I have posted a number of notes about Epic's attitude toward interoperability (see: More on Epic's (Non)-Interoperability and the Recent NYT Puff Piece; Judith Faulkner, EMR Interoperability, and Washington IT Politics; Sharing Medical Records across Hospitals with Epic's Care Everywhere). In general, I believe that Epic loves to encourage information sharing across its own hospital clients but makes it more difficult and expensive in relation to data sharing outside of its family circle. I further believe that the company is seeking to establish its own software as the de facto standard of interoperability, particularly in the larger and more complex hospitals. A recent article discusses how the company is now turning to a Washington lobbying firm to convince Congress that its goals are noble (see: Epic retains lobbyist to improve image on Capitol Hill). Below is an excerpt from the article:
Electronic health-record giant Epic Systems Corp. has hired a lobbying firm for the first time to counter a perception on Capitol Hill that its EHR systems aren't interoperable with other vendors' technology. The Verona, Wis.-based company retained lobbyists Card & Associates in August, according to the federal Lobbying Disclosure Act database. Epic says in the registration that it's making the move to “educate members of Congress on the interoperability of Epic's healthcare information technology.” The move is out of character for Epic, which has a reputation for doing its own thing and staying out of the D.C. fray, sources with knowledge of the lobbying business and health IT said. But the company is now finding itself fighting a perception that its technology is out of step with the drive toward interoperability. Meanwhile, Epic has teamed with IBM to compete with several other heavyweights for a multibillion-dollar contract to modernize the U.S. Defense Department's clinical technology systems (see: Epic Partners with IBM for Military EHR Proposal; This May Be a Problem). Bradford Card, the CEO of Card & Associates, said in an interview that Epic has been the “subject of misinformation.” His firm, Card said, will work to set the record straight....In a July hearing, Rep. Phil Gingrey...had sharp words for the company, citing a RAND Corp. report claiming Epic's systems were “closed records.”
It's refreshing that Epic has hired a lobbyist, Bradford Card, to present the "truth" to our politicians in Washington about the company's enthusiasm for interoperability of medical records. As we all know, it's only through the efforts of such lobbying firms that the truth gains traction in Washington. However, one might well ask the following question: why only now does Epic feel a need to clarify its position of interoperability for our elected officials after a number of years of what would seem to be total indifference to its reputation in Washington? Take note in the above excerpt that the author threw into the article the fact that Epic has recently decided to partner with IBM to bid on a huge military EHR contract.
I personally think that there is a connection between this new partnership with IBM, the military EHR contract up for grabs, and this new Epic recent enthusiasm for public relations. Here's a quote from an IBM executive regarding this military contract: we don’t bid on everything, but when we do, we want to change the world (see: Epic Partners with IBM for Military EHR Proposal; This May Be a Problem). IBM has always presented itself as a white knight, solving technology challenges for appropriate compensation. I think that some of this IBM culture is rubbing off on Epic executives and persuading them that what politicians think about Epic outside of Wisconsin may be relevant for the future of the company.
Interoperability is so amorphic a term that most people on the Hill will just not get what that means and how the meaning is often manipulated. It's akin to saying you're HIPAA compliant, whatever that means. Makes for good marketing though.
Epic, and every other vendor on the planet, is selling nothing but this: "Health IT would be interoperable if you all just did it our way".
Those of us who've trudged through implementations know that just ain't so even if you use the exact same product.
What we really mean to say is that the content is predictable. I, as a clinican, can reasonably predict that of you send me what we call a patient summary record, I'll know what to expect it would contain with little or no variation.
Take the multiple and almost infinate iterations of the document we call discharge summary. When I receive one from a hopsital and another one from a different hospital, one would reasonable expect that they would contain the same pheynotypes of data and data elements. And you'd be 100% incorrect, Batman!
The heart of interoperabilty is standardized content and definition. Moving the data is in its essence pretty darn easy. Knowing what I'm going to get when I need it is something totally different.
The rest of the arguments about interoperability as simply spurious noise.
Posted by: Chris Brancato | September 25, 2014 at 09:23 AM