- During a Tuesday hearing of the Senate Committee on Health, Education, Labor, and Pensions, the Director of Interoperability at Epic Systems revealed the EHR vendor charges $2.35 on a per-patient, per-year basis for Epic EHR end-users to exchange data with other providers.
"We charge on a per-patient, per-year basis — so it's not per transaction — and it's the same whether that patient is sent to a hundred different places or one another place. And that charge is $2.35," Peter DeVault said into response to a question posed by Senator Bill Cassidy, MD (R-LA).
DeVault was one of four witnesses who participating in the hearing, "America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care."
Inquiries about the costs of EHR interoperability, however, began earlier than this exchange between Sen. Cassidy and DeVault when Sen. Elizabeth Warren (D-MA) began asking questions of the panel, which led to a curious exchange on the relationship between health IT standards and interoperability costs:
ONC: Meaningful use incentives will continue despite shutdown A call for transparent data NCQA Recommends 11 Changes to Quality Payment Program Rule Why Thorough EHR Adoption Must Precede Population Health GE Healthcare investment targets clinical workflows, coordination EHR Vendor athenahealth Expands Scope of Healthcare Services OIG releases top 10 management challenges of 2012 Federal agencies draft HIT risk-based regulatory framework What nursing, patients gain from EHR adoption, use? Does EHR Coverage Data Affect Continued Patient Care? CMS Announces MIPS Registration Period for Group Reporting EHR replacement: Challenges for providers making the switch Updates for Meaningful Use, Interoperability, Health Reform Extensive use of health IT improves patient care at FQHCs Missouri Lawmakers Consider Health Information Exchange Bills As EHRs Proliferate, Medical Students Must Learn to Use Them Cerner Ranks Highest for EHR Capabilities in Chilmark Report Data registries, more surveillance needed for medical devices MIT develops new NLP system for freehand EHR medical notes Physicians are ready, willing, but not quite able to qualify for meaningful use CMS Outlines 2015 PQRS Reporting Challenges, Trends Understanding Interoperability, Value of Health IT Standards athenahealth Leads Epic, Cerner in Ease of EHR Data Sharing Groups Urge Congress to Cover Telemedicine under Medicare Meaningful use fraud: HHS, DoJ issue warning Are Lab Test Displays Subpar Among EHR Technology? Q&A: ICD-10 progress with Pat Schmitter New Committee to Operationalize Interoperability Framework Meaningful use: Stage 1, Stage 2 comparison Healthcare CIO challenges meaningful use naysayers Nephrology HIE Adoption Leads to Improved Care Coordination Vendor dispute leaves rural practice without EHR data access Director of the Office of Consumer eHealth to depart ONC Congress Strongly Leaning towards 2015 ICD-10 Implementation High rural REC enrollment, partnerships help EHR adoption NYDHA inaugural class aims at EHR improvement Health IT Interoperability to Enable Clinical Integration Accountable Care, EHR Interoperability Vital for DOD Healthcare Clinic biller nabbed for $400,000 Medicare fraud AHIMA: ICD-10 delay shouldn’t overshadow benefits, preparation Does Stage 2 Meaningful Use show lack of support for HIEs? Bayonne Medical Center receives Stage 6 EMRAM recognition NJ hospitals save $113 million via value-based care pilot athenahealth, Epic Systems Trade Health Data Exchange Barbs Is your ICD-10 transition headed for a Code Blue? NIST Releases More Test Modules for ONC 2015 HIT Criteria National pharmacy chains inject Surescripts with immunization reports HIMSS: Health IT Standards Guidance Lacking in Many Areas DoD Reaches Long-Anticipated EHR Interoperability Goal Latest Health IT Certification Criteria Extends Beyond MU NJ-HITEC readies for Stage 1 Meaningful Use deadline EHR Vendors Operationalize Carequality Interoperability Plan ONC reminds providers of July 1 hardship exception deadline ONC’s Farzad Mostashari takes on meaningful use naysayers EHNAC expands with five new commissioners Patient portals boost diabetic medication adherence by 6% Pennsylvania doles out $8.9M to connect 11 regional HIEs OIG finds ONC’s oversight of EHR certification lacking Why Prioritizing Usability Effects Better Ambulatory EHR Use How’s payment reform changing the traditional revenue cycle? Centura Health Earns Davies Award for IT Excellence Survey: 62% of small providers say EHRs make practices run more smoothly Despite EHR Grumbles, Docs Spend More Time with Patients Montefiore ACO receives AHRQ praise CMQs gain prominence in Stage 2 Meaningful Use ONC to hold annual meeting next week AHA says hospitals are not ready to report electronic CQMs How can rural healthcare providers afford EHR? Five ways to avoid repeating mistakes during EHR replacement As Aussies