Healthcare Informatics Editor-in-Chief Mark Hagland spoke on March 13 to Carl Dvorak, the number-two executive at Epic Systems Corporation, the Verona, Wis.-based vendor organization. Dvorak, who started with Epic back in 1987, and who had been executive vice president for a number of years, this month was given the title president. Judy Faulkner, co-founder and CEO of Epic, retains her title. Dvorak spoke exclusively with Hagland regarding the latest developments around the CommonWell initiative announced at HIMSS13, and other issues. Below are excerpts from their interview.
Congratulations on your title promotion.
Is there a special significance to the announcement?
No, not really; it’s really just a natural progression.
Given the very forceful statements from Marilyn Tavenner, R.N. [acting administrator of the Centers for Medicare & Medicaid Services (CMS)] and Dr. Mostashari [Farzad Mostashari, M.D., national coordinator for Health IT and head of the Office of the National Coordinator for Health Information Technology (ONC)] during the HIMSS Conference last week in New Orleans, what are your general thoughts about CMS and ONC, and the level of intensity of change they’re asking from the industry?
There are a couple of key drivers going on right now, and one is still [the transition to] ICD-10, and clarity and certainty are very important right now around that. Many of our customers had set up all their deadlines and timeframes around the original deadline, but when that was pushed back, the laggards were rewarded and the proactive people were penalized. So that created an uncertainty. I met with Marilyn Tavenner the morning before she gave her speech [Wednesday, March 6], and she assured me that ICD-10 will not move, and that it will be payers and providers together, not staggered.
So you felt better about being reassured?
What’s your perspective on the CMS/ONC announcement, first made by Ms. Tavenner and then confirmed immediately afterwards by Dr. Mostashari in a press conference, that they’re delaying the release of the preliminary rule for Stage 3 of meaningful use until after the end of calendar year 2013? Do you see that as a positive or negative development?
It’s reasonable not to regulate ahead of understanding; and I think we were beginning to see ONC beginning to regulate ahead of their understanding. That said, I want to emphasize the minimum 18-month timeframe needed to comprehend the standards and regulations, get through the FAQ process, design usable, elegant software that can help enhance clinical practice and not detract from it, and give time for customers to implement and upgrade the software. And if you’ve got 1,000 doctors in your practice, you’ve got to give them time to implement. So while I think it’s wise not to publish regulations in haste without understanding, at the same time, it does not give them carte blanche [at ONC/CMS] to foreshorten the time needed to accomplish things.
So they’d have to extend the deadline at the back end, then?
Or, the alternative would be just to extend the percentages around compliance.
Though they’re saying there will be new requirements under stage 3?
Yes, inevitably; I think it’s a question of how many new requirements, and of the balance.
What’s your reaction to the announcement of the creation of the CommonWell Health Alliance during HIMSS13? Many viewed it as a competitive maneuver, especially since you were not contacted beforehand about it, at Epic.
There are a lot of elements to it. A couple of things: I know Neal Patterson [CEO of the Kansas City-based Cerner Corporation] has personally championed the notion of a single national patient identifier; and we support that as well; we think that’s a good thing. At the same time, we believe that you can be very, very successful with interoperability without that. And in today’s world, we’ve pretty much concluded that folks like [the Arlington, Va.-based] SureScripts are doing a pretty good job based on collecting demographic information and using the last four digits of the Social Security number. So we’re supportive of that concept.
With regard to CommonWell in general, many times, people who are behind in a market will gather others together with them. We have been using open standards and have been doing so for several years. And we basically have plug-and-play interoperability. As of a couple of months ago, we were doing 780,000 patient transitions per month, and that’s about 3.4 million CCD documents [continuity of care documents] moving per month. And a little over a third of those are between Epic and other vendors. People have asserted we’ve been a walled garden, but we’ve never been a walled garden. And we directly connect to [the Carrollton, Ga.-based] Greenway [Medical Technologies], and we’re working on direct connections to Cerner, which is already been done and is being tested; and we’re doing one with [the Horsham, Pa.-based] NextGen [Healthcare Information Systems]. And we actually connect in production with about 21 others and 18 are in testing—and that includes organizations like the VA [Veterans Administration health system], DoD [Department of Defense], etc. And we have an active initiative going on with SureScripts that supports the Direct Project open standard.
So we’ve been using the open standards for years, and if this initiative helps people adopt those standards, we welcome that. And to the extent that collaboration makes sense, we would certainly consider it. We weren’t invited to the dance; I’ll let the industry decide what that means. I live in a world of competition, so nothing that competitors do surprises me. But I was a little bit surprised that some key industry figures didn’t recognize that it was in part a commercial endeavor. What’s for the national good and what’s for commercial purposes? There are both elements. And it felt like people were naïve about some of those commercial aspects to this [in their stated reactions during HIMSS13], that this was purely about national standards.
So would we collaborate with them? Possibly. And can we learn from what they do? Possibly as well. But we need plug-and-play standards, or we’ll never figure out this problem. It’s got to be as simple as setting up your e-mail on your iPhone.
Has anyone from CommonWell contacted you since the announcement?
Yes, they have asked us to become involved, and we’re having some discussions with them. We don’t join things lightly, and we really want to put our energy behind things like HealtheWay. I would certainly call on the CommonWell members to join the ONC’s Healtheway Collaboration. We’re less interested in commercial endeavors, and more interested in true moves towards national open standards.
I keep hearing the concern expressed that Epic has achieved near-monopolistic status in some markets, and some CIOs and CMIOs are feeling a kind of pressure to switch to Epic simply to be able to participate with other providers in health information exchange in their markets. Any thoughts on that?
You know, we don’t think of ourselves that way; we try to make our customers happy, and we sincerely focus a tremendous amount of energy on physician happiness and nurse happiness; and at the end of the day, that’s why many clinicians recommend turning to Epic. And it’s not perfect. But our mission is to do everything we can to make doctors happy and successful; and we also have a tremendous respect for the nurses who put their hands on patients. And what’s happening is, it isn’t a CIO thing necessarily, it’s about our focus on doctors. And I think if we maintain our focus on physician happiness and success and not get sidetracked by commercial endeavor issues—I think we’ll succeed. It’s a beautiful thing to work in a simple company, and Epic is very much a simple company, with 1,000 programmers coming to work here every day in pursuit of that mission. That’s our focus.