"This sounds like a very positive incremental improvement in the use of patient portals in the Epic customer base," said Dr. David Kibbe, CEO of the not-for-profit governance group DirectTrust. "But it doesn't seem to me to be a global solution. The most obvious limitation is that it's available only to customers of Epic who also have MyChart accounts," he said, referring to Epic's patient portal. According to Charles Christian, vice president of technology and engagement at the Indiana Health Information Exchange, Share Everywhere doesn't quite count as interoperability. "It's not really moving data around but providing access to it." Pamela McNutt, chief information officer at Dallas-based Methodist Health System, agreed, calling Share Everywhere "another vehicle for access to very important information. It's really exciting, and it's moving us closer to a patient having a personal health record that they can control." Her system, which uses Epic, will advertise the new feature on its website and when it encourages new patients to sign up for MyChart. Epic argues that this kind of data exchange does indeed qualify as interoperability and, more importantly, makes that interoperability patient-directed, said Sean Bina, Epic's vice president of access applications. "Whether traveling internationally, receiving home care, or simply seeking a second opinion, patient-driven interoperability is now a reality even when the caregiver doesn't have an interoperable EHR," he said. Patient control over medical records is a requirement under meaningful use, which specifies that patients are supposed to be able to view, download and transmit their data. Epic's Share Everywhere achieves the crucial "transmit" portion of that trio, centering the data around the patient rather than around a single provider and maintaining a patient's privacy under HIPAA along the way, since the patient is the one moving the information. The industry has long touted the potential benefits of patient-centered care, calling it an important part of the Triple Aim, since it will improve outcomes and lower costs. But, Christian said, "at times, we may be asking too much of the patients." Sometimes, he said, patients want providers to initiate the exchange of data. "It's an idea that makes a ton of sense, to put patients in the middle of interoperability," said Dr. Christopher Longhurst, CIO for UC San Diego Health. But, he said, he's found that "when you ask our patients, most of them tell you they don't want to be in the middle." Epic's Care Everywhere—not to be confused with Share Everywhere—helps in that quest. Using the technology, organizations exchange 2 million records per day with Epic and other vendors' systems. Epic is also a member of Carequality, an initiative of the Sequoia Project whose framework supports data transfer among its members. Carequal- ity members will soon be able to exchange data with members of the Commonwell Health Alliance, co-founded by Epic market rival Cerner Corp., greatly expanding interoperability. Share Everywhere will be available for free in November to Epic users. Epic declined to say what the average cost of implementing its EHR is. But installing new systems can be expensive: The installation of an Epic EHR at Vanderbilt University Medical Center in Nashville this fall, for instance, is estimated to cost $214 million. Asked if providers might be drawn to purchase Epic because of Share Everywhere. Longhurst said likely not. "It's not a game-changer," he said.
By most accounts, Epic Systems Corp.'s announcement that it was releasing a digital tool allowing patients to share their medical records with any provider was a huge leap toward reaching the ever-elusive digital exchange of medical information.