Epic Customers in Favor of HHS Interoperability Regulation, Survey Finds

March 3, 2020
Approximately three-fourths of healthcare stakeholder respondents said they support eliminating the barriers to interoperability and improving access to patient information

New data shows that the vast majority of hospitals using an Epic EHR (electronic health record) support the government’s information blocking regulation, placing them at odds with the health IT vendor that has been vocal against the rule in its current form.

The survey from Utah-based software company Reaction Data included responses from 178 healthcare stakeholders, with clinicians making up the largest group of respondents. More than seven in 10 (73 percent) of IT leaders who were surveyed said they are aware of the interoperability regulation, though that number dropped to 50 percent of C-suite respondents, 28 percent of clinicians, and 26 percent of department heads acknowledging they are aware of the upcoming mandate.

A proposed rule, issued more than a year ago from the Office of the National Coordinator for Health IT (ONC), represents great significance for health IT stakeholders, who will now be more under the microscope than ever before as it relates to their efforts in making sure that health information is seamlessly moving—while not restricting such efforts. For example, key elements of the ONC rule are related to application programming interface (API) standards, EHR certification, and EHR vendor business practices and behaviors. It also has a significant section devoted to information blocking with potentially hefty fines for violators.

In recent weeks, controversy over the rule has gained steam as last month Epic emailed the chief executives of some of the largest hospitals in the U.S., urging them to oppose the proposed regulation. Then, in a Jan. 27 statement posted to its website, the EHR giant—whose technology systems house data for some 250 million patients—said the rule contains “serious risks to patient privacy,” as currently proposed.

Indeed, as laid out in ONC’s proposal, EHR systems would be required to allow patients to download their medical data to apps of the patient’s choosing, which Epic and other stakeholders believe presents a major risk since third-party apps are currently not required to follow data blocking policies under ONC's proposed rule.

About 60 health systems did pledge their loyalty to Epic by signing a letter to the government opposing the rule, though many of Epic’s largest health system customers did not.

Perhaps muddying the waters even further, there are those who believe that Epic is using the regulation’s patient privacy elements as a front to further delay the regulation and maintain the status quo since the rule calls for hefty fines for data blocking violators. For years, Epic has been criticized around the industry for making it difficult on providers that don’t use its system to share data with Epic users.

What the data revealed

In this latest survey, 39 percent of respondents said Epic is their core IT vendor, with Cerner coming in second, but with just 13 percent of respondents using the Cerner platform as its core product. When asked about the impact of the regulation, 75 percent of healthcare professionals tipped the scales towards eliminating the barriers to interoperability and improving access to patient information. The other quarter of respondents said the mandate would have some form of negative impact.

Interestingly, provider organizations using Epic are largely in favor of the HHS ruling. Asked to rank the impact of the rule on a 1 to 6 scale, with 6 being “a very positive impact” and 1 being a “very negative impact,” 68 percent of Epic users responded with a 4 or higher. Similarly, 83 percent of Cerner users responded with a 4 or higher, as did 84 percent of Meditech user respondents and 70 percent of Allscripts user respondents.

A few comments released by Reaction Data provide some context to the information. One neurosurgeon at an integrated delivery network noted, “EHR companies have used the Obamacare promises to build wide moats for themselves to the detriment of patients and their caregivers. It is about time that this pendulum starts swinging the other way.”

A CIO at an academic medical center added, “Epic’s acting like an out of control monopoly.”

What’s more, when it comes to controlling access of patient data, 48 percent of respondents said patients themselves should be in charge of that access, while 47 percent said it should be hospitals/clinics, and just 5 percent reporting that vendors should control that access.

Unsurprisingly, nurses and physicians are more opposed to IT vendors involvement and control over the process of patients and providers accessing health information.

According to the report’s authors, “Epic, along with Cerner, Allscripts, Meditech, and all the other pertinent health IT vendors, will have no choice but to adapt to this new world. And if this rule becomes the law of the land, so to speak, every hospital and clinic will need to rely on their core IT vendors to help them comply and move forward.”