Epic Fail: Doctors can’t share digital medical records
“You want it all but you can't have it/it's in your face but you can't grab it,” is what the Faith No More song Epic says. Doctors who attempt to share digital medical records through programs built by healthcare software company Epic Systems probably experience similar feelings of impotence and frustration. The New York Times reported that Dr. Raghuvir B. Gelot – an ear, nose and throat specialist in Ahoskie, N.C. who uses a system made by Practice Fusion – can’t share patient records with local medical center Vidant Roanoke-Chowan Hospital, which employs an Epic Systems program.
This isn’t an isolated case, either. As it turns out, Epic Systems holds the medical records of almost half the patients in the United States. A couple of new studies have shown that fewer than 50% of the nation’s hospitals can transmit a patient care document, while only 14% of physicians can exchange patient data with outside hospitals or other providers. There is no strong indication that this is Epic’s fault as opposed to Practice Fusion’s – or other competitors for that matter – but the Verona, Wisconsin-based company is bearing the brunt of the criticism for what has been perceived as a deliberate effort to promote a communication breakdown between competing systems.
Physicians at UnityPoint Health-St. Luke’s hospital in Sioux City, Iowa are unable to transmit patient care documents to Mercy Medical Center - which is only two miles away – almost a year after installing an Epic program. Other facilities, such as the University of California Davis Health System, can share information between its Epic system and both internal and external non-Epic systems, but there are steep upfront connecting charges or recurring fees involved. “We’re a huge organization, so we can absorb those costs,” chief information officer at the U.C. Davis Health System Michael Minear said. “Small clinics and physician offices are going to have a harder time.” Additionally, Epic charges separate fees through its maintenance contracts and other agreements to send information to certain non-Epic systems.
Once again, Epic is not the only company that charges several feels. Moreover, its fees are not necessarily higher than what its competitors charge. However, the barrier that this type of charges produce “affects the small and rural providers much more significantly,” according to public health information exchange the Colorado Regional Health Information Organization’s executive director Morgan Honea. A RAND Corporation research report called Epic a “closed” platform that made interconnecting with the clinical or billing software of other companies “challenging and costly for hospitals.” Most of the leading companies in the field have been taken to task for the same reasons, but the criticisms against Epic has been such that it prompted the company to hire a Washington lobbying firm to rebut the attackers, which the company feels are “vendors throwing smoke screens.”
According to the company, Epic’s clients – including some of the largest hospitals in the U.S. such as the Cedars-Sinai Health System in Los Angeles, the Yale New Haven Health System, and New York’s Mount Sinai Hospital – share more patient records that any other. Epic executives asked several of these clients to e-mail the New York Times and state that they are indeed able to send records through Epic systems. Furthermore, Epic founder Judith R. Faulkner – whom the Times describes as “enigmatic” – said in a rare interview that her company was one of the first to come up with rules to share data as well as platform to do it on.
She said that her team began to write the code for Care Everywhere in 2005, when she thought the government was not ready to provide a set of interoperability rules. Care Everywhere currently connects hospitals and public health agencies and registries throughout the country. “Let’s say a patient is coming from U.C.L.A. and going to the University of Chicago, an Epic-to-Epic hospital. Boom. That’s easy,” said Faulkner. “These are hospitals that have agreed to the Rules of the Road, a legal contract, that says the other organization is going to take good care of the data.” She quietly criticized regulators for not being able to create a contract to assist providers in connecting with another as well as offer a way to authenticate so that only the correct person could have access to the patient information – in other words, what she did.
Regulators, on the other hand, say interoperability is a main goal, and that they have come up with a 10-year vision and agenda to accomplish that goal. The Office of the National Coordinator for Health Information Technology added that interoperability “requires stakeholders to come together and agree on policy-related issues like who can access information and for what purpose.” Meanwhile, hospitals and practitioners like Dr. Gelot are on pins and needles. “The systems can’t communicate, and that becomes my problem because I cannot send what is required and I’m going to have a 1 percent penalty from Medicare,” he said. “They’re asking me to do something I can’t control.”