A recent investigative piece questions the fact that Judith Faulkner, CEO of Epic, has been appointed to the 13-member national Health Information Technology Policy Committee (see: Democrat donor gets federal health policy slot despite conflicts of interest). She is described in the piece as a "Democrat donor" with Epic having donated nearly $300,000 to Democrats since 2006, according to the Center for Responsive Politics. For me, the most important part of the article addresses the interoperability aspects of EMRs. Below is an excerpt from the it:
Obama has long pushed for "interoperable" health information technology, including digitized medical records that can be shared across platforms, regardless of who develops the underlying software. A December 2010 report on the implementation of health IT from the President's Council of Advisors on Science and Technology described the ideal system as "interoperable and intercommunicating, so that a single authorized query can locate a patient's records."...Faulkner's appointment is notable, though, in that it runs counter to Obama's goal of multivendor interoperability. Faulkner told Bloomberg News in 2009 [regarding an IT problem at Geisinger Health System] that sharing medical records "doesn't work when you mix and match vendors....It has to be one system, or it can be dangerous for patients." Epic's website touts its work with interoperable software, but all such systems are made by Epic, meaning they are only interoperable if every provider uses Epic's software. Glen Tullman, CEO of health IT company Allscripts, recently called Epic "the least-connected system of any out there." He added, "The only people in the market who are fighting connectivity are Epic."....[Epic] is...vying for a contract for a massive expansion of the Veterans Administration's electronic medical records. The VA is adamant that the resulting system be open source and interoperable, but five members of Wisconsin's congressional delegation recently wrote a letter to the VA's chief information officer stressing the importance of single-vendor electronic health record systems -- i.e., the type that Epic provides."While multi-vendor EHRs were common in the past," the letter states, in a near perfect reflection of Faulkner's position, "patient safety, workflow efficiency, and other concerns have caused the industry to move away from this model."
Faulkner belongs on the Health Information Technology Policy Committee for one important reason. Her company, Epic, holds a near-EMR-monopoly for the larger hospitals in the U.S. (see: Does Epic Exercise a Near-Monoply for EMRs in Larger U.S. Hospitals?) A central tenet of the Epic business model is hospital client control, driven by the fact that the hospitals install the software that Epic delivers when the company delivers it. In essence, she determines the IT strategy for some of the most important hospitals in the U.S. As noted above, the hospitals are also under intense pressure to install the Epic departmental systems (e.g., lab, radiology, oncology), thus ensuring smooth integration and "interoperability" and widening the influence of the company. Even small hospitals are being drawn into the Epic family as larger hospital host the Epic software for these smaller regional facilities (see: Epic Helps Convert Its Large Hospital Customers into Epic Hosting Sites/Consultants). She therefore needs to sit on this committee.
Now comes a little secret that is not discussed much. Hospital CEOs and CIOs have little interest or enthusiasm for multivendor interoperability, either within their hospitals or hospital systems or across the outside hospital systems that they compete with. Customized interfaces between heterogeneous systems are a pain in the rear-end for the CIOs. They would thus rather have shrink-wrapped integration delivered by a vendor like Epic, the so-called "enterprise solution." Moreover, CEOs don't want to encourage broad patient and clinical data portability because it gives the payers (insurance companies and the federal government) a strategic advantage during negotiations about reimbursement.
So, when the feds raise the topic of interoperable EMR software, most hospital CEOs and CIOs will stand up and cheer. However, when they go out to purchase EMR software, they largely select Epic, particularly the larger ones that can afford it. Faulkner provides the non-interoperable product that they really want. She can also runs political interference for them. She donates generously to the Democratic party, she is tight with the Wisconsin congressional delegation, and takes no prisoners in her political feuds (see: Epic Flexes Its Political Muscle in Wisconsin with Boycott). And she can now try to block any inconvenient initiatives in the arise in the Health Information Technology Policy Committee.