Two of the largest vendors of electronic health records products are in discussions to make their EHR patient data exchange interoperable -- a deal which, if completed, would potentially present a shift in the entire interoperable landscape for hospitals, physicians and patients.
Cerner Corp. and McKesson Corp. are working on a joint agreement to enable cross-vendor, national health information exchange, say sources with some knowledge of an impending deal between the two vendors. The deal would position Cerner -- which has more EHR users -- and McKesson -- which has a strong HIE product in RelayHealth – to take on Epic Systems, Inc., a leading EHR vendor that has been reluctant to open its proprietary platforms to other vendors.
The sources, who asked not to be named, caution that the deal is still in progress and legal machinations are not yet complete. But an announcement could come as soon as the Health Information Management Systems Society (HIMSS) 2013 annual convention March 3 to 7 in New Orleans. Neither McKesson nor Cerner would confirm the agreement is in the works and both refused to comment for this story.
But analysts familiar with the companies said an announcement is likely forthcoming.
"I think that there is some reason to expect a big announcement at HIMSS including those vendors," said Wes Rishel, vice president and distinguished analyst in Gartner Inc.'s healthcare provider research practice. While Rishel, a member of the federal Health IT Standards Committee, could not confirm any details of any specific deal, he said "I suspect it will be around ways of collaborating to share data."
If such a joint agreement comes to pass, it could be a watershed moment for building a network of interoperable health information exchange, Rishel said. There is the potential to "put the fulcrum in the right place to make the seesaw fall the other way" from the present environment, in which disparate vendors develop proprietary patient data systems that at times cannot communicate with each other.
Rishel added a Cerner-McKesson agreement would be only the first step of a long journey to achieving national HIE. It would take other EHR vendors to join into the agreement to make such an exchange network happen.
That said, an announcement between two such EHR vendors allowing information exchange among their products wouldn't be just another HIMSS marketing splash. "I think [it would be] a serious effort taken on by people who seriously understand the issues," Rishel said.
Cerner's EHR customer base is expanding from hospitals into the ambulatory space. Almost 4,000 eligible providers on the company's system have attested to meaningful use as of Feb. 1, by Cerner's count.
A source who asked not to be named said the deal "has been on-again, off-again so much I wouldn't give 100% that it's happening, but they've spent a lot of money on lawyers -- so I think it's going to happen." The source described the deal as a "joint agreement for health information exchange at a national level."
Cerner CEO testifies on HIE
At a HIE public hearing convened Jan. 29 by the Office of the National Coordinator for Health IT (ONC) in Washington, D.C., Cerner CEO Neal Patterson testified about his company's "ambition to put...an open ecosystem" of consumer-driven patient data into U.S. health care. He called for "a more aggressive approach to data liquidity and exchange."
While Patterson didn't tip Cerner's hand in regard to a joint interoperability deal with McKesson, he said "cross-vendor data liquidity is a necessary requirement" for the success of new business models in health care such as accountable care organizations.
"We are committed to enabling data liquidity for every product. We are committed to enabling our solutions to send and receive data in a universal manner. We are committed to putting these principles to work for every system in every venue of care," Patterson said in his testimony. "As a result of meaningful use, we now have the chance to move into what should be a post interface-contract era. There is no reason that we can’t have plug-and-play data liquidity delivered at commodity prices."
Rishel, a participant in the HIE hearing on the federal advisory side, told SearchHealthIT the day's discussions showed ONC is setting the groundwork for policies that will support such cross-vendor interoperability. Vendors, he believes, have gotten the message that they need to become interoperable across competing EHRs on a broader level than the current system of IHE interfaces and Connectathon competitions. What they do next will determine their ability to survive.
Taking on Epic
Data interoperability across EHR vendors systems is the big issue stalling the development of national health information exchange, and some insiders say that Epic Systems is one of the more difficult vendors to work with. McKesson and Cerner collaborating for interoperability could exploit Epic's weakness and bring to market a more open system -- especially if other vendors join in. While that might not knock Epic off the top of the mountain, sources believe it would create competitive problems for Epic that don't exist today.
The potential agreement should be considered not as just involving Cerner and McKesson, but more like a potentially larger group of EHR vendors in the future banding together with them for interoperability's sake. The more that join, the better they can take on Epic Everywhere, the vendor's HIE suite of personal health record (PHR) and physician mobile apps.
McKesson's RelayHealth is a strong HIE competitor with a loyal user base. Opening it up to other EHR vendors might stave off capitulation to Epic that already is happening in some markets such as Portland, Ore., where McKesson recently lost a large contract to Providence Portland Medical Center because of interoperability concerns between its EHR and other vendors', leaving Epic nearly the only vendor in town, according to a source familiar with the business negotiations of these types of large EHR vendor contracts.
According to this person, Epic's reach in that region is so complete that new EHR customers are signing up with Epic "solely because other people in the region already have Epic." This creates what National HIT Coordinator Farzad Mostashari, M.D., refers to as "walled gardens" confining patients to a particular health care organization because their data can't go with them to others -- holding them hostage, in effect, because of health IT.