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How Epic Systems Is Advancing Healthcare Interoperability

As both a participant in Carequality and supporter of FHIR, Epic has the look of a forerunner in healthcare interoperability.

By Kyle Murphy, PhD

- Last year, Epic Systems received a considerable share of criticism for its approach to health information exchange compared to other EHR vendors, but what a difference a year makes.

Healthcare interoperability at Epic Systems

"In years past, there has been a lot of criticism and a lot of it has been unfair, but now we certainly have the numbers to prove that it doesn't pertain today," Epic's Vice President of Interoperability Peter DeVault recently told HealthITInteroperability.com.

More than a year ago, DeVault himself provided testimony to the Senate Committee on Health, Education, Labor, and Pensions and later faced questions about the company's role in enable information sharing through its Care Everywhere platform. The hearing revealed that Epic charged customers on a per-patient, per-year basis, which led its competitors to criticize the EHR company and the company itself to eliminate the fee.

With the recent announcement of the Carequality Interoperability Framework enabling more than 3,000 clinics and 200 hospitals using Epic and other EHR vendors to exchange health data, the tables appear to have turned.

"Our numbers — as well as the numbers of other vendors that have participated in the Carequality framework  — have significantly increased even in the couple of weeks since the press release," DeVault explained. "Today we have, just among our own customers, over 300 hospitals and 6,600 clinics connected to any other Carequality participants."

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Carequality and its framework have helped mitigate variation in EHR system design and implementation contributing to inefficient information sharing. Whereas Epic's HIE platform enforces standardization so that Epic users with different Epic implementations can exchange clinical data, the same cannot be said of Epic to non-Epic exchange.

"We do see some variation, not surprisingly, among us and other vendors, which is one of the things that Carequality helps to solve because they specify fairly precisely how you should implement the record exchange," said DeVault. "Rather than one vendor saying to another, 'You've done it wrong,' and vice versa, it's a neutral convening ground where we can all work out those issues and point back to that standardization process."

To begin, Carequality-enabled health data exchange has taken the form of directed query so that providers at the point of care can request a patient's record from other EHR systems that have enabled the its interoperability framework.

"That's typically used for transitions of care — so a patient comes to the emergency department and you need to get their home organization or you're discharging a patient back to their PCP," DeVault added.

The HIE technology has also enabled data reconciliation between different EHR systems, allowing updated medication, problem, and allergy lists to move back and forth between clinical settings.

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Fueling Epic interoperability with FHIR

Advancements in healthcare interoperability at Epic are not limited to health information exchange.

The EHR vendor is a key member of the Argonaut Project along with competitors Cerner Corporation and athenahealth and health systems Beth Israel Deaconess Medical Center and Mayo Clinic. The privately-funded project has the goal of accelerating the use of the Fast Healthcare Interoperability Resources (FHIR), a set of specifications and an application programming interface (API).

According to DeVault, FHIR still has much to prove, but it should spur innovation in untapped areas of IT development.

"Compared to some of the other standards that we have been using in health IT for quite a while now, it's a modern web-services architecture," he explained. "For that reason, it's very familiar to people outside of health IT in the way that it works and so it will attract developers who would might not otherwise want to develop apps on top of EHR systems."

READ MORE: Health IT Standard FHIR Ready to Advance Interoperability

FHIR also has the benefit of enabling the widespread implementation of novel applications beyond those using Epic EHR technology.

"Some of the things we know are going to be enabled by the technology is being able to have apps that are substitutable," DeVault maintained. "We've had open APIs for our customers and their partners to use for many years now, but this will be industry-standard so that if one person wanted to write an app for an Epic system it could possibly be ported without much effort to other EHR systems as well."

Additionally, the widespread adoption of FHIR could pave the way for EHR users to leverage unique proprietary technologies belonging to other healthcare organizations.

"Today, if one healthcare organization develops an algorithm that helps determine whether somebody should have a radiology study done based on their presentation, that algorithm lives in that system and others would have to reproduce that in order to get the same decision support result," DeVault said.

"What we'll be able to do with some of these FHIR-based APIs is take the data to the algorithm," he continued. "If one organization is curating this algorithm and keeping it up to date, other organizations can use FHIR-based APIs to basically ask that organization what we should do in this situation."

Whether last year's criticism of Epic and its approach to information sharing were warranted, the EHR company is now part of two initiatives with the potential to make healthcare interoperability widespread.

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