Epic tells feds it's happy to share
One of the biggest knocks against the Verona, Wis.-based behemoth, of course, is that its proprietary software does not play well with others.
"While Epic preaches interoperability, it practices non-interoperability and vendor lock," Edmund Billings, MD, chief executive officer of rival Medsphere Systems, developer of the OpenVista EHR, charged earlier this year.
John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center in Boston, wrote in a 2013 blog post that, while Epic had unquestionable selling points, he wasn't quite willing to join the growing crowd of similar-sized healthcare institutions flocking to rip-and-replace their existing IT.
"Beth Israel Deaconess builds and buys systems," he wrote. "I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC."
Speaking to the policy committee's interoperability and HIE governance subgroup recently, Dvorak argued for a more inclusive definition that would "open up the interoperability topic slightly more broadly."
While discussion of data exchange usually focuses on more narrow use cases of patient summary document exchange, he said, "one thing people don't often count at this moment is the kinds of interoperability between systems within a healthcare system, or these high-speed, high-volume feeds off to HIEs.
Epic has strong support for "standard HL7 traditional interfaces," said Dvorak, as well as other transaction types such as NCPDP and ANSI X12, enabling "about 20 billion data transactions per year, over 12,000 different interfaces across our 320 customers, to about 600 other vendor systems – including 88 public health agencies, 18 research societies, 51 immunization registries across 46 states and 17 research registries."
As for meaningful use, "specifically we support the Direct protocol, which is reasonable for planned transitions of care."
That "is clearly better than nothing," he said, but it's just as clearly inadequate for unplanned transitions such as ED visits. For those, "we support Healtheway exchange standards – the Connect or NwHIN standards; we think both are vital for solving interoperability in the country," said Dvorak.
More generally, he pointed out that Epic's Care Everywhere technology enables the exchange of 480,000 consolidated clinical document architecture, or C-CDA, documents each month with products built by other vendors – and that number is on the rise: more than double the amount that changed hands as of January 2014.
That exchange ecosystem "includes about 900 hospitals, 20,000 clinics, with another 85 hospitals and 3,000 clinics coming online in the coming year," said Dvorak.
"We connect to 26 other vendors systems, 21 HIEs, 29 HISPs and 28 eHealth Exchange members," with 20 more coming online soon, he said.
As for ways around the traditional "impediments" to data exchange, "one of the things we did a little bit different within the Epic community is to define simple rules of the road – a simple point-of-care authorization method and a single trust authority – and we just activated it by default," said Dvorak.
"Having that phone book (of exchange-ready participants), that trust and point-of-care authorization, has really made a huge difference," he said.
"In the last 12 months we've done 29 million transitions of care within that community. And that includes transitions to non-Epic EHRs. We connect directly to Cerner, athenahealth, Allscripts, Greenway, eClinicalworks. We do direct EHR-to-EHR transfers, as well as EHR to HISP and EHR to HIE. And that has gone just amazingly well."
As such, said Dvorak, "one strong recommendation to ONC and CMS is, if we could create a meaningful use phone book – anyone who takes meaningful use money has to register in the phone book – if we created a meaningful use certificate authority and created simple meaningful use rules of the road, we would probably, within 12-18 calendar months have an ATM for healthcare."