In eHealth circles, the Epic’s stand against ONC’s rules of the 21st Century Cures Act has taken us on quite a roller coaster of pro-et-contra discussions in the past few weeks. For those who don’t know what that is, the Office of the National Coordinator for Health IT in the US proposed a set of rules that would require EHR vendors (Epic being /the/ vendor with the biggest market share) to openly share the data – in other words, they require EHR vendors to be prepared to exchange data from their systems to other systems and/or patients via the publically known API and with cooperation (mind you, the rules even state this has to be done in a timely manner, with the reasonable and non-discriminatory license).
An actor that controls technologies or other interoperability elements that are necessary to enable access to EHI will not be information blocking…
As a patient, as a consumer of health services, this is a dream come true. How great would it be to have everything at any time just when and where you need it? How great would it be to go to a specialist outside your own city and digitally give him consent to see all your past and current documents, so he can make an informed clinical decision? How great would it be, to be able to make a teleconference call, instead of visit a doctor who’s a couple of hundred kilometers away and just needs to review your test results? How great would it be, to live in the 21st century where all of this is possible..? Oh wait…-.
On the other hand, this, of course, is a nightmare for monopolistic companies like Epic, as it’s a direct threat to their business model. We’ve known for a long time now that data is money and the information is the oil of the 21st century. By conforming to these rules, companies like Epic would need to open up their data siloses, their money, their treasury.. and all only for the greater good, for empowering patients and give them what’s theirs in the first place. Imagine. The horror.
Effectively, it’s a start of a war against the vendor lock-in phenomena. And it’s the beginning of an end of these huge privately owned corporations who think that interoperability means that two of their own systems can exchange data with one another. And we’re on the wrong for not sharing their monopolistic vision and their idea of interoperability.
Vendor lock is when a hospital is unhappy with its EHR system but is unable to pursue an EHR replacement because of the cost of remaining contract payments. Expensive contracts can leave hospitals financially locked into keeping a lackluster EHR system, leading to dissatisfied, frustrated physicians.
The way I see it, there are two ways how Epic could approach this proposal by the ONC. They could either embrace the change that’s set out to empower the patient, make the information flow seamlessly through systems, reduce the costs, bring the healthcare industry finally in the 21 century (…) or they could do what they did: threaten with a lawsuit if this rule passes. Ironically, Epic’s slogan is as follows: “Epic | …with the patient at the heart“.
But to be honest, I would be surprised if they didn’t fight this for the reasons I’ve stated above. After all, we live in a capitalistic world where money (in this case: data) is everything and no corporation really cares about the “little man”.. and so if this proposal directly threatens their enterprise, what did we really expect?
So that’s not really what bothers me – what bothers me the most here is the irony in their public statement. Because supposedly, they really do have “the patient at heart”. They say that interoperability will damage the patients, make them vulnerable and open up all kinds of security issues. Supposedly, the third-party apps that should gain access to their data will take it and sell it. Supposedly, this is another Cambridge Analytica debacle waiting to happen. I’m not saying that it can’t happen, not at all – but this shouldn’t be a part of the same discussion. De-facto interoperability should happen regardless and security is an issue that should be properly addressed. I can’t wrap my head around the idea of blocking the progress altogether because of it.
And this is what bothers me – they’re playing on the one card, the one argument that’s the main reason why the healthcare segment is still where it is in people’s minds – privacy and security issues. We’re all really privacy-aware of our medical situations and it really hits a home run when someone even suggests that there might be a security issue with something in regards to our e-health, because that same second, we start having doubts. And even though they (Epic) could embrace the change, be an implementator one could look upon, show everyone that we have advanced so much when it comes to security and privacy in the e-health and once and for all start building people’s trust in e-health, they did the exact opposite; and did so using the one argument we should all be fighting against (not disregarding it but fighting against).
Luckily, there are other corporations in favor of these proposed rules – Microsoft, CARIN Alliance (Google, Apple, ..) – I’m not going to kid myself and pretend there are altruistic tendencies behind their support for these rules, as acceptance of them essentially means these companies have doors wide open to even more properly enter the said market, but if this means that consequently a patient finally has some huge corporations on his side and against all Epics of the world, then so be it.
Gašper Andrejc, Health IT Domain Lead
Views are my own and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.