Epic’s Matt Doyle talks about why patients need interoperability

The electronic health records giant says it will join TEFCA, a new national health information exchange framework. With records and data more easily available, patients and providers will see the benefits, Doyle says.

Patients are going to be big winners when the healthcare industry truly reaches nationwide interoperability, Matt Doyle says.

Doyle, Epic’s R&D team lead and software development team leader for interoperability, talked with Chief Healthcare Executive about the need for the greater exchange of health information. Epic, the nation’s largest electronic health records company, is the first EHR firm to say it’s joining the Trusted Exchange Framework and Common Agreement, or TEFCA.

The new framework is designed to make interoperability truly nationwide. Participants will agree to a core set of principles for the exchange of health information. The Office of the National Coordinator for Health Information Technology (ONC) and its coordinating entity, the Sequoia Project, have developed the framework, in consultation with the healthcare industry. Applications to participate are expected this year.

Epic says about 70% of America’s hospitals are already exchanging data through its own framework. But patients and providers will see better outcomes when all of the players in the healthcare ecosystem are easily exchanging data, and TEFCA will help make that happen, Doyle says.

Doyle outlines a scenario of being on vacation in another state and needing to go to the emergency room.

“I want them to see my medical record,” Doyle says. “If I have an allergy to penicillin, I want the attending doc in the e.d. (emergency department) to see that, so that she can be aware of that and prevent a potentially harmful and dangerous interaction.”

“Each of us as patients truly benefit by having health information be available,” he says. (The story continues after the video.)

‘Patients expect it’

The healthcare industry is going to see more interoperability because patients are demanding it, Doyle says.

Increasingly, patients are looking for the same convenience in the healthcare sector that they take for granted in banking, travel, and many other areas. Healthcare leaders have acknowledged that patients have higher expectations, and providers are going to have to meet them.

“There’s been a very fascinating shift over the last several years,” Doyle says. “When this was new 15 years ago, patients were pleasantly surprised when it works. No one expected it but people were happy when it worked.”

Now, he says, “patients expect it to work. It’s no longer just a pleasant surprise when something goes right but it’s now a core expectation.”

“Patients expect their doctors, and their nurses, and their pharmacists, and their whole care team to understand them individually,” Doyle says. “That’s what interoperability, and TEFCA specifically, can really help with, to make sure the right information gets to the right person at the right time.”

The easier access to health information can be seen in Epic’s patient portal, MyChart, which now has more than 130 million active users, Doyle says. Patients can use it to look up health records and communicate with their providers.

“It’s not just to see a lab result,” Doyle says. “It's to communicate with my doctor, schedule appointments, do telehealth visits, which during the pandemic has had a fantastic uptake and increase.”

The federal government is also requiring providers to share information with patients, other hospitals, and insurers. At the HIMSS 2022 Global Health Conference in March, Health & Human Services Secretary Xavier Becerra said his department is receiving too many complaints about information not being shared, mostly from providers. Tougher enforcement measures are coming, he said.

“Closing this enforcement gap is an HHS priority,” Becerra said in March.

Providers need to be sure they’re complying with federal guidelines, Doyle says.

“Organizations need to look at their policies, and how their policies promote health information exchange, both the logistics of what they’re doing as well as the reasons for why we do this,” Doyle says. “We do this because it’s good for patients and we do this because it’s good for providers and helps providers be more successful.”

Protecting privacy

As more information is exchanged, Doyle says it’ll be paramount to protect privacy.

Health systems around the country have faced a growing number of cyberattacks, exposing information of tens of millions of patients.

“Privacy is important,” Doyle says. “Healthcare is personal to each one of us. We have to make sure that there are appropriate safeguards in place.”

The developers of TEFCA have taken some smart measures to protect patient data, Doyle says.

Those agreeing to join the national framework must adhere to the requirements of the Health Insurance Portability and Accountability Act, or HIPPA, even if they aren’t entities typically subject to the federal law.

“That means, you can’t have folks who just grab data and just sort of do willy nilly, whatever they want. They have to comply with a well-understood and accepted set of guardrails that the industry has had for many years,” Doyle says.

In the wake of the Supreme Court decision overturning abortion rights, the Biden administration has told providers they must protect the privacy of patients who are seeking reproductive care. The court’s ruling, and subsequent state laws, poses new challenges, Doyle says.

Still, he says patient protections don’t have to derail progress on interoperability.

“I think it’s important that we don’t lose traction on the successes … while simultaneously being respectful of patients and respectful of their wishes,” Doyle says. "Historically, one of the ways that’s been done is by giving you the patient the opportunity to sign consent.”

“If you don’t want your information to be exchanged,  for whatever reason, reproductive health or otherwise, there should be a pathway that you can make an individual, informed, and educated choice to exit interoperability,” Doyle says. “Historically, very few patients choose that, but it’s important that we educate folks and help them understand what their choices are.”