New research shows that the increased adoption of Epic EHR technology could prove beneficial and detrimental to the healthcare industry.
A new paper in the Journal of the American Medical Informatics Association concludes that an emerging EHR monoculture — that is, the dominance of Epic EHR technology — would provide both advantages and disadvantages for EHR usability, interoperability, and innovation.
“It is not feasible, sensible, or morally acceptable to interrupt the firm’s impressive (and often laudable) success,” write Ross Koppel and Christoph Lehmann. “Prudence suggests, however, that increasing domination of both covered providers and patients necessitates scrutiny to ensure that its growth does not endanger patient safety by outsized influence on clinician judgment, data fluidity, usability, or the development of data standards and interoperability.”
As the authors note in their EHR market analysis, most recent EHR implementations or replacements involve healthcare organizations and providers becoming Epic EHR users. “Epic is replacing other EHR vendors in the market and is beginning to establish a single-vendor landscape, a monoculture,” they add.
The analysis of an Epic EHR monoculture provides a list of the advantages, mixed advantages and disadvantages, and disadvantages of one EHR developer dominating the healthcare industry.
Starting on the positive end of the spectrum, an EHR monoculture would establish data and interface standards allowing for advanced data sharing and care coordination among clinicians. Additionally, this Epic EHR monoculture would ensure compliance with federal and state regulatory regulations (e.g., meaningful use) and support both provider and research communities.
In the second category, Koppel & Lehmann raise concerns about restrictions on application programming interfaces resulting from the closed nature of the Epic EHR ecosystem. Moreover, a lack of competition could limit EHR innovation and force other developers to consider consolidation as a survival story.
According to Koppel & Lehmann, the most significant of the disadvantage is cost. “Epic costs are significantly higher than comparable competitor products, and, in at least one study, did not produce savings for payers,” they note. Beyond implementation, Epic EHR adopters also incur an array of costs for maintenance and upgrades. Of the latter, Epic’s upgrade costs as a percentage of system’s initial cost are much higher than its top competitor Cerner — 40–49 percent to 30–35 percent, respectively. And then there are the costs associated with vendor lock-in, which can last a decade or more.
To avoid an EHR monoculture, Koppel & Lehmann recommend the following principles for EHR end-users and federal officials to consider:
• Speedy implementation of new consensus data standards allowing independently assessed exchange of data with other EHR systems
• Creation of tools and databases that promote innovation by local developers and allow real-time Clinical Decision Support (CDS) and secondary data use
• Requirement of unrestricted usability assessments, allowing transparent comparisons of vendors
• Permission for customers to share safety-related data, known hazards, and screen images by prohibiting non-disclosure clauses in vendor contracts
• Development of model contracts that outline realistic costs of implementation, training, linkages, reprogramming of existing IT, etc., and contain realistic estimates of time required for implementation and for time to reach previous levels of efficiency
• Provision of objective information to assist Chief Medical Informatics Officers (CMIOs), CIOs, and Chief Technology Officers (CTOs) and practice office managers in purchasing and negotiations
• Recognition that model contracts are guides for future actions. Intervention is required now to enable patient safety-related reporting as soon as is practicable
• Consideration of the role of future MU regulations on vendor market control and provider capabilities
• Enhancement of collaborative relationships with academia to foster innovation for future products
The full analysis is available here.