Epic’s interoperability quest: A key cog in the TEFCA framework

With a long history in cross-industry efforts and data exchange, Epic’s entry into the TEFCA framework raises eyebrows and expectations alike.

This article is part of the August/September 2023 COVERstory.

In many ways, Epic is an understandable choice for an interoperability initiative such as the Trusted Exchange Framework and Common Agreement. It’s long participated in cross-industry efforts to expand the capability to easily exchange data; it’s enabled information exchange between facilities using its or other EHR systems; and it’s participated in large national interoperability frameworks, such as Carequality.

Still, some observers have concerns that the inclusion of Verona, Wis.-based Epic in the pantheon of seven organizations working to become Qualified Health Information Networks (QHINs) in the TEFCA framework stands out a bit – the quintessential kids’ game of, “One of these is not like the others.”

To review, CommonWell Health Alliance and eHealth Exchange have long pedigrees as information networks; and Health Gorilla, Kno2, KONZA and MedAllies are pure secure health data sharing platforms. Epic appears as a bit of an outlier as one of the nation’s largest records system vendors.

But it is Epic’s share of the market and its work to ensure facilities and individuals can access health information that help explain the logic behind its inclusion in the group of QHIN aspirants, says Matt Doyle, Epic’s interoperability software development lead.

Epic is an influencer that can help link its users to join TEFCA. For example, in late May, about 30 large health systems – primarily users of Epic information systems – including Kaiser Permanente, Johns Hopkins Medicine, Mayo Clinic, Intermountain Health, Mount Sinai and others – made commitments to join TEFCA.

Epic’s credentials

Doyle notes that Epic has pioneered Care Everywhere, which enables healthcare providers to securely access and update patient records, whether they use Epic applications or other vendors’ systems. Care Everywhere has been live for 15 years, and some 14 million patient charts are shared every day, half of those with federal partners, state health information exchanges or other EHR vendors.

The hope of Epic and the industry overall is to expand the early efforts for interoperability across all providers in the country. Doyle acknowledges that some connections will be more difficult to make than others.

“With Carequality, some 70 percent of hospitals are able to exchange data in real time,” he says. “The last mile is the real challenge. It means that 30 percent of hospitals are unattached, and that’s why we are getting into TEFCA. As an industry, we need to get to the core benefits of interoperability. We want to help the industry move forward.”

While Epic has integrated interoperability technology into its product offerings, TEFCA introduces some new requirements and “some software development still needs to be done,” Doyle says. “To ONC’s credit, they realize that private industry has built technology standards, and they work. The majority of the work is how do we create the governance and sense of community. (Epic) has a role to play, working with the customer community, to understand the benefits.”

In terms of development, some overarching components are necessary to make TEFCA work, Doyle believes. While many of the technology tools already exist, the initiative will need a directory of exchange-ready participants and policy governance that outlines the expectations for exchange.

Still, some questions remain

Some industry observers, however, say there are questions injected into the TEFCA movement by the selection of Epic, as a technology vendor, as a QHIN candidate.

“It really complicates the matter,” says Lisa Bari, CEO of the Civitas Networks for Health, which represents health information exchanges and other data exchange entities. “Many hospitals will continue to work with Epic, and TEFCA for them then may happen behind the scenes, and we really think that makes sense – there is no one solution for information exchange.

“But the initiative runs the risk of limiting exchange to what’s happening in EHRs, while not impacting the last mile of interoperability,” she adds, referring to currently unconnected small provider offices, federally qualified health centers and others. Without expansive connection efforts, “TEFCA may not grow much beyond big health systems,” she suggests.

Bari worries that the selection of a dominant EHR technology vendor to be a QHIN may complicate or even “harm the cause of exchange” if providers feel they are locked into using a specific EHR. Particularly for hospitals that are subsidiaries to larger systems, “They won’t feel like they have any control over (EHR selection or interoperability connections). That structure can be complicated for providers who are not in the driver’s seat.”

For ONC’s part, Micky Tripathi, the national coordinator for health information technology, recognizes Epic’s years-long efforts in advancing interoperability and believes its selection helps round out the list of range of connectivity options that are needed to get TEFCA out of the gate successfully.

“Epic has been a terrific partner for ONC and has been deliberate in moving forward with the technical build and coordinating with the other QHINs,” he adds.

The technology vendor believes it can help add value to the interoperability push by using exchanged data to improve care, Doyle contends.

“One of the big opportunities as an EHR vendor is using interoperability that’s directly connected to the workflow of nurses, physicians and people who need to see data – we can connect it right into workflow,” he says. “Last month, using data exchange through open standards, we closed 30 million care gaps. When I can close that care gap, nurses can focus efforts on those who need outreach.”

TEFCA, in general, needs to work toward achieving deliverables that make a difference in care. “The No. 1 thing we can do is to become practical, to figure out what’s possible,” he concludes. “If we can close in the gray areas, we can make (care delivery decisions) more black and white.”

TEFCA also can advance the cause of making healthcare information available to patients through third-party apps. “What we’ve found is that technology doesn’t solve problems alone – it has to be part of an ecosystem,” Doyle adds. “TEFCA can help a lot with that, and we’re excited to see how it can grow patient engagement.”

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