EHR vendors have come far in interoperability, but still more to do

EHR vendors have come far in interoperability, but still more to do

Epic Systems and Cerner say too much has been made of a supposed rift between the two electronic health record vendors, especially when it comes to the exchange of patient information.

Some of that controversy surrounds CommonWell Health Alliance, a collection of EHR vendors that includes Cerner. CommonWell is working toward building a vendor-neutral platform. Some have criticized Epic’s decision not to join.

“Cerner and Epic often get in the line of fire because of CommonWell and interoperability in general, when really the focus really needs to be on the patient and what’s good for the industry and providers,” said Bob Robke, vice president of interoperability at Cerner, in an interview with Wisconsin Health News.

Robke noted that CommonWell is in its early stages, and that “it does take a little bit of time to fill that network up and make it valuable.”

At the Disruptive Healthcare Conference produced by WTN Media in Madison Tuesday, Robke said they “would love” to have Epic become part of CommonWell since it would guarantee its success.

Peter DeVault, Epic’s vice president and director of interoperability, did not say whether Epic would join. But he said Epic has made good with CommonWell and hopes for the best for the Alliance.

“There’s been much too much made about the rift between Epic and CommonWell,” DeVault said. “There’s a whole lot of water under the bridge.”

CommonWell is doing some things well, but Epic would be going backwards for its customers if it retooled its EHR systems to work with the Alliance’s architecture, he noted. DeVault stressed the need for networks to communicate.

“There is not a magical future down the road in which there’s one health information exchange network called CommonWell or anything else,”he said.

DeVault told Wisconsin Health News “there are lots of pieces to the puzzle” for interoperability.

“Interoperability is a broad category of problems that continue to get solved whenever there’s a need and an incentive to solve them,” DeVault said. He noted that one obstacle for exchanging medical information is that until everybody agrees on standards, “there’s a limitation.”

New standards, including FHIR also known as HL7 version 4, could help make that work better, he said. He noted that it will take several years for standards around clinical vocabularies to come into wide use.

He added that ambitions for what interoperability can do have grown enormously in recent years.

“People now want systems to be able to exchange hundred thousand term vocabularies and are often seeing the failure of that happen to as maleficent influence the result of bad actors, which it actually isn’t,” he said.

“I often hear the expression let’s get everybody in the room together to figure it out,” he noted. “We’ve figured out lots of stuff and we continue to figure out lots of stuff. It’s not really a question of willingness.”

Added to that are competing healthcare delivery organizations, said Dr. Christopher Alban, vice president and clinical informaticist at Epic.

“Sometimes their mission drives them to, ‘We want to share that information because that does make sense to our mission of taking care of the patient,'” Alban said. “And other times, it’s a complicated equation.”

But he noted that compared to where they were, Epic and others have come far.

“It’s a question of how fast do we really need to go or how fast do we have to go?” Alban said in an interview. “The reality is the amount of actual sharing for patient care purposes between disparate organizations on different systems is tremendous. From that standpoint, we’ve done a lot, and that’s not to say we’re done. There’s lots more to do.”

He said next steps include to enable better patient care at the point of care. How to use records and collect information to improve population health, especially for management of chronic disease, is the “next trick,” Alban noted.

“It’s painting a picture of where each of those patients are,” Alban said. “That’s a complex set of information to pull together and collate.”

This story previously appeared in Wisconsin health News