struggle with e-health, is meaningful use that bad? Finding an EHR fit for specialty practices What’s so important about connecting EHRs and genomics? Five ICD-10 tasks to complete by the end of 2013 Rural hospitals fall behind on EHR adoption, mortality rates OIG Estimates $729.4M in Erroneous EHR Incentive Payments From EHR Use to Information Exchange for Community Health Black Book survey declares 2013 the “Year of EHR Replacement” Success in Stage 2 Meaningful Use will depend on resources? VA Continues Pursuit of EHR Interoperability with DoD Top EHR Twitter resources FSMB announces finalized telehealth licensure model compact Draft Bill Proposes New Plan for EHR Interoperability Future of EHR innovation is integration of health IT ONC Addresses MACRA Health Data Interoperability, HIE Measures Integrating care through HIE to benefit mental health patients Funding to Fuel Tech Adoption at Georgia HIE Intermediaries ONC shows path to Stage 2 Meaningful Use via Blue Button UPMC study to focus on patient-centered mental health IT Is Patient-Generated Data the Solution to Incomplete EHRs? Access to psychiatric data affects patient readmission, treatment HHS 2014 budget would boost ONC, meaningful use, HIT funding Part II: The go-to resource for meaningful use in NH EHRs drop on ECRI 2014 hazards list, but alarm misuse reigns Atrius Health recommends new direction for meaningful use Allscripts Eyes Post-Acute Care, Behavioral Health Markets Kalorama: EMR market exceeds $20 billion in 2012 Study: Only 27% of providers see ROI on EHR adoption Lawsuit: Adventist failed to protect PHI of 763K patients Patient Safety Not Improved by Cutting Resident Working Hours Telemedicine, remote monitoring set to hit $296.5M in 2019
WARREN: Once we have uniform standards, can we expect that health information exchange will be easier and cheaper:
DEVAULT: It's a very good question and often I hear that the problem with interoperability is the lack of standards and I would argue that's a minor problem compared to some of the others. We have had standards for several years now for being able to interoperate with some kinds of data —
WARREN: I'm sorry — Let me make sure I’m following this. Are you saying we already have uniform standards?
DEVAULT: We don't have standards for everything. We have standards for being able to exchange some information such as medications, laboratory results, problem lists —
WARREN: But we saw the business here: X-rays, blood tests —
DEVAULT: Absolutely, there's much more work to be done. However, we can do a lot of important —
WARREN: And so the question I'm asking is when we get standards, would we expect that the cost of creating interoperability among systems would decline?
DEVAULT: It will eventually decline. Here are some of the costs that —
WARREN: I just want to focus right now on this question about what standards will do for us and how it is that we get this cost down. And so I assume having better standards means we get these costs beaten down, at least some. There may be other issues going on here.
DEVAULT: Once they're implemented.
When Sen. Cassidy began his period of questioning, the focus turned to the specific costs on enabling health information exchange between providers.
"We're hearing over and over again about the cost," he said. "You all have 50-percent market share, so I guess that kind of looks, you know, at you. How much to you all charge each practice for each patient to interface with, if you will, to put each patient into Epic and to share their data?"
In response, DeVault revealed that costs fall into two categories for Epic, creating the connecting and charging for software licensing. The former is less predictable. "The creating the connection to begin with to that other system can wary widely. We charge for that based on an hourly fee," he stated.
DeVault did note that experience working with certain EHR vendors did make the process more straightforward. "With some vendors we have done it so many times that it is plug and play. For example, when we connect to a Greenway, we have done that many times," he added.
Moreover, Epic's Director of Interoperability credited Stage 2 Meaningful Use requirements with removing barriers to interoperability in the form of health IT standards.
"We have seen a large uptick in the last year and a half of our customers being able to connect easily to non-Epic systems," he described. "Previously, that was not the case — different implementations of standards was an impediment and now some of that has shaken out. That is reducing the cost of those connections significantly and the time to implementation."
While Epic was the only EHR vendor taking part in the hearing, its approach to charging for EHR interoperability provides insight into how a large portion of EHR adopters goes about paying for health data exchange among Epic and non-Epic EHR end-users.