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Do EHR Vendors Influence User’s Health Information Exchange?

New research suggests that EHR vendors in a high competition market limit user health information exchange and interoperability.

By Sara Heath

Are EHR vendors to blame for lacking health data interoperability and health information exchange?

Recent research published in Health Affairs suggests they may be.

According to researchers Jordan Everson and Julia Adler-Milstein, hospitals in more competitive regional EHR markets engage in less health information exchange (HIE) than those in markets where there is one dominant EHR vendor.

According to the researchers, hospitals using the dominant EHR vendor in typical market landscapes engage in 45 percent more HIE than other hospitals. Those results changed when the EHR vendor markets changed.

When an EHR vendor had 20 percent market dominance, its users engaged in 59 percent more HIE than other hospitals. When the vendor controlled 80 percent of the market, its users engaged in only 25 percent more HIE than other hospitals.

This suggests that when an EHR vendor has less market dominance, its users can typically only exchange data with each other. When there is less competition, users are able to exchange data with other EHR users.

These results point to an issue with EHR vendors and the way they control EHR interoperability. When they are in a more competitive market landscape, vendors may potentially limit the amount of HIE hospitals can engage in with users of other vendors.

According to the researchers, this especially an issue with EHR vendor behemoth Epic Systems. Epic was the most dominant EHR included in the study, accounting for nearly a quarter of all beds in the study and used in 16.6 percent of the investigated hospitals.

When Everson and Adler-Milstein looked at markets in which Epic was the most dominant, they saw that users could almost exclusively exchange data with other Epic users.

The fact that when Epic was the dominant vendor we saw a different pattern—in which increasing dominance was not associated with greater HIE among hospitals that did not use Epic—may reflect the fact that Epic clients can readily exchange data with other Epic clients, and as a result, doing so with providers that are not Epic clients may appear prohibitively costly and complex.

This was a significant revelation considering the industry rumblings about Epic’s lack of inter-EHR HIE.

For their part, Epic has made moves to improve on its interoperability efforts. At the HIMSS 2016 conference, the vendor signed onto the Department of Health and Human Services (HHS) interoperability pledge.

Epic Systems CEO Judy Faulkner, has also defended the vendor’s interoperability efforts.

“We do about 26 million patient interoperability exchanges – that’s not the same thing as queries – every month,” Faulkner said in an interview with HealthITInteroperability.com.

“If it’s Epic-to-Epic, we’ve connected everyone,” she continued.  “If it’s Epic-to-non-Epic, we do it any time they have a C-CDA available, because technically speaking, it’s the same thing.  It doesn’t matter if it’s Allscripts or athenahealth or anyone.  We can do that just about as easily as we can do it with our own software.”

Regardless of those efforts, Everson and Adler-Milstein’s results still confirm what has recently been hypothesized throughout the healthcare industry: EHR vendors may influence HIE between different vendor users.

“If the dynamics we postulate are real, policy makers should consider pursuing targeted efforts to combat information-blocking practices and may be well served by creating stronger incentives for providers and vendors to pursue cross-vendor HIE, which has been successful in other nations,” Everson and Adler-Milstein wrote.

Going forward, researchers should continue to investigate these patterns, the researchers suggested. Those efforts could help confirm these initial findings.

If further research can confirm that EHR vendors influence HIE depending on market competition, Everson and Adler-Milstein suggest policymakers continue their efforts to monitor and enforce intentional data-blocking. By continuing those efforts, policymakers may help bring the industry closer to its goal of nationwide interoperability.

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