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For EHR vendors, there's no one approach to interoperability

Cerner, Epic and Meditech are tackling interoperability in their own ways, but all their efforts will come up short until healthcare organizations ask for it, according to a Chilmark Research analyst.

Interoperability may not be a word commonly used to describe EHRs, but three large EHR vendors are trying to change that. 

Cerner Corp., Meditech and Epic Systems Corp. have taken steps to improve interoperability by building and participating in ways for providers to share and use patient data beyond their own organizations. They face a landscape mired by data silos and outdated technology that makes exchanging information difficult. Additional players, such as app developers and federal regulators, add to the complexity, forcing EHR vendors to approach interoperability from more than one angle.

Even then, true interoperability won't happen unless healthcare organizations push for it, rather than settle for a limited and even fractured patient data exchange, according to Brian Murphy, analyst at Chilmark Research, based in Boston.

"You can say what you want about the EHR vendors, but for the most part, I think they're trying to do what their customers want," he said. "Right now, it seems like the healthcare organizations need to want to do it more than they have to do it."

EHR vendors on interoperability

Epic's One Virtual System Worldwide initiative, which launched last year, is an effort to increase the amount of data Epic customers can exchange with each other. The initiative enables its customers to access images such as CT scans from across Epic organizations, as well as make referrals and send messages. The initiative also enables patients to access a merged view of their healthcare records and schedule telehealth services with any Epic organization.

Matt Doyle, Epic's software development team leader for interoperability, said One Virtual System Worldwide aims to connect all of those involved in a patient's care, including primary care doctors, emergency room doctors and community-based organizations.

But Epic isn't just working on creating interoperability for its customers. The EHR vendor also participates in The Sequoia Project's Carequality Interoperability Framework. The Carequality Interoperability Framework develops initiatives for nationwide health exchange and is used to connect more than half of healthcare providers in the U.S.

Cerner and Meditech serve as contributing members in the CommonWell Health Alliance, a nonprofit that deploys a vendor-neutral platform for healthcare data exchange and is connected to the Carequality Interoperability Framework.

"CommonWell-connected providers provide a centralized method for identifying patients and locating records for document retrieval across different organizations and EHRs," Christine Parent, associate vice president at Meditech, said in an email. "They also give all clinicians convenient access to comprehensive patient information for an uninterrupted view of the patient story."

Meditech Expanse is an interoperable system that facilitates access between Meditech healthcare systems and affiliated organizations by giving providers access to patient records in other EHRs, according to Parent.

"With one touch, providers can access the patient's record in another EHR without logging onto the other system or searching for the patient, thus streamlining workflow," she said.

Cerner wants to help establish a network of trusted exchange partners between healthcare systems, according to John Gresham, Cerner's vice president and general manager of DeviceWorks and interoperability.

Trusted exchange partners are non-Cerner healthcare systems for which Cerner customers have vouched. Once a non-Cerner healthcare system is identified as a trusted exchange partner, Cerner can automatically compile patient information from that organization on patients who check into a Cerner hospital. The EHR vendor can then validate and prepare data from a trusted partner to be integrated with the Cerner system, Gresham said, which makes the interoperability process easier.

"You can still exchange data with everybody else, but the workflow simplification will occur there, because, in essence, the organization is saying, 'I'm comfortable with what they're sending, and I trust them. And, therefore, I'm OK with it to reconcile into my legal, clinical record,'" he said.

All three EHR vendors already support the FHIR standards, as well -- something that recently proposed rules from CMS and the Office of the National Coordinator for Health IT would require healthcare organizations to use to better enable health data access for patients.

The proposed rules would require healthcare organizations to adopt and use APIs to standardize how healthcare systems talk to each other. Meditech, for example, provides a set of FHIR APIs within the EHR software that enables patients using third-party applications to gain access to their data, Parent said.

"We believe that, at its core, standards-based APIs promote innovation, as well as help providers deliver better care and encourage patients to be well-informed and active participants in their care," she said.

One of interoperability's biggest hindrances: Healthcare organizations

Murphy said, while interoperability ultimately benefits healthcare organizations, EHR vendors need to make sharing and using health data a seamless experience.

"Your doctor could've benefitted from some other place you might've gone to," Murphy said. "But if we're taking 20 minutes to figure out where it was and how to get the data, the benefit is wiped out by the frustration of spending time looking for it."

Even then, EHR vendors can waste a significant amount of money addressing interoperability as a technical problem when it's really a business problem, Murphy said.

At this point, it's the healthcare organizations that need to decide to move ahead with this.
Brian Murphyanalyst, Chilmark Research

"At this point, it's the healthcare organizations that need to decide to move ahead with this," he said.

As things stand, there aren't a lot of good reasons for healthcare organizations to double down on interoperability, according to Murphy.

Healthcare organizations compete with each other, so the fear of losing patients to other systems and referral networks eroding is real, despite the fact that most Americans participate in some form of narrow network-type arrangement with their payers, according to Murphy, who described the fear as irrational. Patients don't often have the ability to jump easily between healthcare organizations, because they're limited to providers covered by their insurance.

Murphy said healthcare organizations have to decide that sharing usable data represents an opportunity, not a threat, before there is widespread commitment to interoperability.

They may have to make that realization sooner rather than later. The newly proposed, more aggressive rules and regulations from federal regulators are creating a greater push for interoperability. The rules call for easier health data access for patients and attempt to foster a more competitive healthcare market.

"There is some sense of urgency about getting the taxpayer's money's worth that hasn't been there in the past," Murphy said.

The shift to value-based care should also help, Murphy said. Focusing more on quality of care, rather than quantity of services provided, could push healthcare systems to rethink their approach to holding onto data.

"This advent of value-based care is certainly going to help in the sense that it's going to cause providers to think less about the number of referrals they're getting and more about delivering the best possible care to patients and attracting more patients based on higher-quality care," he said. 

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