Epic, Other Vendors Drop Health Information Exchange Fees

Ken Terry

April 20, 2015

Epic Systems, the largest electronic health record (EHR) vendor, has dropped its fees to healthcare providers for exchanging information with other providers who use different EHRs, according to the publication Modern Healthcare.

Commonwell Health Alliance members athenahealth and Cerner have said they also would not charge for information sharing by its EHR customers.

The Epic announcement came just a week after the Office of the National Coordinator for Health Information Technology (ONC) issued a report about "health information blocking." The report slammed EHR vendors for limiting the exchange of health data. Among other things, it cited high charges for interfaces and high per-page charges for transferring data to competitors' EHRs.

The report concluded that ONC does not have all the tools it needs to counteract information blocking and that Congress might have to weigh in.

Up to now, Epic customers had to pay 20 cents for each clinical message they sent to a health information exchange; inbound messages from non-Epic users cost $2.35 per patient per year, Epic CEO Judy Faulkner told Modern Healthcare.

These messages have been exchanged through an Epic module called Care Everywhere. Faulkner promised that the vendor would not charge for Care Everywhere at least until 2020.

Along with Epic, athenahealth recently said it would not charge for information sharing by its EHR customers through the Commonwell Health Alliance. Cerner has said it would do likewise, except for a one-time startup fee, through 2017.

Although Commonwell's 25 member companies supply health information technology (IT) to about 70% of the hospital market and 20% of the ambulatory care market, the 2-year-old coalition has so far provided interoperability services to only about 60 provider sites. The alliance plans to expand its patient matching and record location and retrieval services to at least 5000 provider sites this year.

What About "Direct" Messaging?

Although Epic's announcement will be welcome to many providers, it does not address the fees that most providers have to pay for Direct secure messaging. These fees go to health information service providers (HISPs) that are either owned or hired by EHR vendors, including Epic. HISPs route messages with clinical data attachments from one provider to another. Although the fees they charge are fairly low, some observers view them as an impediment to the uptake of Direct messaging.

This is important, because Direct is the principal means by which practices can exchange clinical messages to show meaningful use in areas that have no health information exchanges.

Meanwhile, Epic has been going to lengths to defend itself from charges that it has purposely blocked the free flow of information between its EHR and those of its competitors. Last summer, Epic President Carl Dvorak told the Health IT Policy Committee that Epic contributes to interoperability by enabling information exchanges among its own customers as well by interfacing with other EHRs through Care Everywhere, according to Healthcare IT News.

Epic has not joined the Commonwell Health Alliance. Recently, Peter DeVault, Epic's director of interoperability, told a Congressional committee that the company declined to join because of the high cost and because it involved signing a nondisclosure agreement, according to Healthcare IT News.

Nevertheless, Epic has been cooperating lately with Cerner and athenahealth, two of Commonwell's charter members, on the development of the SMART on FHIR platform. This is a new set of standards and programming for connecting healthcare apps with EHRs.

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