VERONA, WISCONSIN — Epic is clearly the electronic health record vendor that catches the most flak from competitors when it comes to data interoperability – or lack thereof.

The CommonWell Health Alliance, for instance, was formed – without Epic – by many of its competitors, all pledging to come together and tackle the challenges of data exchange (and perhaps better compete against it in the process). Epic can be found in just about any conversation about the contentious matter of data blocking. And athenahealth CEO Jonathan Bush had harsh words for Epic earlier this summer: "Allscripts and Epic were dead in the water before meaningful use, they were obsolete, unable to do the job that needs to be done."

Another commonly-lodged claim against Epic, of course, is that it benefits its own bottom line by not enabling customers to exchange data with healthcare providers that use other companies' software. 

[CEO spotlight: athenahealth's Jonathan Bush slams meaningful use as 'incredibly dark hubris']

"There are a few persistent rumors about us," Epic Vice President of Interoperability Peter DeVault acknowledged in a meeting with Healthcare IT News at the vendor's Verona, Wisconsin campus. "One is that we're old technology, that we're closed and basically that we have been one of the bad players in the industry that has been trying actively to block interoperability."

DeVault, along with CEO Judy Faulkner and Epic President Carl Dvorak, bear the brunt of the charges that buzz around the health IT giant, as if someone had rattled a wasp's nest.

Customization inhibits interoperability
As many vendors point out, every rollout of an EHR platform is unique and – as is the case with so many enterprise applications, such as accounting, ERP or CRM from the likes of SAP, Oracle or Microsoft – they are often tailored to fit various customers' specific needs.

A standard EHR system has about 150,000 data elements.  

"Maybe the initial set comes with 30 responses to that data element – 30 coded answers," Faulkner told Healthcare IT News. "Maybe your organization has 20 more to add and wants to change five."

That degree of customization gives customers flexibility to decide what pieces of the software work and which ones don't work, but it also makes it much harder for systems to share data between one another, even with the same vendor, she said.

"It's an interesting thing about interoperability – people think it just all of kind of magically comes together," Faulkner said. "You would think: Why couldn't I take the system that UCLA has and have that be the system that University of Chicago uses? You'd think it would be just fine, but typically it isn't."

Epic counters the many criticisms from competitors, arguing that its platform is more open than other systems. In March 2016, independent research firm KLAS placed Epic at the top of its list for interoperability, with a score of 91.3 of 100 among EHR vendors.

Open? Or not so much?
This is where the debate about exactly how interoperable Epic is or is not gets tricky. Is it simply interoperating between providers that both use Epic? Or are health systems using Epic frequently sharing records with hospitals that use other vendors?

Some 80 percent of the quarter billion records exchanged by Epic Clients in 2015 and 2016 are Epic-to-Epic transactions, according to Eric Helsher, the company's VP of Client Success – but he added that is not the entire picture.

Helsher explained that Epic-to-Epic transactions dominate because the vendor has so many clients on the network. And he pointed to recent additions such as Partners HealthCare and NYC Health + Hospitals. In other words: Large health networks heavily engaged in data would naturally drive that Epic-to-Epic percentage higher than the other types of exchange.

And as DeVault points out, Epic has made it possible for customers to swap patient data not only with other Epic users, but also with thousands of other healthcare providers via 44 non-Epic EHRs, including Allscripts, athenahealth, Cerner, Greenway, Meditech and NextGen.

But until Epic can prove that its customers are widely exchanging health data with non-Epic users, competitors will no doubt continue calling it out for not being truly interoperable.

And Faulkner will likely keep refuting the claims.

"I don't think there's any system more open than we are," Faulkner said. "So I don't get the closed system – the same thing with interoperability."

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

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