Will EPIC join the industry's "HIE friendly" sandbox?

Thursday, August 16, 2012 | Mike Mytych

Recently, Forbes published an article that laid out a less then exciting scenario that describes the challenges presented by the Epic Systems approach to Health Information Exchange (HIE).  http://www.forbes.com/sites/davidshaywitz/2012/06/09/epic-challenge-what-the-emergence-of-an-emr-giant-means-for-the-future-of-healthcare-innovation/ The article also attempts to leverage the Software as a Service (SaaS) delivery model as a comparative approach to Epic’s customer based delivery of software with the SaaS model being described as the modern and more open solution thus leading to easier and more effective information exchange. I was asked to respond to the article and to put it in perspective of what we see in the marketplace here in the 3^rd quarter of 2012. As a foundation, we have worked with almost two dozen HIEs and all of the major EHRs across the country including Epic, Cerner, Meditech, NextGen, GE Centricity, Allscripts, GEMMS etc., and all of the vendors have struggled to some extent with meeting the demand for information exchange.  That being said, there are some offerings/scenarios that pose more significant challenges and the article zeros in on one vendor in particular, Epic. The author accurately points out that Epic has dominated the large hospital, integrated delivery network and academic medical center landscape for the past 24 months. The industry has never experienced this type of domination by one company. It is estimated that they have 400 or so of the largest hospital companies in the country as customers. Certainly while that is a large footprint, we must also realize that Meditech, Cerner and Allscripts have thousands of hospitals collectively, and the ambulatory EMR vendors equally have a much greater footprint than Epic. Epic is singled out by the article as not playing well in “HIE friendly” sandbox.  The general consensus that we have seen across the country is that this perception is true and there are many HIEs that are struggling to deliver consistent and high quality data exchange while dealing with Epic customers.



If we follow the basic premise of patient record exchange, that it is truly “patient centric” and that the information that exists should follow the patient no matter where they present for care, coupled with the methodology choices for providers that need to be in place to both send (push) or retrieve (pull) information depending on the patient care scenario, then yes Epic is a challenge. Epic ‘s approach was to build effective exchange, linked through a technology that they have in their cloud, that exchanges records from one Epic customer to another. They are on record stating that they will follow industry standards for record exchange, but that is somewhat cloudy when it comes to community HIEs. What is interesting to note, is that there are major Epic customers who are using the Epic to Epic exchange, Care Everywhere, in addition to also being major participants in their local or regional exchanges. Epic points to this as evidence that they are indeed friendly. However, when interviewing the HIE executives, they have stated that they modified their approach to HIE use cases based on the strict methods that Epic requires that does not always provide for the level of HIE functionality that they are working toward.  It is also important to note, that there are Epic customers using outside or non-Epic HIE tools to better enable more comprehensive exchange within their own enterprise and affiliated physician relationships. One point that the article tries to make, is that SaaS based EHR vendors are somehow more adept at providing effective information exchange, but that is a stretch in my opinion. The delivery of the software itself, has less to do with the HIE standards of patient identity, data definitions, security, consent tracking etc., and then it does with where the computers reside and how the EHR software is operated. The article intimates that the SaaS vendors are also somehow more compliant with “Open” systems standards and therefore more effective. HIE certainly benefits from Open standards but it is much more complicated than this proposition by the author. It is doubtful that Epic will control the market movement to data standards as the ONC and HHS will certainly not let one vendor become the definer of what is going to be deployed throughout the county. Epic is under increasing pressure to be able to both push and pull clinical record summaries and discrete data and to really make it match up with what the patient wants along with their provider at any one point in time. The Epic approach, while effective for Epic customers, is not as effective as it needs to be to meet the growing demand by consumers and their providers for effective exchange and access to pertinent information at the point of care. Health Information Exchange and use of Data Standards as defined in the notice of proposed rulemaking for Meaningful Use Stage 2 are in their infancy and the baby is just beginning to crawl, so stay tuned as the market as defined by patients and their providers with a push from the federal government will decide what will be effective in the long run, and it won’t be all Epic. Just as the article points out, once standards are in place down the road, the explosion of Apps just as in the Apple and Droid world occurring in other markets, it too will evolve in healthcare supporting the demand for the patient and their provider to better manage health in the future.