December 20, 2015
In February 2015, EPIC announced that it would enable an open API in their electronic health record (EHR) software and open an app exchange store called the App Orchard. It is now only a month or two from its official release. EPIC is the nation’s leading provider of EHR software to small and medium sized healthcare organizations. For those not well versed in the health IT industry or the long-time frustrations with EHR software, this may not seem like a big deal. It is.
With the rise of smartphones, tablets, and smart devices of all kinds, we often assume that an open API is the standard approach for software and devices, but this is not always the case. For years, the healthcare industry has been forced to silo their patient data to the specific EHR they employ. It can be incredibly difficult, expensive, or impossible to establish links between these programs. That is, if the healthcare group uses a digital solution at all.
To understand the significance of this move, one must go back six years to the HITECH Act of 2009 and see how even with government incentives and subsidies, the digitization of the healthcare industry has faced challenges every step of the way.
The HITECH Act Sets the Stage
In 2010, it was estimated that only 4 in 10 doctors had a digital solution for patient records, which left the majority of physicians still relying on hardcopy files. To make matters worse, only two out of four doctors were using EHR software to its fullest. The healthcare industry was dragging its feet into the twenty-first century and budgetary concerns put up roadblocks to the adoption of digital solutions.
The HITECH Act aimed to help shepherd and incent an essential industry to enter the digital age. By doing so, the Obama administration hoped to increase patient care quality while reducing costs. It made a lot of sense, because digitization has yielded similar results in almost every industry. The ultimate objective was to successfully transition 90% of doctors and hospitals to the adoption and proper use of an EHR system by 2019. It planned to accomplish this with $35 billion in subsidies and three key strategies.
- Certified EHR: In order to receive subsidies, the organization must utilize a certified EHR program.
- Demonstrate Meaningful Use: Simply using an EHR program is not enough. The doctor or hospital must demonstrate the proper and effective use of the software to qualify for up to $44,000 in Medicare incentives and $63,750 in Medicaid incentives. The meaningful use requirements are structured to expand and evolve over time in “stages” to increase the sophistication of the hospital’s use of EHR software.
- Regional Extension Centers (REC): $2 billion dollars were set aside in 2009 to construct REC facilities throughout the country. The REC facilities are tasked with developing and enacting regional outreach and education programs to both explain the nuances of the HITECH Act as well as the importance of EHR programs.
The HITECH Results
The HITECH Program had one glaring flaw in its design. Stage 1 of meaningful use requirements do nothing to require EHR developers to implement interoperability between their programs. As a result, medical organizations have found the EHR programs to be difficult to use and lacking in easy record exchange features. Patient records are often siloed in their EHR program and unable to be transferred across platforms, which can make coordinating patient care immensely difficult.
Unfortunately, merely 25% of eligible medical providers are registered at the Stage 1 or Stage 2 level, according to a report by the Centers for Medicare and Medicaid services. However, other data suggests that 75% of healthcare organizations have at least some form of digital solution. Whatever the real number may be, this dynamic may soon change with the release of the App Orchard in the next few months.
The EPIC App Orchard: A Potential Bridge across Platforms
The App Orchard is poised to change the EPIC program from a locked, enclosed software into a platform for any number of uses. Think back to the rise of smartphones. Before the App Store and the Google Play Store, if a user wanted an additional feature added to their phone, they had to wait until the manufacturer built a new model with that capability. Through the app store, manufacturers created a new dynamic and morphed the phone from a simple device into a platform. It allowed the massive community of developers worldwide to increase the value of the product without the need for investment from the developer. Now, smartphones can do anything from mapping a path from your couch to Beijing to providing an interactive game for your cat.
The App Orchard has the same potential for EPIC software, including developing a bridge across EHR programs to more easily share data. This could be the key to the increased care quality at reduced prices the HITECH Act aimed to achieve.
While the HITECH Act had its heart in the right place, the EHR software itself was not up to the task in many cases. That is not to say that EPIC and other EHR software is entirely flawed, but they were operating on a tight-lipped philosophy of non-collaboration. Hopefully, the App Orchard will address this problem while simultaneously expanding the functionality of the program to better leverage medical data. That being said, sharing these medical records across software platforms comes with a slew of security risks and patient privacy concerns worthy of its own article, so any developers crafting solutions for the App Orchard must bear this in mind.
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