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Epic Systems Corp. is now an "underdog" in light of a recent Cerner-Siemens deal in which Cerner Corp. purchased the health IT division of Siemens AG, said Epic President Carl Dvorak.
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Judging by his tone, his statement was half-wry, half-serious, in a hearing convened by the Governance Subgroup of the Interoperability and Health Information Exchange Workgroup, which reports to the ONC's Health IT Policy Committee. Dvorak said it in response to a committee member's question about Epic's domination of the EHR market, which eventually could lead to Epic governing health data interoperability.
Since Epic's estimated 300 customers -- including retail pharmacy chain CVS's Minute Clinics -- possess at least one piece of data for roughly half of U.S. patients, will Epic's privately held standards become de facto throughout the U.S. healthcare system? Or, as it was put to him during the hearing, "through the means of a monoculture?"
"I don't think so," Dvorak said, adding that there's more activity among Epic customers in its Cerner interoperability lab than the Epic lab, which he takes as a sign that cross-vendor EHR interoperability efforts are alive and well. "We interoperate with 49 other vendors' systems; 20 billion transactions per year go to non-Epic destinations or come from non-Epic places."
Carl Dvorakpresident, Epic Systems Corp.
"I don't think we'll ever go [to Epic as the interoperability standard] because the voice of the customer will always matter," said Dvorak, who remarked the Cerner-Siemens deal made Epic second or third in size among EHR vendors. "I do think we'll see more and more integration, which can be one vehicle for safety, efficiency and lower cost."
CMS provider directory could promote HIE
To facilitate exchange, Dvorak said that Epic would like to see CMS create a "phone book" of meaningful use participants, which would also include providers outside the program willing to volunteer contact information.
Epic also believes that interoperability would improve by creating a simple meaningful use "rules of the road for data exchange," strictly for use in treatment; not complicating rules of exchange by segmenting patient data, considering most patients opt to share their whole record; and putting regulatory restrictions on the secondary use and sale of health data.
Dvorak called for simpler, less expensive methods for validating the identity of providers who send and receive patient data. Participating in DirectTrust, one popular method for authenticating providers, is prohibitively expensive for some healthcare providers, particularly those in smaller hospitals and health systems, he claimed.
HIE fees are hurting some providers, too, he continued. Epic customers, he said, report that HIEs and HISPs are "holding immunization registries hostage" and turning them into "walled gardens" by charging expensive membership fees for access to data whether the provider uses them or not.
Interoperability via APIs or health data standards?
Another topic discussed by the Governance subgroup and the panelists was promoting interoperability through application program interfaces (APIs). Dvorak said that he didn't believe APIs had any "material effect" on interoperability, but instead it would be created through health data exchange standards such as Direct and Connect (also known as Healtheway).
However, Epic does make its APIs and much source code known to its customers for developing interfaces between systems, he said, adding that the company publishes some APIs publicly, too.
Steven Waldren, senior health IT strategist for the American Academy of Family Physicians, disagreed during the public comment period of the hearing. According to Waldren, standards still pose significant challenges, even though health IT leaders have been working on them for at least 10 years.
"I completely disagree that [open APIs aren't] an integral part of what we need to think about [to promote] interoperability," he said. "Right now, when we talk about interoperability, we're in the era of continuity -- to be able to move data from one point to the other. We really need to get to the notion of collaboration...APIs are really the only way to be able to do that."
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