Becker's Hospital Review

17 INNOVATION Epic's new interoperability push, explained By Giles Bruce Epic has intensified its pursuit of interoperability in recent months. Here are nine things to know: 1. e EHR vendor pledged to have all its customers commit to joining the Trusted Exchange Framework and Common Agreement, or TEFCA, a government-sponsored interoperability network, by Dec. 31, and go live by the end of 2025. e goal is to have patients easily share and access their health data no matter which EHR vendor their hospital, health system or clinic uses. TEFCA is the "North Star the industry is going toward" for health data exchange, Epic interoperability director Rob Klootwyk told Becker's. 2. So far, 84 Epic health system customers have gone live on TEFCA, while another 136 health systems have pledged their commitment. Also, 1,521 of Epic's 3,000 hospitals and 33,139 of the 69,000 clinics on the EHR have gone live or made the pledge. ese include some of the biggest health systems in the country. Rochester, Minn.-based Mayo Clinic, Salt Lake City-based Intermountain Health and Palo Alto, Calif.-based Stanford Health Care have gone live, while Oakland, Calif.-based Kaiser Permanente, Altamonte Springs, Fla.-based AdventHealth and Sacramento, Calif.- based Sutter Health have committed. 3. Health systems that go live with a new Epic EHR or upgrade their system are automatically live on TEFCA (though they can still opt out). e ultimate goal is to make TEFCA participation "automatic," Mr. Klootwyk said. 4. Epic is covering the costs of TEFCA enrollment through 2025, aer which fees will be "phased in," Mr. Klootwyk said. e costs cover Epic setting up and operating a Qualified Health Information Network, a requirement of TEFCA. Meanwhile, health systems can check off their participation in the Promoting Interoperability program, formerly known as "meaningful use," by taking part in TEFCA, and membership could also satisfy health systems' information-blocking requirements. "e main thing we're focused on is wherever the patient goes, her record can follow her when she needs it, at the time of treatment," Mr. Klootwyk said. 5. e No. 1 barrier to health systems joining has been awareness. "Otherwise, it's just getting the terms and conditions of participation in front of your legal team," Mr. Klootwyk said. 6. Health systems can go live in a matter of weeks. Others have taken months when it's a lower priority for the legal department. e technical li, Mr. Klootwyk said, consists of changing a "handful of settings" in Epic. 7. About 70% of hospitals are fully interoperable, HHS reported in May. "Universal interoperability across the country, that unicorn people have been talking about for a long time, more now than ever I think people can actually see it and understand it," Mr. Klootwyk said. 8. e incoming Trump administration could make changes to TEFCA but hasn't indicated it will. Interoperability has largely received bipartisan support throughout the years. 9. Epic also recently advanced interoperability standards for digital health app developers. Meanwhile, the EHR vendor asked for some changes to a proposed HHS interoperability rule while founder and CEO Judy Faulkner has recently touted Epic's Care Everywhere program, which allowed Epic patients to electronically share their data with any provider they wished, as the scion of "modern interoperability." n Most expensive EHRs, ranked By Giles Bruce EHRs are among the largest investments health systems will ever make. Here are EHRs that cost $500 million or more, according to Becker's reporting and other publicly available sources (this list contains ties): 1. U.S. Department of Veterans Affairs (Washington, D.C.): $16 billion (Cerner aka Oracle Health) 2. Military Health System (Washington, D.C.): $5.5 billion (Cerner) 3. Kaiser Permanente (Oakland, Calif.): $4 billion (Epic) 4 (tie). Catholic Health Initiatives (Englewood, Colo.): $1.5 billion (Cerner and Meditech) 4 (tie). Mayo Clinic (Rochester, Minn.): $1.5 billion (Epic) 6 (tie). Mass General Brigham (Somerville, Mass.): $1.2 billion (Epic) 6 (tie). Northwell Health (New Hyde Park, N.Y.): $1.2 billion (Epic) 8 (tie). Dignity Health (San Francisco): $1 billion (Cerner and Meditech) 8 (tie). NYC Health + Hospitals (New York City): $1 billion (Epic) 8 (tie). Sutter Health (Sacramento, Calif.): $1 billion (Epic) 11. NewYork-Presbyterian (New York City): $964 million (Epic) 12 (tie). Providence (Renton, Wash.): $800 million (Epic) 12 (tie). Trinity Health (Livonia, Mich.): $800 million (Epic) 14. Duke University Health System (Durham, N.C.): $700 million (Epic) 15. AdventHealth (Altamonte Springs, Fla.): $660 million (Epic) 16. Memorial Hermann Health System (Houston): $500 million (Epic) n

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