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Is $2.35 per Patient a Fair Price for EHR Interoperability?

- 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:

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  • 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.

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