback on this post. You can send your questions and comments to brendan.iglehart@redoxengine.com.