Epic Systems Corp. has a reputation that runs along the lines of "doesn't play well with others" when it comes to health data interoperability between its EHRs and competing EHRs, health information exchanges, and even other instances of Epic. KLAS Enterprises LLC interviewed 28 Epic and non-Epic users to find out if its reputation is deserved.
In the report -- titled Epic HIE 2014 Everywhere, Elsewhere, or Nowhere Else? -- author Mark Allphin got to the heart of the matter: While the federal government and EHR vendors have worked together to foster adoption of health data standards, variance in each vendor's implementation of those standards -- and to a lesser extent, variance in how healthcare practitioners fill out EHR fields that populate continuity of care documents -- creates an interoperability rat's nest.
That gives rise to the need for intermediaries such as HIEs or health information service providers (HISPs) to translate data between healthcare providers. If nothing else, the report from the healthcare research firm validates the business need for HIEs for years to come.
Most Epic-to-other vendor sharing is done through HIEs and HISPs.
KLAS Enterprises LLC
Epic-to-Epic connections are typically "stress-free," Allphin, senior research director at KLAS, wrote. Meanwhile, non-Epic customers trying to share Epic data found Epic "inflexible." However, according to the report, "HIE organizations and non-Epic providers say Epic is capable but inflexible, and that other vendors must meet Epic where Epic stands." For that reason, most Epic-to-other vendor sharing is done through HIEs and HISPs.
"We found that yeah, by and large, Epic was able to share with other EMRs," Allphin told SearchHealthIT. He acknowledged that, for non-Epic users, it can be more costly and complicated. HIEs and HISPs in particular bear the brunt of health data interoperability troubleshooting. "Depending on which seat you're sitting in, you can have a different experience."
In practical terms, it can cost $10,000 or more to develop a simple, single form for medical researchers to collect data via a "big, giant EMR everyone's using," said Weill Cornell CIO Curtis Cole, M.D., speaking at the HealthImpact East conference in New York earlier this month. Weill Cornell needs thousands of such forms to do its work, and they need to be created dynamically as its research leads it further down the road to discovery of new treatments and disease data.
With many healthcare providers working on low-single-digit margins, the cost of non-interoperability can be tough to swallow. "One of the ideas behind meaningful use is to get structure built into the clinical data so you can actually analyze it and we can move away from billing data and look at what's actually happening clinically," Cole said. "We're not there yet; the standards are too weak."
KLAS also reported that non-Epic users have different experiences as far as integration of shared Epic data. Some practitioners enjoy the benefit of live updating inside their EHR systems with the Epic data ported directly to the patient's file; others have to go outside their clinical workflows and use an HIE portal to access it.
That's going to be the norm between competing EHR vendors, Epic and others for the indefinite future, Allphin said. Cross-vendor initiatives -- like CommonWell Health Alliance, Carequality and Healtheway -- show some promise in migrating U.S. healthcare to a more vendor-agnostic "plug and play" environment. But from the tenor of the interviews for this report and other research Allphin has conducted for KLAS, the country isn't yet close.
"You have multiple initiatives where, in essence, vendors are willing to work one with another to help solve the interoperability challenges -- specifically around the areas of security, permissions and patient privacy -- so that we can get to a world where sharing information EMR to EMR is more seamless than it is today," Allphin said.
He added that accountable care and other quality-based financial incentives are also creating business and financial reasons for providers to demand access to patient data -- necessitating better interoperability between rival EHR vendors. "With that much effort, it's hard to imagine that it won't get better moving forward."