The Great Recession devastated many industries, but health information technology was not one of them.
The stimulus package Congress and President Obama approved in 2009 included $29 billion in incentives for U.S. hospitals and clinics to adopt electronic health records (EHR) systems. The legislation ignited a period of explosive growth for companies that develop software for managing those records.
A 2010 White House report on using technology to improve healthcare envisioned an ideal setup in which all systems are “interoperable and intercommunicating, so that a single authorized query can locate a patient’s records.” The list of leaders whom the report credits for their input includes executives from two leading EHR vendors: Watertown, MA-based Athenahealth (NASDAQ: [[ticker:ATHN]]) and Epic Systems, based in the Madison, WI, area.
Five years later, the industry still seems nowhere close to achieving the functionality described in the White House report. Epic is among the companies chastised by critics who consider it a “closed platform.”
“It can be challenging and costly for hospitals [that use Epic] to interface their EHR with the clinical or billing software of other companies,” according to a 2014 report from the Rand Corporation.
Given that unfavorable assessment, it may come as a surprise that Epic was rated as an industry leader in overall interoperability, according to a report published earlier this year by Klas, a market research firm.
Observers are naturally starting to ask whether the $29 billion was money well spent. Anecdotes abound from people inside and outside the healthcare industry on the headaches that result from incompatible systems.
A key question is whether vendors are deliberately walling off their systems in an attempt to add customers. In June, Connecticut became the first state to pass a law banning the use of EHRs to block the flow of data. Politico reported that independent practices are accusing large hospital groups—including Yale New Haven Health System, an Epic client—of using their records systems to coerce the smaller groups, who might be on different systems or still using paper records, into joining their networks. Epic could not be reached for comment regarding the law.
By contrast, the Klas report found that information blocking, which it defines as intentionally refusing to share data, is rare.
Still, sectors like telecommunications and banking are light-years ahead of healthcare when it comes to data sharing, something industry-leading companies are now acknowledging by launching cross-vendor networks known as health information exchanges (HIEs). In 2013, Kansas City, MO-based Cerner (NASDAQ: [[ticker:CERN]]), Athenahealth, and five of their peers formed CommonWell Health Alliance. According to the association’s website, its goal is “to drive forward ubiquitous interoperability.”
Noticeably absent from CommonWell is Epic, which belongs to Carequality, another vendor collective. On Monday, Carequality announced it has published an interoperability framework, which it said is an alternative to “one-off legal agreements” that have heretofore been necessary any time organizations wished to share information.
Last month, during a panel discussion at a healthcare technology conference in Madison, Bob Robke, vice president of interoperability at Cerner, invited Epic to join CommonWell.
“We have a lot invested in CommonWell, and we’d love for Epic to be part of that,” Robke said. “That would guarantee [its] success.”
Peter DeVault, Epic’s interoperability director, did not say whether it would join. Instead, he explained that Epic will proceed based on the wishes and needs of its customers, and that scrapping its interoperability work in favor of CommonWell would be “going backwards.”
“The way we operate is our customers say who they want to connect to,” DeVault said. “If they want to connect to CommonWell, we can make it happen. We have nothing against CommonWell.”
He went on to say that there will always be a need for multiple systems.
“This is the world we will always be living in,” DeVault said. “There’s no magical future down the road in which there’s one HIE called CommonWell.”
The focus of vendors should be to “make sure that Carequality, CommonWell,
