Health IT

Epic Systems VP defends company’s interoperability record

Epic has made a concerted effort to burnish its image in recent months by playing up its Open.epic program, blogging regularly about its customers and by making its executives more accessible to the media than in the past.

Electronic health records market leader Epic Systems has developed a reputation for being a roadblock to interoperability of health information. The Verona, Wisconsin-based vendor is well aware of the image and has been taking steps to change hearts and minds.

“There is a perception that Epic doesn’t play well,” acknowledged Dave Fuhrmann, Epic’s vice president of interoperability, in a recent phone interview. Then he dismissed the notion by rattling off statistics about Care Everywhere, Epic’s in-house interoperability platform.

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The Care Everywhere platform allows health systems on Epic EHRs to share patient records, test results, referrals, clinical summaries and other pertinent data with other organizations that also use Epic. Johns Hopkins Medicine, for one, which gets referrals from all over the world, has raved about this functionality on its website.

In theory, Care Everywhere is able to share data with non-Epic providers because it follows the Continuity of Care Document (CCD) standard specified in Meaningful Use regulations, as well as the newer Fast Healthcare Interoperability Resources (FHIR) specification. Some, though, have complained that Epic adds proprietary extensions to CCD files, making interoperability difficult without dedicated interfaces to the EpicCare EHR.

Care Everywhere is available to 436,726 providers at 1,183 hospitals and 33,989 clinics nationwide, according to an Epic white paper on interoperability released last month. Together, those providers serve about 183 million people or more than half the population of the United States.

“[Patients of those providers] have their charts go with them,” Fuhrmann said. He added that the Care Everywhere network transfers 1.25 million patient records between organizations daily. “We see way more of it than we ever expected.”

Epic has made a concerted effort to burnish its image in recent months by playing up its Open.epic program, blogging regularly about its customers and by making its executives more accessible to the media than in the past. Epic still doesn’t issue press releases or have a big presence on social media, though.

One impetus for the increased outreach could have been a scathing article in liberal commentary publication Mother Jones a year ago. Mother Jones ripped Epic for taking heaps of taxpayer money from the $35 billion Meaningful Use EHR incentive program while supposedly hindering data flow between organizations, which was supposed to be a tenet of Meaningful Use. The story said:

But instead of ushering in a new age of secure and easily accessible medical files, Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. That hurts patients who can’t be assured that their records—drug allergies, test results, X-rays—will be available to the doctors who need to see them. This is especially important for patients with lengthy and complicated health histories. But it also means we’re all missing out on the kind of system-wide savings that President Barack Obama predicted nearly seven years ago, when the federal government poured billions of dollars into digitizing the country’s medical records.

The magazine cited a 2014 RAND Corp. report that “singled out” Epic for stifling competition, as well as Epic’s continued refusal to join the CommonWell Health Alliance.

CommonWell is an interoperability network featuring most of Epic’s largest competitors. It’s often been viewed as a response to Care Everywhere from other EHR vendors, and some of the public rhetoric between Epic and various CommonWell members has been heated.

Epic still has shown no desire to join up. Fuhrmann said CommonWell is a technology platform, something Epic already has in Care Everywhere.

However, Epic is a signatory to the Carequality Interoperability Framework. The company has called this framework the “rules of the road” for interoperability of healthcare data, not unlike the agreement banks have regarding the global network of ATMs.

“When we first developed Care Everywhere, our customers told us they wanted clarity around governance and trust,” Fuhrmann said. That is what Carequality is supposed to offer.

Carequality also connects vendor networks and community health information exchanges together. Fuhrmann said Epic is working on connecting Care Everywhere to the Carequality framework. In August, Epic customer Sutter Health in Northern California became the first health system to go live with health information exchange with organizations on other EHRs following the Carequality framework.

“We expect all Epic customers to eventually connect,” Fuhrmann said. That could even happen before the end of 2016, he surmised.

Because Carequality is a framework that runs on top of platforms that including Care Everywhere and CommonWell, Epic has no need to participate in CommonWell, according to Fuhrmann. Plus, at least for its pilot phase, CommonWell has been using technology from RelayHealth, a McKesson subsidiary.

“Our customers already had the technology they needed to connect and exchange,” Fuhrmann said. He noted that Epic already is connected with several members of CommonWell, including eClinicalWorks, NextGen Healthcare and athenahealth.

Last week, another Epic VP, Peter DeVault, spoke up from the audience at the U.S. News & World Report Healthcare of Tomorrow conference in Washington, D.C. “Our hope is that all of the HIEs that are still around, the vendor networks like our own and athenahealth’s and eClinicalWorks’ various networks, as well as CommonWell’s will be able to share information without everybody having to come onto everybody else’s network,” DeVault said, according to a Politico report.

An Epic white paper on interoperability released last month featured a graphic from a 2014 KLAS Enterprises report. That report said Epic was the only major EHR vendor with both “sophisticated” and “successful” levels of interoperability in its customer base.

“We accomplish this in three ways: 1) Care Everywhere, Epic’s patient record exchange platform 2) interfaces, and 3) application programming interfaces (APIs),” the white paper said.

In a 2016 report, KLAS had Care Everywhere as the top-ranked commercial HIE product, as scored by healthcare provider organizations.

“More than anything, we like to let the outcomes speak for themselves,” Fuhrmann said. He added that Epic customers are the “most connected” to the eHealth Exchange — formerly known as the Nationwide Health Information Network — an infrastructure launched by the federal government and later transferred to the Sequoia Project. (Sequoia, which also spearheads Carequality, is a not-for-profit in McLean, Virginia, that advocates for secure health information exchange.)

The white paper claimed that interfaces with Epic EHR installations handle “billions of data transactions” annually. Per the document,

We connect with hundreds of bedside monitors, biometric devices, and home monitoring devices such as Withings home scales and Fitbit activity monitors. Data from these devices files to the patient’s Epic record, so it is visible to clinicians and care managers for review and decision support in combination with other clinical data.

We partnered with Apple on Apple HealthKit, allowing MyChart for iPhone users to upload health and fitness data to Epic’s clinical system using HealthKit-supported wellness apps and devices. Similar integration is planned for the recently announced Google Fit.

As Fuhrmann put it, “We certainly do understand [the importance of] having all the parts all work as a whole.”

Photo: Benjamin Derge/Wikimedia Commons