Today I got a rather interesting response to a question I’d posted on question and answer site Quora.com. I’d originally asked whether anyone thought giant EMR vendor Epic would go public anytime soon, but the conversation has veered a bit.
The comment that caught my eye:
“Unless HIE standards are adopted quickly over the next 5 years, interoperability of health records will at some point require a single, strong player. Outside of claims data from the top 4 insurers, Epic is the only EHR company that has large enough stake to play this role.”
The poster, one Akshay Kapur, doesn’t say whether he’s an Epic employee, competitor or health IT end user, so I’m not sure what prejudices he brings to the table in making such a statement. That being said, his assertions are worth a thought or two.
To date, the growth of HIEs has been terribly stunted, in part because each has to essentially reinvent the wheel when they launch. Sure, they may be doing similar work but not necessarily interoperable work, so they’re far from achieving the kind of universal data sharing everyone dreams about today. (Their pricing models have been very dodgy as well, but that’s another story.)
So, would it help the HIE market coalesce if a big player like Epic laid down the tracks? Almost certainly. The HIE model has nowhere to go but up.
But would it be a good thing? I suppose that depends on where you sit. My guess is that one-vendor domination of the HIE market could be very helpful at first but would ultimately impose a choke collar on the industry. Talk about vendor lock-in: if a whole HIE and its users was tied to any single technology, imagine how hard it would be to shift gears.
From where I stand, I’d rather see HIEs struggle their way into a viable model rather than relying on any single company. But hey, maybe that’s just me.
Katherine, in my opinion, one of the greatest opportunities that was missed by the government was the opportunity to place the burden of interoperability on vendors instead of placing the responsibility for “meaningful use” on end users. I would have been thrilled to see a standardized data schema — even if only on a basic level — to which vendors were required to comply. As it stands now, scenarios like the one you mention above are the only likely way that HIEs will evolve, because vendors have no real incentive to play nicely together.
As we all know, banking figured out interoperability decades ago. Vendors’ self-interest is the biggest reason why our industry hasn’t done the same.
This is exactly why there must be an openly available information model that works across all healthcare applications (not just EMRs). Messaging alone is messy and there are semantic losses in translations.
Much like a DNS system and a HTTP protocol for healthcare. Okay, those are loose analogies. But I think the idea comes across.
Chuck Amos,
I agree with you completely. The government money was misguided. They should have done as you describe. Not only would it help interoperability happen, but would also have the side effect of EMR adoption.
Katherine,
The problem with Epic being the HIE is that they’re too busy making money hand over fist to consider the idea of being the HIE. They still have too many hospitals to sell to that they don’t need to go the HIE route. So, they don’t. Focus is good for business, as Epic has shown.
John:
I have no doubt that Epic is plenty happy with raking in the giant enterprise EMR bucks. I just thought that the Quora poster’s idea offered an interesting perspective on the HIE model.
Unfortunately, I’m forced to agree with his thesis, e.g. that it will take a large, almost monopolistic player to foster true HIE interoperability at this point.
-Anne
Katherine,
It is an interesting idea. Do you remember this post I did at HIMSS about Epic and Interoperability: https://www.healthcareittoday.com//tag/healthcare-data-interoperability/ ?
It’s an interesting thesis about a big player making it happen. What do you think about the care connectivity consortium that Neil Versel wrote about: http://www.meaningfulhitnews.com/2011/04/04/big-health-systems-to-promote-connectivity/
I think some readers here will understand this, but not all. We desperately need to understand that HC is not the first industry faced with the need for interoperability and data structure standards. I spent many years in big telecom and experience some deja vu.
A business is driven by profit, even if hugely influenced and subsidized by big gov, and they compete for that profit. No surprise. Asking a company to not only own and manage a standardized, required structure but to NOT use that power to lock-in customers, suppress innovation in the products and technologies and deny judgement and self-determination among users/customers is like asking a dog not to chase a cat. It is simply not in their values, objectives or even their nature.
The *original* AT&T worked as a technology monopoly 130 years ago, but … things have changed.
Furthermore, bigness is often not the best determinant. Do we really want to set as an industrial standard – for expedience – a product base that still has quite a few of its users grumbling and scratching their heads ?
Well put Don. Of course that makes no sense. But, I do wonder where the driver is get the vendors to come to terms with a common information model is needed?
This is the key point that I’ll be addressing in my blog posts (link above) by taking from the academic literature those issues concerning interoperability. My next post will be on a new paper entitled: What are the barriers to conducting international research using routinely collected primary care data?