Epic Systems, Leading Defense EHR Bidder, Slammed for Lack of Interoperability

Epic Systems, considered the front-runner for the Defense Department’s $11 billion electronic health record contract, has come under sustained criticism for lack of interoperability with other EHRs, including most recently a front-page story in The New York Times last Sunday.

The Times story reported the privately held Epic, which partnered with IBM for the defense EHR contract, “and its enigmatic founder, Judith R. Faulkner, are being denounced by those who say its empire has been built with towering walls, deliberately built not to share patient information with competing systems.”

Interoperability between Epic and other EHRs is possible, but only after hospitals pay high fees, the Times reported.

Modern Healthcare, in a recent article on Epic, said, “While interface fees are common across the EHR industry, some observers say Epic's leading role in the EHR market means it has a disproportionate negative effect on interoperability.”

This March, in a report on a variety of medical technologies, the Rand Corporation described the Epic EHR as a “closed platform,” which “can make it challenging and costly for hospitals to interface their EHR with the clinical or billing software of other companies.”

Large Hospital Systems Embrace Epic

Large hospital systems, such as Kaiser Permanente, the second largest health care system in the country with 8.6 million patients – compared to 9.6 million in the military health system – have embraced Epic.

Rand said Epic has “established itself as the enterprisewide solution of choice for large private health care systems and academic medical centers, irrespective of ongoing concerns about its limited interoperability and less-than-ideal usability.”

As the biggest player in the market, Epic has derived huge benefits from the $24 billion of incentive payments paid out by the Centers for Medicare and Medicaid Services to clinician and hospitals that adopt EHRs, Rand said.

At a House Energy and Commerce Committee hearing July 17, Rep. Phil Gingrey, R-Ga, who’s also a doctor, noted the incentive payments were made to encourage interoperability.

He asked: “Is the government getting its money's worth?… It may be time for the committee to take a closer look at the practices of vendor companies in this space, given the possibility that fraud may be perpetrated on the American taxpayer.”

Modern Healthcare reported Epic officials blame negative perceptions about the company and its software on misinformation spread by rivals.

Interoperability Key in Pentagon's Planned EHR System

Interoperability is a key requirement for the new defense EHR system, which will replace the existing Armed Forces Health Longitudinal Technology Application outpatient EHR and the inpatient Essentris system. The new EHR needs to exchange data with Department of Veterans Affairs systems as well as with civilian clinicians and hospitals covered by the TRICARE insurance plan.

EPIC did not respond to a query from Nextgov on the interoperability of its system.

Andrew Maner, the leader of IBM’s federal services division, said in an email: “Epic is the most open solution by any measure. They have the highest-rated electronic health record suite with the most large-scale successful implementations in the U.S. and are securely transmitting billions of pieces of patient data through interfaces and open APIs.”

He said Epic’s health record exchange platform “also leads the nation, transmitting 5 million patient records a month between 295 Epic organizations and over 7,500 non-Epic organizations.”

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