Earlier this week, when Epic Systems Corporation, the Verona, Wis.-based electronic health record (EHR) vendor—a health IT giant company whose platform some 190 million patients have an electronic record on—announced its latest technology upgrade that will allow patients to grant access to their data to any provider they want, there seemed to be an overall sense of optimism amongst industry observers in terms of what this means for interoperability growth.
Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, is perhaps as well-connected as anyone when it comes to health information exchange (HIE) and interoperability. Tripathi sits on the board of directors of The Sequoia Project (of which the Carequality interoperability framework is part of) and also does project management work for the CommonWell Health Alliance, which operates a health data sharing network of its own. Tripathi has been a part of countless meetings, conversations and project work within and for these organizations, with the broad goal always being to advance nationwide interoperability.
Tripathi caught up with Healthcare Informatics’ Managing Editor Rajiv Leventhal after the Epic news was released to talk about its impact, what’s specifically unique about it, and more wide-ranging interoperability issues at hand. Below are excerpts of that interview.
What were your initial takeaways from this announcement as it relates to how it could spur interoperability, given the market share presence that Epic has right now?
I think it’s a great, incremental addition to functionality and it [continues] what Epic has already been doing, which is contributing a lot to interoperability growth across the U.S. There isn’t new technology here and I don’t see it as a huge driver of interoperability. I actually think they are doing other things that are better and more important for interoperability that they don’t get as much credit for, such as pushing forward into [efforts] like Carequality, and [helping with] the connection between Carequality and CommonWell. Those things are very critical for interoperability and will have a lot more impact on interoperability compared to this [announcement].
That being said, what’s really cool about this is that Epic is very good at being practical about saying where they are now, and [realizing] what’s an important step to take forward that’s isn’t necessarily trying to be bleeding edge, but rather will offer real value to people in a practical way that they recognize. So let’s implement this in a solid way that we have high confidence people will use, it won’t break anyone’s workflows, and we’re not expecting anyone to do anything heroic. But it does push people to do things differently and think about where these types of technologies can take us.
What I think is really great about this is that Epic, along with other vendors, have always had the ability to allow portal access to a patient’s medical record information for providers who are not using that vendor’s EHR. So that part isn’t unique—the ability to say, you’re not an Epic user but here is a way to issue you credentials so you can log into a portal via a basic browser and see a patient’s information regardless. And the vendors all sort of have that; that’s part of the Community Connect solution in Epic.
But that’s something that’s always been provider-driven. The provider himself or herself says, ‘My patient is going to a cardiologist, I know they’re not on Epic, I am going to reach out and see if they’d be willing to get a username and password to come into this portal so they can see this important medical record for this patient who we share.’ And that’s for providers who aren’t able to partake in the interoperability that Epic already has in place, like through Care Everywhere or Carequality.
So the important innovation here is that it’s not the provider who is driving it, but the patient. So you have the patient who might be at the ED and the physician wants to know which medications the patient’s daughter might be allergic to. But the patient can’t remember all of them. Now, that patient can go into the MyChart app, get a code, give it to that provider, and he or she can log onto the Share Everywhere website, type in that code, and up will pop the medical record summary that the patient could have gotten through his or her MyChart portal, but now the provider can look at it. And the provider can also now look at it and type into a text box whatever he or she want, and that [note] will go back to the provider who has the patient’s medical record, and who can then decide if it should be incorporated into the medical record. I think that’s a really cool innovation—the patient is driving it, the patient can decide who gets it, and another provider gets access to it when he or she wouldn’t have before.
You mention that even before this, Epic has had the ability allow portal access even for those who are on another system. That’s interesting since Epic has long been criticized for not being motivated to interoperate with non-Epic users. Do you see this as a false narrative?
I can’t speak to the history of it, but I do think there is a little bit of a false narrative there. If you look at what they’re doing with respect with to their active participation in Carequality, their active participation in the connection between Carequality and CommonWell, and that Care Everywhere is not an open network, but does have transactions with other EHRs, yes, I think there’s bad rap on them which is probably related to the fact they are so large and easy to pick on. And yes they have competitive juices flowing, as does Cerner and Meditech and Allscripts, but in general I wouldn’t put them in the category of being prime suspect number one of impeding nationwide interoperability. They have done a lot to continue interoperability, and they are a key driver—not a blocker—for where we are and where we’re going in the next 18 to 24 months.
A big part of this news is that interoperability will be more in the hands of patients, as you alluded to. Is this a direction where more interoperability efforts will be going in the future?
I think it’s a question of [patient] willingness, and that’s an important point. So that’s why I don’t think [this news is] a big driver of interoperability, but an important capability to put out there for those patients who want to do it. It also pushes the market a bit more; it’s another example of the market to say, here is another incremental step forward to putting more power in the patients’ hands—and that’s a good thing for everyone. This is not groundbreaking technologically, but it moves us one step closer to the world we want, which is patient-controlled apps. This specifically doesn’t preclude that or do that, but offers an incremental step towards that by saying patients aren’t teaming with apps right now, but I can offer something in a portal that can be helpful.
For the most part, the majority of patients at any given time don’t want to do this type of thing. They want their providers to be connected; they don’t want to be in the middle of it. At any given time, 10 to 15 percent of us have chronic conditions and have to think about the sharing of our records every day, but that’s not even close to half of all of us. Providers have to think about this every day, while patients necessarily do not. They come and go in terms of their episodic need for this kind of thing.
When you think about the interoperability initiatives out there right now, with CommonWell and Carequality, with CommonWell having sparred with Epic before, how might other vendors in CommonWell react to this?
I want to give credit to the other major vendors who are also leaning forward into interoperability. It’s not just an Epic thing; all vendors are doing important work—Cerner, athenahealth, Surescripts, Allscripts, [and others], too. You can point to Congressional testimony and tweets sniping back and forth between different entities, but I really think that’s completely behind us.
The work [I am talking about] that’s going on right now, and I can attest this since I directly observe and participate in conversations with Carequality (which includes Epic) and CommonWell (which includes Cerner), when we had the agreement last December, we’re now talking actively about where we are in implementation. The market needs this, so let’s keep track of it. By the end of the calendar year is the commitment goal for implementation at the first production site. We had a check-in last week and everyone is still committed to it. So it’s water under the bridge. Epic and Cerner are working cordially and collaboratively. And yes they are head-to-head competing, of course. That’s part of the [business].
When I say that I’m bullish on nationwide interoperability, if you asked a person not involved in health IT that we will, in the next 18 to 24 months, have live a system where most (80 to 85 percent) providers in the U.S. will be able to securely send a medical record to most other providers anywhere in the U.S.; and that most providers will be able to request and receive a medical record from most other providers in the country, would you consider that nationwide interoperability? And I’d bet most people would say yes. I am confident we will have all this in the next 18 to 24 months.