Three leaders in the HIE space have speculated that a potential interoperability deal between Cerner Corp. and McKesson Corp. could open patient data exchange and make implementation of a nationwide network a little more straightforward. But even if the deal goes ahead, as SearchHealthIT sources are sanguine it will, it likely won't be the Northwest Passage to HIE nirvana that patients and providers are hoping health IT technologists will find.
If the Cerner-McKesson deal goes through as planned, smaller EHR vendors might join in on what could be an open HIE standard, considering Cerner's support of open, crowd-sourced patient data exchange standards. The potential agreement would take advantage of McKesson's RelayHealth HIE product and Cerner's base of EHR users. An announcement could be forthcoming early in March during HIMSS 2013, this year's Health Information Management Systems Society's annual convention.
Sandlot Solutions CEO Joe Casper said in a SearchHealthIT interview that even if that were to come to pass, "the elephant in the room" still would be exchanging patient data with health care providers using EHR and HIE software from Epic Systems Corp. "What's it going to take to get Epic to the table to do this in a way that starts to become more open?" said Casper, whose HIE and patient data analytics software company is mostly owned by a group of Texas physicians. "We're familiar with those platforms; we certainly understand the approach they've taken. But if this is an intent to squeeze two fairly large organizations [Cerner and McKesson] together to combat one, then great move. But this is a chess game, and we can see whether or not that move does anything."
Cerner-McKesson deal is all about Epic, analyst says
A potential Cerner-McKesson patient data interoperability deal doesn't surprise John Moore, founder of Chilmark Research. In the course of his HIE market research efforts, he hears a lot of frustration about EHR vendors and their non-interoperable "silos" of data, he said. The market is seeking a way out.
"With the juggernaut that is Epic Everywhere, the other EHR vendors have to respond," Moore said. "They believe that Epic isn't the answer to all of health care's ills, that they have a good story to tell and they're going to tell it. But they're also going to differentiate themselves from a monolithic approach by partnering with each other ... and compete on other features and functions, not siloing the data in these different systems." Non-interoperable systems no longer "make good business sense," he said. "The business model is changing. It was fine for a while, but the business of health care has changed, and that model isn't going to work in the future."
Moore said he's skeptical about the actual interoperability that would happen between Cerner and McKesson products, saying it will take a close examination of the specs that are actually agreed on to determine the likelihood of its success. He's most curious to see how an eventual deal would go beyond what is required by the meaningful use standards set forth by federal health IT authorities. Will it support all the vendors' various EHR products, and will it also support lab and pharmacy data systems, a market in which McKesson is a big player?
"There are a lot of things we just don't know yet," Moore said, pointing out that the RelayHealth division operates separately from other McKesson health IT software groups. He also points out that because of technical considerations involving cloud connectivity, some EHR vendors, such as NextGen, might have a more difficult time hooking into a Cerner-McKesson HIE system than other vendors -- even if they wanted to.
Please, no HIE 'postage stamps,' Halamka says
Looking at the potential of a Cerner-McKesson deal to break the present patient data interoperability logjam, John Halamka, M.D., said it's possible that RelayHealth could be the hub to standardize a seamless exchange of data over disparate systems, much as trains can operate on rail lines owned by different corporations or cellphone calls can be routed over towers owned by different carriers. He added, however, that while a potential deal would appear promising, there remain many potential obstacles to nationwide HIE.
Halamka, who serves as Beth Israel Deaconess Medical Center's CIO, as well as vice chair of the federal advisory Health IT Standards Committee and chair of the New England Health Electronic Data Interchange Network, said many EHR vendors don't consider themselves experts in the Simple Mail Transfer Protocol, or SMTP, and Secure Multipurpose Internet Mail Extension, or SMIME, data transport protocols as required by meaningful use and the Direct Project's patient-data exchange standards.
EHR vendors are looking for a third party with which to partner to satisfy those technical certification standards for exchange. Arien Malec, vice president of data platform solutions for McKesson's RelayHealth, was instrumental in getting the Direct Project off the ground, Halamka points out. That connection could be why the deal is happening, he speculated.
"It sounds very reasonable that Cerner might look to RelayHealth and Arien Malec to build that front door, because he has the technical strength and experience to do so," Halamka said.
The one concern that worries Halamka the most, he said, is how HIE will be paid for in the future. The worst-case scenario amounts to what he calls "toll booths on the information superhighway," when data from one vendor's EHR system travels to another.
Halamka thinks that for interoperability to work, providers can't be hung with the bill when, for instance, Epic patient data moves to Cerner or vice versa -- a notion he said that Epic CEO Judy Faulkner has suggested in the past. While she said Epic-to-Epic exchange would always be free, there could be subscription or per-click fees to take patient data to other systems, Halamka said, recounting past federal meetings.
"Imagine this: McKesson says that McKesson-Cerner transactions are free, but with Epic, well, there's a charge. And then Epic says that Epic-to-Epic is free, but for Epic-to-Cerner, there's a charge," Halamka said. "For Dr. Smith and Dr. Jones, it's like postage stamps on your email."
"Let's hope it gets rationalized somehow" in such a way that network services are not impediments to commerce, Halamka said.