Taking Sides – The CommonWell EHR Conundrum
Like a colossus surveying its landscape from MountOlympus, Epic was once seated on the high altar of EHR greatness. But as they say, even the mighty fall, and so even though Epic is still a considerable force to reckon with, other innovative products have had their fair share of limelight in the EHR arena. Of these the five nimblest; Cerner, McKesson, athenahealth, Allscripts, and Greenway Medical Technologies have gone ahead and formed an alliance of sorts, the CommonWell, at the Healthcare Information and Management Systems Society Conference in March of this year.
The Purpose of the CommonWell Alliance:
Facilitating interoperability has been cited as the primary objective of this initiative, but later statements of Epic CEO, Judy Faulkner, seemed to indicate that she and the Verona, Wisconsin based Epic do not buy the argument, and that the alliance could have arisen due to competitive reasons. “It appears on the surface to be used as a competitive weapon and that’s just wrong, it’s wrong for the country.”
How Important is Interoperability ??
There are now hundreds of EHR products in the market and there is a very real need to find a way for all of them to talk to one another, if the federal dream of health exchanges is to become a reality. While standards such as HL7 are of some help, these alone will not suffice in the exchange of information between today’s EHRs whose databases hold a multitude of information across many fields.
Also, if a provider is transitioning between EHRs for whatever reasons, the cost of the transition under currently available technology may include a one time fee in upwards of $15,000 in addition to a whole lot of continuing costs, till all the data has been completely transferred into the new system.
This is not an appealing situation to be in, especially for small practices, who already must be reeling financially from the first time bad purchase. Also, there is a very real possibility of a provider being locked out of his data in his old EHR, if the EHR vendor goes bust or there is an ongoing skirmish with the vendor. This could affect the ACO credentials of the provider.
To avoid all of the above, better interoperability is certainly a good idea and the CommonWell Alliance, albeit a private initiative, seems to be a step in the right direction. This is particularly so, since no federal programs are in sight to tackle the issue of interoperability big time.
The Epic Side of the Story:
There is no doubt that Epic has had a stranglehold over the top-end EHR market for some time now. From a very smallish startup company in 1979 Epic’s earnings today exceeds well over $1 billion, chiefly due to its mid-level and large hospitals clientele, in which it has a market share of more than 40%. Epic’s highly centralized control of its product installation and support along with its non-inclination to sprout support vendors has invariably given it an unmistakable monopolistic overtone.
But its tightly integrated EHR and ambulatory care product EpiCare Ambulatory, has been incessantly drawing in more and more high-end customer base, such that it has remained the undisputed market leader.
But its negligence of the smaller practices has led to the proliferation of a host of other EHR products, which have started to slowly erode its monopolistic status in the EHR market.
And Epic believes that the CommonWell Alliance is indeed one such effort to surreptitiously undermine its customer base, since a direct confrontation with its product is not going to get the other EHR vendors anywhere, at least in the high-end segment. Many of its ardent supporters in fact believe that interoperability would not be that big an issue now if everyone had gone “Epic” so as to speak, because the product is already as interoperable among its various components as any EHR could be.
WHAT YOU SHOULD BE DOING AS A SMALL PRACTICE
As a small practice looking to buy that first EHR or trying to correct the mistakes of the first purchase by switching, it would be prudent to remain unmoved by the current Epic-Non-Epic drama being played out. Both segments of the market have very good reasons to exist, and as an EHR customer what you should be mainly concerned about is the suitability of the product to your practice.
But then sifting through all the arguments and counterarguments to make an informed EHR decision might be too much to ask of a busy provider, already reeling under umpteenth deadlines. So, the ideal thing to do would be to hand over the mantle of EHR purchase, installation, and support to your medical billing vendor or your EHR support company and let them sift through all the noise, while you continue to provide your fullest attention to your patients.