The Connecticut State Attorney General is investigating Epic Systems' information sharing practices after independent medical groups accused hospital networks of using EHRs to control patient referrals and steer patients back to their networks, according to a Politico report.
The independent practices claim large health networks like Yale-New Haven (Conn.) Health System can leverage connectivity to Epic's EHR as a way to coerce practices to join them and punish physicians who are out of network, according to the report.
As more hospitals and health systems join Epic's network, independent physician practices say it is harder to control referrals for their patients. Epic controls more than half the state hospital EHR market in Connecticut, and critics claim Epic is "in effect collaborating with the hospital networks to pressure practices to sell out," according to Politico.
State Sen. Len Fasano (R) told Politico independent physicians were unable to gain access to patients' full medical records unless they were associated with the hospital.
While health information exchanges are often discussed as a means to easily share electronic data, state-sponsored HIEs often fail. Connecticut invested $10 million to build a statewide HIE, but public networks are often weak and underutilized, as is the case in Connecticut, according to Politico.
Furthermore, Yale Health System CIO Daniel Barchi does not believe HIEs are the solution to information sharing.
"Epic has become the de facto HIE for the state," Mr. Barchi told Politico.
Mr. Barchi also did say that not being on the same network as hospitals can be challenging for independent practices. "We're doing pretty much everything we can to share information every way people want it. But I understand there are physicians who want to remain independent, and being linked through the EHR is one less way they are independent."
In addition to information blocking, independent physicians who refer patients are often coerced to refer them to hospital-affiliated physicians. "If I have a patient with cancer, I can't send them to anyone but a physician owned by Yale. Their costs are three times higher than anywhere else, and it gets tracked back to me," an internist told Politico. "How can I participate in an accountable care organization if the specialists in my community are owned by a hospital and their costs are much higher?"
Eric Helsher, vice president of client success at Epic, told Politico Epic is not involved in the conditions surrounding the complaints, saying instead the allegations are the result of the move from fee-for-service to fee-for-quality. "Physicians are aligning with health systems to reduce costs and improve patient outcomes," Mr. Helsher said. "Epic enables this alignment by providing deep integration around a single patient record, a robust patient portal to increase patient engagement and population health management and analytics tools that drive coordinated care."
Yale offers options for independent physician practices that want to join its network. For an initial $5,000, Yale provides Epic installation and training to small practices, and there is a monthly $175 fee per physician. For practices that do not want to use Epic but still want to connect to the hospital, Yale helps build interfaces to enable the exchange of discharge and admission summaries between the system and the practice. The cost of that is around $5,000, too, Mr. Barchi told Politico.
In June, Connecticut became the first state to make information blocking illegal, according to the report. The law took effect Oct. 1.
More articles on Epic:
To prep for Epic, Mayo Clinic to build $6.1M electronic substation
Mother Jones piece hits Epic hard: 5 criticisms of the EHR vendor
Former Epic engineers raise $3.5M for health IT startup Redox: 4 insights