• Epic Software User Guide

Epic Systems, the Verona, Wis.-based electronic health record (EHR) vendor of which some 190 million patients have an electronic record on, has launched a new functionality called One Virtual System Worldwide to enable healthcare providers on the Epic EHR to not only exchange more patient data, but to interact with each other on that data. According to Epic executives in a Jan. 30 press release, the new functionality leverages its Care Everywhere platform and moves the Epic community from the ability to “view more” to being able to “do more” across all organizations using the Epic EHR platform.

There are three parts to the new functionality—gathering data, presenting the combined data in an easy-to-read format and enabling providers to take action across organizations. The “Come Together” functionality enables Epic to find health records for individual patients from various organizations, including Epic clients, hospitals on other EHRs, the government, and networks, to bring data together. The work builds on Epic’s previous interoperability initiatives, which already allows Epic providers to exchange records—over 2.3 million patient records are exchanged per day, and approximately two-thirds of the people in the United States have a current record on Epic, according to the company. Via MyChart, its patient portal, and technology Epic calls “Happy Together,” once the data is brought together, it is then presented in a single, merged view, helping clinicians eliminate gaps in care, alerting them to possible opioid overuse or other medication problems, and helping them deliver better care faster.

This functionality also lets patients see a combined view of their healthcare record without having to log in and out of different portals, the company said. “Over the last decade we expanded the amount of data that customers can exchange, going well beyond industry requirements.

Now, our new functionality ‘Working Together’ will allow clinicians to work across Epic organizations to improve the care for their patients,” Dave Fuhrmann, Epic vice president of interoperability, said in a statement. The “Working Together” technology encourages providers to collaborate with one another. For instance, according to Epic, this functionality enables providers using the Epic EHR to see image thumbnails from other Epic customers, and, once they choose the image they want to examine, Epic goes to the source and retrieves a reference quality image for their review. As another example, schedulers referring a patient to another Epic customer can directly book the appointment in that system. Clinicians also can send secure messages directly to clinicians at other organizations, which is especially useful for those receiving referrals who want to have a deeper dialogue. The functionality enables provides to search data received from other organizations and examine discrete data as well as free text, such as in notes and documents.

What’s more, patients can use Epic’s self-assessment triage and then self-schedule a tele-visit with their organization, or with another Epic organization if their own is not available. According to Epic, additional functionalities that are in the pipeline include allowing providers to perform duplicate checks. For instance, a clinician will receive an alert that the order just placed, such as for imaging or for a lab test, has recently been completed at another organization and may not be needed.

Also, patients with a referral from one Epic organization will be able to see appointment options from the other Epic organization and schedule directly. “Ten years ago, MemorialCare was the first organization in the world to exchange a patient record via Care Everywhere. Of significance, the exchange capability was inherent with the Epic system. No incremental effort was required, and the results were available to clinicians in their native workflows, something that we had not been able to achieve in working with health information exchanges (HIEs). Now we are taking a big step forward in interoperability by being part of a single virtual system with the rest of the Epic community,” Scott Joslyn, CIO at MemorialCare Health System, said in a statement.

“Deploying Epic across our organization has not only enabled us to become deeply integrated within our own organization, but by leveraging Care Everywhere we have been able to share patient information across other organizations caring for that patient. Now, with One Virtual System Worldwide, we are excited to be able to join a connected community that we think can dramatically improve our efficiency and the quality of care we deliver to our patients,” Darren Dworkin, CIO at Cedars-Sinai Health System, said in a prepared statement. Epic was named a Most Interesting Vendor by Healthcare Informatics earlier this year, and in an of the company, Faulkner and COO Carl Dvorak exclusively conversed with Healthcare Informatics’ Editor-in-Chief Mark Hagland about how Epic has been able to build its market dominance over the years.

To this point, with revenues of $2.5 billion in 2016, the privately owned company ranked sixth on this year’s Healthcare Informatics 100 list of the top healthcare IT in the U.S., the third EHR/clinical information systems vendor on the list. In his profile of Epic published last May, Hagland wrote that during his interviews with company executives last spring at Epic’s Verona headquarters, Faulkner and Dvorak expressed satisfaction with where Epic is right now in the marketplace, and challenged some of the contentions of critics. “Certainly, both believe that their company’s ongoing financial success silences all criticism.

