Most Healthcare Is Local: Connecting Epic with Regional Health Information Exchanges

Steve Hess, CIO at UCHealth

Imagine a patient who arrives at the hospital for a transplant evaluation. She’s been treated at three different health systems over the past two years, seen specialists across the region, and filled prescriptions at pharmacies in two states. Her oncology navigator needs a complete picture of her care history before tomorrow morning’s appointment. Some of that data lives in our EHR. A lot of it doesn’t.

This is the reality at a tertiary and quaternary referral center. Patients arrive from across Colorado and surrounding states because their conditions demand specialized care. Getting their full health history at our fingertips is the difference between catching a complication and missing one.

Every hospital is working on this problem, and most of the country is working on it with the same software. That fact shapes how the industry talks about interoperability, and what gets missed in the conversation.

Nearly half of U.S. hospitals run on Epic, according to a recent KLAS report, and because they include many of the country’s largest health systems, they account for the majority of inpatient beds. UCHealth is one of them. Epic is an excellent EHR, and the Epic-to-Epic interoperability tools are a fundamental part of our strategy for moving data between health systems.

But half of America’s hospitals aren’t on Epic. Neither are many ambulatory clinics, skilled nursing facilities, home health agencies, or the community-based providers a patient touches in the course of getting well. If we can’t move data to and from those settings, we aren’t serving our patients the way we should. That’s the last mile of interoperability, and it’s where local health information exchanges (HIEs) do the work no EHR network is built to do.

Some CIOs take a different view. The reasoning goes something like this: we’ve made a significant investment in our EHR, it has its own interoperability tools, and the national exchange frameworks are maturing. Do we really need a local HIE on top of that? It’s a fair question, and I understand the pressure CIOs are under to justify every line item. But the answer becomes clear once you watch what happens at the local level without one.

Without an HIE, hospitals fall back on fax, on one-off point-to-point interfaces with each ambulatory partner, on portals that require clinicians to step outside their workflows to find information. These workarounds fail when you need them most, and they don’t scale across the volume of data flowing to and from the small clinics, nursing facilities, and home health agencies.

The clinical impact of getting this right is measurable. Last year, providers used external data from Epic and Contexture, our local HIE, to avoid 13,000 unnecessary procedures, change 580,000 medication orders through clinical decision support that drew on outside data, and close 2.8 million gaps in care. Those numbers reflect both systems working together. They’re complementary, not competing.

Clinicians also vote with their clicks. Our users log into the HIE millions of times a year. Transplant coordinators, burn nurses, and oncology navigators- the people caring for our sickest patients- use it to fill in what they don’t have at their fingertips. If they weren’t getting value from it, the logins wouldn’t be there.

The case extends past patient care into public health, too. We rely on the HIE to share immunization data, lab results, and capacity information with the Colorado Department of Public Health and Environment. No EHR is set up to do that at scale, and it isn’t optional work. It’s part of our responsibility to the community we serve.

That community responsibility is also why I push back when I hear the argument that combining a strong EHR with the emerging national networks is enough. Frameworks like Carequality and TEFCA do important work and are getting better, but most healthcare is local. The patient walking through our doors tomorrow was treated by a clinic down the road, not a health system across the country. The data that matters most to her care is local data, and the infrastructure that moves it is the local HIE.

For CIOs weighing this decision, cost is the wrong frame. The real question is whether you’re serving every patient and provider in your community, including those who aren’t on your EHR. We’ve made our choice, and we make it again every year. The health of our communities depends on it.

About Steve Hess

Steve Hess is CIO for UCHealth, the largest health system in Colorado. UCHealth encompasses 15 hospitals in Colorado and hundreds of clinic locations across Colorado, southern Wyoming, and western Nebraska. He serves on the board of Contexture.