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Part I - A Q&A on Share Everywhere with Stephen Beck

Part I

With news of Epic’s Share Everywhere making its rounds in the past couple of months, Bluetree Network’s Ryan Hill sat down with colleague Stephen Beck, our Director of Physician Services, to assess the news’ impact, what patients and providers can expect with the changes, and the long-term implications of such an initiative.

Beck, a physician who has practiced internal medicine in both ambulatory and inpatient settings for more than 20 years, was elected to Epic’s Care Everywhere Governing Council for a pair of two-year terms. The council, which strives to maintain the customer focus of care in relation to Epic’s Care Everywhere platform, consists of representatives from participating organizations.

RYAN: How do you think your physician counterparts reacted to the Share Everywhere news? Do you think it surprised most?

Stephen: I suspect it caught many people off guard. At the highest level, I believe it’s a great idea for patients to have more control over their own records. After all, they can access them in any time despite the fact that some organizations and providers feel like patients shouldn’t have access. It is their legal right.

So, if a patient has two providers and they want to share their record among the providers, they can elect to do so in MyChart and have been able to do so for quite some time. Then the organization already has the patient’s consent for a shared record. Organizations can require a second consent if they desire, which I believe all of the governing council has been trying to eliminate.

Essentially, no second authentication was required, so you could query against the organization immediately and be able to pull up those records anytime you were within an encounter, while seeing your patient, or while completing your charting, so on and so forth. So that’s pretty neat.

What’s new about this functionality, from my understanding, is the patient would be able to transfer any information already shared with them through their MyChart account with an external provider as a one-time event. Not all organizations are sharing notes directly with patients - the initiative called Open Notes. Currently, a patient can go into an office and request a copy of their records at any time and then have them hand carried or mailed to another provider. This new functionality would take the guesswork out of it and allow the patient to send this information electronically, if all the chart data is currently being shared.  This seems like one more incentive for organizations to move toward Open Notes!  

RYAN: In your eyes, is Share Everywhere a product of Meaningful Use? Was this sort of initiative inevitable?

Stephen: I believe it’s good practice, and aligned with Meaningful Use. What they’ve outlined so far, is that the transfer —whether it’s Epic or non-Epic—can take place electronically or via email. It shouldn’t matter who the two providers are and what system they use, or if they use a system at all. You should still be able to grab that data electronically and send it. It sounds like that’s what Epic meant to achieve with this functionality, along with control at the patient level. Again, it’s a great idea in practice. I believe our challenges will be in how it’s actually used and implemented.

But the best news is, these types of electronic transfers, even if emailed to a provider who doesn’t have an electronic record, will save tremendous time and resources for HIM / medical record departments.

Here’s the best example I can give. Normally when you get a disability claim request, you must provide the records to the Social Security Administration. In fact, patients already consent when you receive the request. In the past, you’d get a request in the mail, you would print or copy their record. You’d get paid for getting it printed off, but the process to pull all the records, do all the printing, and then mail it were fairly resource intensive.

It would take a patient the process of months, literally, for the record to be obtained, reviewed, copied, sent over to SSA, and a disability judgement rendered. Well, once we hooked up with SSA electronically and started receiving the message electronically for the request, we automatically fulfilled it electronically. So, there was no human intervention, it was an agreement at the system level.  The electronic message with the patient summary and history was sent back and received.

We were matching successfully almost 70% of the time. Once the record was received, SSA deposited funding in our master account. So they still paid us for the request, just as they had before, except now there’s no human intervention, and the time has gone from months down to days or hours to really improve the patient turnaround time, and therefore provide great patient care.

The whole idea of transferring data near to real-time or real-time is an important one as we have more electronic health data across the country. And again, I believe the biggest challenges are how much data is being sent. Is it a summary of their record? Their entire medical record? How much is too much? Sometimes we send way too much.

As an Internal Medicine physician, being on the receiving end of that, I had some copies of records that were just horrible. Each page was a separate PDF, and I had to open up each document to see what it was. And it was a nightmare. I recall thinking I don’t want to see one of those records ever again. It was a complete waste of my time. I’m sure there was some important info buried inside, but it would take hours to find it. Worse than a needle in a haystack.

I believe the way this process is streamlined is important. But the way the information is organized is important, too. The good news is that what we, as providers, want most of the time is a recent history. The entire medical record is rarely useful. Most of us realize that the meat and potatoes of what we need for most patient care is really within the past six months or the past one or two visits, and then a summary of all the care and history that goes along with that.

How the information is packaged together will be interesting. The information released will be compiled and include display versions of C-CDAs for each patient visit, along with the Problem List, Allergies, Medications, Immunizations (PAMI data), labs, and patient histories. For patients with several years’ worth of visits, it could be quite a large file to review!

RYAN: How long before Share Everywhere—or something similar—is commonplace? Does that depend on how it does in its first couple of years on the market?

Stephen: Well, I believe having a first vendor to do something like this will be the spark to a bigger flame. Now, many of us on the Care Everywhere Governing Council thought that having a great platform like Care Everywhere would really enable other organizations to have similar platforms, but the CommonWell Health Alliance (non-Epic conglomerate of organizations) has simply not reached the same type of integration or interoperability volume many hoped it would. So I’d love to see this really ignite the enthusiasm and get the technology off the ground for others to share data in a similar fashion.

I believe the good news is Epic has really done a lot to have outside data sources shared through Care Everywhere. Leverage the same platform, but pull in outside data. Some vendors have really done a lot of good work in that space. Athena Health, for example, has worked hard to make the integration easy and they’ve worked with Epic through the Care Everywhere platform. We connected to Athena Health with Mercy Health last year and had 10,000 exchanges within the first week of connecting to about 150 ambulatory sites in Ohio.

So, it has the potential. I believe other vendors, those that are aggressive, will get on the bandwagon pretty quickly. Again, until we better understand how often a patient will use the new functionality, and how health systems and providers promote it, we won’t know how much of a game changer this really is. Regardless, it’ll be interesting to see what happens next.

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That’s it for Part I. In Part II, where Dr. Beck will offer up his thoughts on discrete data, the legal ramifications of the Share Everywhere initiative, and what this initiative means for the future of population health.

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