The company is expanding so rapidly, in fact, that Faulkner says it’s hard to give a precise number of customer organizations, both because it is winning contracts at such a fast pace, but also because many of Epic’s customers are merging with and acquiring each other. So, Faulkner says, ‘about 400’ is probably the most accurate number one can turn to. Hagland further quotes Faulkner: “Sometimes you have two customers that merge, and other times, you have a customer that breaks apart, so it really is hard to estimate,” she says. In terms of hospital-based organizations and physician practices active in its “Connect” EHR-share program, “We have 160 hospitals and 32,500 physicians, all connecting, via Connect,” she notes, Hagland wrote. “Meanwhile, 84 percent of our customers extend out” their contracts to provide EHR functionality to affiliated practices and organizations.

What’s more, Epic allows patient care organizations to extend out to federally qualified health centers (FQHCs), free of charge, within certain limits. So a lot of patient care organizations are getting connected, Hagland noted in his article.

Epic Software User Guide

Verona, Wis.-based Epic plans to lower program fees for health IT developers participating in its App Orchard program, and will launch a new entry-level program tier, called Nursery. Epic announced the App Orchard updates at its App Orchard conference last week at its Verona headquarters, according to reporting from Politico published Oct. In an email statement, Brett Gann, App Orchard director, confirmed the company is reducing and simplifying the costs associated with participating in the app developer program. The three tiers of the program will see program fee reductions ranging from 33 to 80 percent as part of the update, Gann said. Epic launched its App Orchard in 2017 as an online marketplace for third-party developers with 13 applications. With access to patient health information now commonplace among providers, the next core investment could be in communication channels with patients, according to CHIME’s 2018 HealthCare’s Most Wired survey.

The survey findings, on October 31 at the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego, included more than 600 participants, and revealed an array of findings related to interoperability and integration, data security, value-based care and population health, and patient engagement. This is the first year that CHIME conducted the Most Wired survey and the first year a trends report based on survey data has been made available for the industry, according to the associations’ officials. Many organizations reported that they do have the capability to consume data from outside entities such as an external hospital system or a retail pharmacy, although less so with home health agencies, skilled nursing homes and chronic care facilities.

Meaningful use has helped drive the development and use of patient portals, and progressive providers have adopted several additional capabilities, according to the analysis. And, many patients have readily transitioned to mobile apps offered by most portals. Regulations on application programming interfaces (APIs) under, the Centers for Medicare and Medicaid Services’ renaming for meaningful use, will expand engagement opportunities with patients but also pose security challenges for providers, according to officials who presented the findings at the CIO Forum. Interoperability may seem like just a technology challenge, but in actuality it is a people, process, and technology challenge. Healthcare systems increasingly look to create high-reliability. The report specifically noted, “As healthcare adopts and leverages new technologies, it is becoming increasingly complex to maintain an ecosystem in which data can be reliably shared. Poor communication between disparate systems can be one of the greatest impediments to clinicians being able to access the information necessary to provide effective patient care.

Communication technologies, like remote access capabilities and emergency alerting, can improve the speed at which critical data is delivered to caregivers.” Indeed, nearly all of the survey’s participating organizations reported that at least 95 percent of their clinicians regularly access clinical information electronically. This includes medical history, nurse notes, order sets, care plans, diagnostic study results, operative reports, medication reconciliation, discharge instructions, care plans, and clinical summaries. Similarly, almost all physicians can electronically access their organization’s EHR, CPOE, clinical guidelines, medical images, and evidence references while in the hospital or clinic. However, only about half of physicians can access these same resources via mobile applications. Adoption of secure messaging also lags behind other remote-access functions; both represent opportunities for the industry to advance the current communication infrastructure, according to the analysis. What’s more, over three-fourths of participating organizations send the following patient-monitoring data directly to the EHR: blood glucose, bedside blood pressure, bedside pulse oximetry, and EKG data. But there are still significant gaps in the integration between EHRs and patient-monitoring equipment—only 25 percent of participating organizations send data from their IV pumps directly to their EHR, and only 10 percent send data directly from in-bed scales.

