Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century

thcbEpic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.

Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure.  Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.

Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing.  The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.

An open-architecture environment, with published Application Programming Interfaces (APIs) and open standards, will improve the functionality of EHRs in myriad ways.  Consider innovations such as full-service, secure, HIPAA compliant mobile care networks within and around hospitals, integrated delivery systems and ambulatory care providers. These networks would facilitate powerful point-of-care mobile automation, such as the delivery of interactive care checklists to doctors, nurses and patients; the sharing of patient medical histories to create a comprehensive care record; and automating the patient hospital discharge process with care plans developed digitally by physicians and nurses for their individual patients.  These networks integrated to the data available through the EHR will also enable advanced workflow applications.  Imagine providers interacting with one another and their patients in real-time, independent of care settings when care considerations and treatments get logged as part of a living patient record and, ultimately, when real-time software and cognitive analytics can aid in the development of patient care options.

The move toward open-standards, cloud-based, mobile-enabled EHR applications will be the biggest development in the healthcare software industry in many years.  The passage in 2009 of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) stimulated the adoption of EHRs, but these systems were largely built on older technology and struggle to incorporate the benefits of internet-based architectures, enabling cloud and mobile computing, and as such, today the EHR value proposition still remains uncertain.  However, open standards for interoperability is the key to opening up the EHR infrastructure to all facets of the provider value chain.

One of Psilos’ investments, PatientSafe Solutions, developer of a smart point-of-care mobile communications network, is already working on adapting their product for to Epic’s open source standards.  As the CEO of PatientSafe Solutions, Joe Condurso, recently mentioned, “All of our customers are now seeking to optimize their EHR investments through interoperability in order to liberate and activate data with mobile tools for clinicians and patients. It’s an important part of our operations today. Being able to leverage OpenEpic to interoperate and connect with the Epic allows us to deliver more capabilities for our customers to prepare for quality and value-based reimbursement.”

Open architecture EHR as the standard, rather than the exception, should set the stage for a much brighter future for participants at all levels in the healthcare arena. Let’s hope it meets its promise and makes the delivery of U.S. healthcare — not just our medical technology — the envy of the world.

Steve Krupa is the Senior Managing Member of Psilos, a healthcare venture capital firm. 

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11 replies »

  1. As an end-user please someone create something better than Epic. It reminds me of where is waldo, who has time for all that junk.

  2. Believe me I understand the skepticism. For the most part I see companies acting largely for competitive reasons and I believe we have reached the point where it is in the competitive interest of EHR vendors to become more open-sourced. Certainly they are all under pressure to provide value to their customers for the significant investments made in their products, but more importantly, a strategy of locking-out compelling applications will be difficult to sustain as our overall computing infrastructure becomes more and more powerful. The land grab from HITECH is largely complete. It will be to the competitive advantage of these companies to enable more system capabilities rather than quell them, and inviting in best-of-breed third-party applications is a powerful way to insure they remain as the centerpiece of the provider’s technology infrastructure. As John points out, the pace will be a big question, and HCIT can be frustratingly slow, but as these applications present meaningful value propositions to providers it will be hard to keep them back.

  3. Okay, I’m all for this. If it happens. But I still have my left eyebrow cocked skeptically, for several reasons. Mostly, it seems to be all about allowing other bits of software to dock onto the Epic ecosystem. There seems to be nothing new here about better Epic interchange with other systems, which would be a real face-about (despite Epic’s claims to the contrary).

  4. Bobby, I think that you can see, even in asking your question, that HIPAA is outdated on this particular issue (being designed for paper or maybe CDs) and that doctors can no longer feel that they own your glucose count or your other information. I think the whole thrust of HITECH and the ACA is that clinicians no longer fear giving information to their “competitors,” who are in theory all united in trying to fix our health problems. I’m glad you highlighted the current, obstructionist thinking in the health care and EHR industries.

    • Yeah, Andy. I had to sit on my HIE’s HIPAA P&S task force (akin to a root canal w/out anaesthesia, replete with $500/hr insufferable know-it-all Counsel), and was our lead for our P&S Policies and Procedures writing for HIPAA compliance. While HIPAA may indeed by “outdated,” the recent Omnibus revisions do in fact govern, and were updated to address ePHI (though they do not address modes of transmission specifically). Another material HIPAA legislative update may be 6-10 years out.

      Lotta people also don’t realize that “PHI privacy and security” was an 11th-hour toss-in afterthought in the 1996 law (aka “Kennedy-Kassebaum”). 13 pages (Title F “Administrative Simplification”) of the 167 page law.

      Worse, PHI data “ownership” is a mosaic crazy-quilt of state laws and regs. They trump HIPAA (inlike “federal primacy” in other areas of law).

      I’ve personally had to do new “dummy patient” EHR chart setups and data population from scratch as part of REC client support training, for multiple platforms (our vendor-agnostic REC supported about 40; my personal caseload was about 8 or 9 of those). Stopwatch at my side, I could quantify the initial and ongoing labor burden. It is substantial. That cost has to be factored in and spread equitably, I think, if we’re to gain more widespread HIE traction — tech issues aside.

  5. Although FHIR is looking like a strong standard, I see two further barriers to interoperability, one technical and one financial. The technical barrier is the definition of profiles that are appropriate to different clinical contexts and followed by all vendors. If profiles are as fuzzy or poorly defined as, say, the CCD-A, FHIR will be of little help to us. The financial barrier is the EHR vendors’ and clinicians’ infuriating charges for exchanging data, which is like charging you to read a book review on its site. That has to change, and the enormous variability of uses to which an API can be put make charging for different kinds of use absurd.

    • On the money side, there’s a significant “first mover disadvantage” thing. As I’ve noted elsewhere on THCB:

      Healthcare data, being way more complex and voluminous than other types of consumer data, are much more expensive to originate and manage. That we should concomitantly expect the originators of those data to simply freely provide them to competitors seems more than just a bit naive.

      Even under HIPAA, notwithstanding that you nominally “own” your PHI (the right of access, more precisely), the curating providers can charge you “reasonable costs” for obtaining them (see 45 CFR 164.524).

      So, what is “reasonable”? And, are recipient providers in effect patient proxies under 164.524? If so, why should they be charged more than a patient (who could just download them personally and then pass them on)?

      As to the techie stuff: “HL7® FHIR®”

      We’ll see. At least we’ll continue to have a thriving Standards Promulgation Industry — one, IMO, content to gloss over inconvenient yet relevant data mapping and workflow minutia, paying lip service to the IEEE definition of “interoperability.”

  6. The skepticism is expected.

    On the other hand, I’m assuming Stephen and his team at Psilos looked very closely at what’s going on here. As investors, they’re looking beyond the immediate noise. It’s important to remember that this is a long-range forecast. Not a one year forecast. Not a two year forecast. There are a lot of very good reasons for Epic to open up their model.

    I’d expect them to gradually do so. I don’t think they’re suddenly going to become the Mozilla Foundation overnight, but I do think they recognize the need to change what they’re doing, if only to address the demands of their customers.

    Stephen, if I may ask – I’m sure you’re well aware of the arguments of the Epic skeptics, how do you respond?

    I’d love to hear from somebody involved with OpenEpic, too.

  7. Yeah, the author of the phrase “trust, but verify” may as well have uttered it with Epic in mind

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