Epic HIE 2014
Everywhere, Elsewhere, or Nowhere Else?

WORTH KNOWING

EPIC-TO-NON-EPIC SHARING IS REAL:

KLAS validated twenty-seven unique instances of Epic customers sharing data with providers using other EMRs. Four out of five are doing so through an intermediary such as a non-Epic HIE or HISP solution. One out of five is achieving interoperability directly between EMRs. In most cases, information is delivered in a CCD format via industry-standard protocols for pushing (XDR) and pulling data (XCA, XDS.b).

EPIC STANDS FIRM:

While interoperability standards are supposed to facilitate sharing, most say significant effort is needed to bridge the gap between vendors’ unique implementations of those standards. HIE organizations and non-Epic providers say Epic is capable but inflexible and that other vendors must meet Epic where Epic stands. This report did not compare standards adherence, but for providers, variability among vendors underscores the value proposition of intermediary HIEs and HISPs.

EASIER FOR EPIC CUSTOMERS:

For Epic end users, sharing with other health systems is a stress-free experience. Epic handles the configuration, and then the already-familiar Care Everywhere tool suddenly has access to outside data. For non-Epic providers, interoperability is often a bumpier ride. When a vendor does not already support the standards Epic uses, providers often face extensive development and expensive interfaces. Once interoperability is in place, usability varies for non-Epic users: some enjoy easy access to Epic data inside their own EMRs, but others must use HIE portals outside their clinical workflow.

AFFORDABILITY NOT A PROBLEM:

While sharing with other Epic facilities incurs no extra charge, providers mentioned that it does result in new volume-based fees. Some objected to such charges on principle, but most cost-related feedback centered on interfaces—whose costs were seen as reasonable when coming from Epic but prohibitive when coming from other EMR vendors.

STILL NO PLUG AND PLAY

Overall, Epic is ready for prime-time sharing with non-Epic systems, but this does not mean that interoperability is without bumps. Providers described some turbulence that is not always unique to Epic: Vendors do not all support the same standards in the same way, preserving a role for HIEs and HISPs. Vendor teamwork is needed, and providers may have to referee. Non-Epic vendors typically must be more flexible in closing gaps. While CCDs have a standard structure, providers fill them out differently based on their EMR's capability, quality of available data, and willingness to share. Even as designed, CCDs don't deliver the depth, breadth, and timeliness of data many desire. Some describe CCDs as no more than electronic faxes. CCDs often contain a mix of discrete and read-only data. The ability to import and reconcile data elements varies by EMR and provider source.