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Epic Systems playing defense on Ebola, interop: A losing game?

Epic Systems Corp. was attacked for health data interoperability problems and blamed for an Ebola patient snafu. Is the U.S. Department of Justice the endgame?

This is the latest installment of "HIT Happens," an occasional news analysis opinion column.

There should be no glee, no schadenfreude, in seeing Epic Systems Corp.'s brutal week, which began with an exposé in The New York Times showing how the lack of health data interoperability directly affects patient care, fingering Epic as public enemy No. 1. The follow-up was an even bigger bombshell, as Dallas-based customer Texas Health Presbyterian Hospital blamed its Epic EHR system for mistakenly releasing a patient infected with Ebola before he returned, much sicker, and was placed in isolation. The hospital quickly retracted that statement, raising speculation that Epic may have invoked a customer gag clause to get the job done, which Epic denied.

Epic knew its image ills were more acute than the EHR Association's D.C. lobbying powers could heal, so on August 1, it hired Card & Associates LLC to work pols onto its side in the health data interoperability debate. This move might have been too little, too late for the  biggest EHR vendor. That's because of past performance; Epic is notorious for not advertising, not speaking to the media, and not having a communications strategy in place to address crises. Silence is Epic's typical response.

No glee, no schadenfreude. The health of patients and financial well-being of taxpayers are eroding while the EHR vendor-sphere drags its feet in order to profit on a lack of health data interoperability, as well as systems notorious for a lack of usability. They are investing in lobbyists when they could be investing in data interfaces connecting competing EHRs, as well as improving usability. That's not funny at all. 

Bush: "Prove your social value"

The lobbyist move, implied Jonathan Bush, CEO and co-founder of rival EHR vendor athenahealth Inc., is bad defense. According to Bush, health IT vendors need a much broader long-term strategy to prove their worth.

"[Vendors need to] come up with their own metric to measure social value for themselves," Bush said at More Disruption Please,  a recent company-sponsored conference for health IT startup partners in Northport, Maine. "Measure it, publish it, audit it."

"In healthcare, God forbid you become successful," continued Bush, whose own lobbyist pushed for athenahealth to quit the EHR Association, partly out of impatience with its fellow vendors stonewalling interoperability standards. "The villagers will come and burn your house down if you start to profit from the illness of others, if someone can be convinced you've done it by ill [begotten gains]. Take a look at Epic, a wonderful company in so many ways, and they're having their house burnt down because people are seeing them profit from the illness of others and they have not done a good job of measuring the social good that they do -- and holding themselves accountable to that metric."

Why ONC matters in this discussion

Pick the catchphrase you want for the Epic Systems story: Pride goeth before you fiddle while Rome burns, too big to fail, whatever. If fortress Epic keeps playing defense and the tales of its nine-figure EHR installations not being interoperable with small doctor's office systems who can't afford Epic themselves keep piling up, there will likely be political fallout.

It isn't ONC that Epic should be worried about. There's a much bigger bully it doesn't want to take on.

There has to be. ONC, the little agency that could, might be preaching interoperability now, with National Health IT Coordinator Karen DeSalvo, M.D. working her 10-year plan in an unending roadshow, as her staffers draft meaningful use stage 3 rules. Rumors heard around Capitol Hill during National Health IT Week suggest that Republicans would gut the ONC of the little power and funding it has if they were given administrative reins. DeSalvo and her team are wringing the most out of their administrative powers they can, consensus-building in the field and fulfilling their duties under the HITECH Act.

So it isn't ONC that Epic should be worried about. There's a much bigger bully it doesn't want to take on if the company, whose electronic medical record supposedly touches half of American patients at one time or another, doesn't get its act together.

Why would D.C. mobilize over health data interoperability?

Anyone who plays sports knows that a good offense can only cover the weaknesses of a bad defense for so long. When your defense has holes, eventually a powerful opponent exposes its deficiencies. Epic Systems -- and maybe some of its peers -- would do well to read up on what happened to too-big-to-fail Microsoft in the 1990s and early 2000s.

Then the U.S. Department of Justice, it turned out, was too much for even Bill Gates's legal army. The times were fractious politically, with Democrats and Republicans shutting down the government because they couldn't agree on anything back then, just like today. Yet, they took down the richest CEO in the world. (The Justice Department did, we note, water down its plans to break up Microsoft during Gates's appeal of the antitrust ruling).

D.C.'s dysfunctional leaders are slowly coming to the conclusion, on both sides of the aisle, that the lack of health data interoperability is blocking access to care for some patients, and causing duplicate care to be ordered for others. Furthermore, it blocks price transparency, so patients and payers can't shop for the most affordable care. On a national scale, that could very quickly add up to billions of dollars in medical expenses.

But wait -- It's a free country, and a free market economy, you say? All healthcare providers have to do is pay for interfaces between their EHRs and everybody else's, and we achieve interoperability? Yeah, right. Medicare, Medicaid, healthcare providers and patients -- most of whom are operating on single-digit margins -- can't possibly afford to have doctors and hospitals pay for health data interoperability, or the lack thereof.

It's time for billionaire EHR vendors to stop crying poverty, stop hiding behind proprietary data standards, and work together for the benefit of patients. Bake interoperability into the system. Health data should work like the Web works: You make the browser, we own the data. Vendors should be mindful of the fact that no politician, regardless of stripe, loses a vote when standing up for patients. When healthcare costs get reduced in the process, that's double the reason to invoke the long arm of the law and solve health data interoperability once and for all.

Really, the only matter left to resolve is if the EHR vendors who aren't playing well in the interoperability sandbox will come willingly, or if it will take a fight.

Let us know what you think about the story; email Don Fluckinger, news director or contact @DonFluckinger on Twitter.

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