Furthermore, when tracking hospital-acquired infections, 59 percent integrate this data with their EHR, 33 percent store the data electronically, and 8 percent use manual processes. Regarding security, few organizations (29 percent) have a comprehensive program in place, which CHIME outlines as doing all of the following: reporting security deficiencies and security progress to the board; having a dedicated CISO (chief information security officer) and cybersecurity committee; providing security updates to the board at least annually; and having a board-level committee that provides security oversight. Indeed, having a dedicated CISO and regularly reporting security updates to an executive committee are some of the first steps to mitigating cybersecurity vulnerabilities. However, for most organizations, establishing these security foundations is still a work in progress, the report revealed. When it comes to value-based care and population health, data aggregation is the first step toward effectively leveraging population health management technology, and while the industry has made progress, there is still room to improve data aggregation across the continuum of care, according to the report. About 57 percent of healthcare organizations are using clinical and billing data as well as an HIE to identify gaps in care. However, only one-quarter of organizations are using these tools and have the ability to access registry data at the point of care.

The analysis noted that care-management practices for areas outside of the inpatient setting are still maturing, especially for home management of chronic diseases. While most provider organizations’ population health strategies target diseases like COPD, congestive heart failure, diabetes, heart disease, and hypertension, few are tracking behavioral health, sickle cell anemia, or end-stage renal disease. Additionally, few organizations currently allow patients at home to do things like manually submit self-test results or report their medication management compliance via email.

The survey also asked participants about their patient engagement and telehealth capabilities. Within the hospital setting, adoption of patient engagement capabilities is shallow. Less than one-third of organizations support patient and family functions for ordering meals based on dietary restrictions, planning for discharge processes, controlling environments, reporting non-clinical problems, and accessing traditional whiteboard information. And roughly one-third support patient engagement–related staff functions for initiating patient pathways, while one-quarter have adopted real-time engagement. Obstacles remain in order to truly engage patient communities, with one example being that price transparency is still emerging—only 27 percent of participating organizations provide the public with cost calculations for common procedures. Virtual care is gaining traction, with over one-third of participating organizations offering virtual visits in a non-clinical setting. While this may seem low compared to adoption of other capabilities, it is actually high given that virtual care is still developing, and few patients have participated in it, according to the report’s analysts.

And while barriers such as reimbursement limitations and evolving regulations currently prevent healthcare organizations from harnessing the full potential of telehealth services, 89 percent of participating organizations offer some form of telehealth services. Most of these organizations are still early in their telehealth journey; few offer focused telehealth services such as eICU, rehabilitation, genetic counseling, or skilled nursing services.

Although nearly all non-federal acute care hospitals have already upgraded to 2015 Health IT Certification Criteria, or plan to upgrade, the majority of these organizations are still not engaging in all four components of interoperability, from the Office of the National Coordinator for Health IT (ONC). Fisher service manual video. The 2015 Edition Health IT Certification Criteria includes new technical capabilities (such as APIs) that were not required as part of the prior 2014 Edition. ONC’s analysis of 2017 data from the American Hospital Association’s (AHA’s) Information Technology Supplement Survey indeed reveals that 93 percent of non-federal acute care hospitals have already upgraded to the 2015 Edition or plan to upgrade.

But when it comes to what the health IT agency classifies as the four domains of interoperability—electronically finding, sending, receiving, and integrating data from outside one’s own organization—just 41 percent of hospitals reported that they were able to engage in all four functions in 2017. However, the number of organizations that have reported performing all four interoperability domains continues to increase each year. In 2014, just 23 percent of hospitals reported engaging in all four; in 2015, 26 percent; in 2016, 26 percent; and in 2017, 29 percent. The analysis revealed that most hospitals can electronically send patient summary of care records (88 percent) and receive such records from outside sources (74 percent). Also in the past year, hospitals that reported they can query or integrate this data significantly increased, from 41 percent in 2016 to 53 percent in 2017. National Coordinator for Health IT, Donald Rucker, M.D., noted that although “this growth is impressive, important work remains, as only four-in-ten hospitals reported they can find patient health information as well as send, receive, and integrate patient summary of care records from sources outside their health system.” The blog post added, “Engaging in all four interoperability domains is critical to ensuring that clinicians have information they need at the point of care.

In 2017, 83 percent of hospitals that could send, receive, find, and integrate outside information also reported having information electronically available at the point of care. This is at least 20 percent higher than hospitals that engage in three domains and almost seven times higher than hospitals that don’t engage in any domain.” See more on.