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Is the Partners Epic EHR Selection Bad for Health IT Competition?

By Kyle Murphy, PhD

Close to three years after equating Epic EHR customers to hostages, a former CEO of Beth Israel Deaconess is now raising questions about legal implications of Partners HealthCare choosing Epic Systems as its EHR vendor for its sprawling health system.

"What we are seeing here is a remarkable reinforcement of mutual self-interest in the behavioral patterns of the two entities," Paul Levy writes on his blog, Not Running a Hospital.

"It is on this front that the provider group is engaged in a relationship with one of the country's largest electronic health record companies, Epic," he opines. "And it is here that the Attorney General should rejoin the antitrust battle — not only in Massachusetts on her own—but in cooperation with Attorneys General in other states.  The target, though, should not be the provider groups per se, but rather the EHR corporation."

In early June, Partners went live after three years of EHR implementation and $1.2 billion in spending (twice the initial estimate).

According to Levy, the Partners-Epic partnership could easily force the hand of affiliated physician groups which have little choice but to make the EHR switch to an Epic EHR in order to stay on working terms with the health system:

Partners enters into a contract with Epic for the construction of an EHR for its facilities.  The two organizations go to the Partners-affiliated, but independent, medical practice groups and tell them that they have to install the Epic EHR—even if the EHR they have had for years is perfectly adequate for their purposes.  If a doctors' practice asks why they can't keep their old system, Epic makes clear that interoperability between its system and the practice's legacy system is not feasible.  Meanwhile, to clinch the conversion, Partners also informs the local practices that failure to install the Epic system will foreclose those practices from participating in the favorable insurance contracting relationships it enjoys.

For the former hospital CEO, the partnership between the health system and EHR vendor upsets the marketplace by virtually eliminating competition in the form of other EHR vendors and their systems.

"They are complicit with each other in helping to ensure that PHS keeps its network strong by holding on to physician groups and that Epic expands its market power by expelling established competitors," he maintains. "This may not be your usual type of anti-trust activity, but it is anti-trust activity nonetheless.  And you can bet it is happening in other states as well."

Levy's views of the Partners-Epic come as no surprise. Back in 2012, he wrote about the agreement the former signed with the latter for a ten-year contract, originally valued at $600-$700 million and highlighted the influence of Epic Founder and CEO Judy Faulkner in convincing the nation's top hospitals to choose an Epic EHR.

"What is striking about this company is the degree to which the CEO has made it clear that she is not interested in providing the capability for her system to be integrated into other medical record systems," he wrote. "The company also 'owns' its clients in that it determines when system upgrades are necessary and when changes in functionality will be introduced."

And with admirable foresight, he actually predicted that Congress would eventually set its sights on the EHR company for receiving its share of the EHR Incentive Programs while not sufficiently safeguarding against shortcomings in its EHR technology.

The solution to potential provider lock-out in government interview at a lower level, concludes Levy.

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