Epic Interoperability: Why It’s Dragging You Down and How to Fix It

If you’re struggling to achieve the desired Epic interoperability you need for productive processes that don’t add stress to a complex system, you are not alone. Many companies have encountered roadblocks like poor test environments and limited interface options. After spending hundreds of thousands of dollars on development, businesses have been frustrated as they’ve attempted to achieve workflow interoperability with critical external third-party solutions.

Epic controls 36% of the US EHR market, followed by Oracle Health, which controls 25%. The passage of the ONC 21st Century Cures Act requires that organizations receiving Medicare or Medicaid payments comply with the law’s open data exchange requirements. 

Related: Understanding Options for How to Integrate with Epic EHR

In 2024, Epic launched its Showroom to highlight third-party applications that integrate with the Epic EHR system. The Showroom is an evolving application that replaces an earlier marketplace. The company has also established an Open Epic website to help third-party developers. Despite its recent efforts, some in the industry question Epic’s level of interoperability with third-party applications. Clinicians need a reliable and effective solution.

How Does Epic Interoperability Work?

Interoperability refers to the ability of a product or system to interact in useful ways with other solutions. Interoperability is divided into the following four levels.

• Foundational. Foundational is level 1 data interoperability. At this level, systems establish connectivity requirements for secure data exchange. These are basic requirements covering protocols and physical connections. 
• Structural. Level 2 data interoperability defines the organization and syntax of data exchange. It outlines data fields and message formats. For Epic interoperability, HL7 FHIR provides level 2 and 3 interoperability.
• Semantic. Level 3 establishes meaning for the interface content. It enables the two systems to understand the value of the data being shared. Data elements follow the FHIR standard.
• Organizational. Level 4 workflow interoperability facilitates the secure, timely, and seamless data exchange with all communicating parties. It enables integration into end-user processes and workflows. 

Most healthcare solutions stop interoperability at level 3. Whether using HL7 FHIR or SMART on FHIR, many solutions have yet to achieve consistent workflow interoperability.

What is HL7 FHIR?

HL7 FHIR is the integration interface Epic supports. The HL7 was created in 1989 by Health Level 7 (HL7) to facilitate the exchange of data among healthcare providers. HL7 version 3 has updated its messaging to follow an XML format rather than its original proprietary standard.

FHIR or Fast Healthcare Interoperability Resources (FHIR) uses web-based APIs and coding languages such as JSON or XML for a more open interface. It defines what information should be returned based on an identifier in the request. The translation table allows diverse systems to exchange meaningful data. The HL7 FHIR standard does not limit the level of interoperability.

What Does Organizational Interoperability Look Like?

Look at the financial services industry. Today, consumers expect their financial institutions to offer online and mobile banking applications. Some use third-party applications for budgeting or investing, requiring that multiple accounts be incorporated under a single application. Users expect that the balance that appears on an app is the same account balance as at their financial institution. They also assume that any transaction performed through an external app will be reflected across all platforms. They expect organizational interoperability.

Related: Transforming Healthcare by Empowering Clinicians with Better EHR Workflow

People do not want to open multiple windows to view their financial health. They expect a consolidated view of their financial holdings to be available as part of their daily routine. 

That’s what level 4 interoperability should be for the healthcare industry. Clinicians and non-clinicians should have access to the best possible tools as part of their workflow. Patients should have access to meaningful information to protect their health.

Why Must Epic Interoperability be Organizational?

A 2024 publication in the National Library of Medicine concluded that physician burnout and emotional exhaustion are quickly reaching a crisis point. While some manifestations are individualized, systemic problems resulting from institutionalized approaches to work create an unsustainable framework for physician health. In almost all studies, administrative workloads were the top reason for burnout.

The research found that the COVID-19 pandemic contributed to increased administrative tasks. Although many frontline workers adjusted to added charting during the height of the pandemic, they expected the “paperwork” would return to pre-pandemic levels. It has not. For healthcare providers who were already overwhelmed by documentation requirements, the added burden has only moved the crisis point closer.

Anyone integrating with an Epic system should provide organizational interoperability to ensure user acceptance, minimize toggle taxes, reduce errors, and improve patient outcomes. Continued use of level 3 interoperability does not improve the patient or physician experience.

Level 2 and 3 Interoperability

At these interoperability levels, data exchange can be as simple as a file transfer or a link to an external application. These methods place the usability burden on the end user. Many third-party applications appear in drop-down menus. Clinicians scroll through the list of applications. When selected, the application appears in a separate window or tab. This approach only adds to user fatigue and increases a hospital’s toggle tax.

Toggle Tax

Context switching or toggling between applications is mentally taxing. Too much toggling increases cortisol production, which slows cognitive function and makes focusing harder. It takes a toll that is reflected in fatigue and burnout. However, there’s a business component to moving among applications. Harvard Business School studied the cognitive cost of excessive application switching to help businesses understand how it ripples across an enterprise.

The researchers found that organizations requiring employees to switch applications frequently paid a toggle tax. The tax amounted to four hours a week of lost time or five working weeks per year. The cost did not include the impact of increased absenteeism due to burnout.

Creating organizational interoperability could add 25 working days to an individual’s productivity. It would also improve cognitive functioning. With healthcare professionals in short supply, maximizing existing resources should be a priority.

Unintentional Errors

Third-party applications can appear in ribbons. Although the information appears automatically, it is not integrated at level 4 interoperability. When users decide to select information from an application, they must remember to enter the information into the patient’s EHR. The data does not transfer automatically.

Clinicians can copy and paste the information or re-enter the data manually. This process increases the likelihood of unintentional errors. Physicians may only highlight a portion of the information for copying. If they re-enter the data, they can make typographical errors that go uncorrected. They may not have the time to re-enter the data comprehensively. 

Whatever the reason, the information is not as complete as it would be if the data were automatically placed in the EHR. Poor data quality can impact patient care.

User Acceptance

Successful third-party applications require user acceptance. Consumers caused the financial services industry to adopt organizational interoperability because they refused to open multiple windows to manage their personal finances. Healthcare workers are no different. They want solutions that smooth out their workflows, decrease stress, and improve patient care..

A 2022 survey by the American Medical Association found that physicians place a high value on validated digital health tools that streamline their administrative burdens. On average, physicians use 3.8 digital tools. 93% believe there are advantages to leveraging digital solutions.

The top reasons physicians adopt digital health tools are to:

• Improve clinical outcomes and work efficiency
• Reduce stress and burnout
• Integrate with EHR solutions
• Ensure data privacy

Although healthcare workers see the advantages of digital applications, they want organizational interoperability with their EHR solutions for improved outcomes, increased efficiency, and reduced stress. For application developers, achieving organizational interoperability with an Epic system is essential for user acceptance.

Current implementations may lack the interoperability that users want in their digital tools. They operate outside of their workflows, adding to their cognitive fatigue and burnout. Healthcare professionals will be slow to add or change digital tools—until interoperability reaches level 4.

What Could Level 4 Epic Interoperability Look Like?

Patient visits become more personalized. They don’t pause their conversation to allow physicians to read the information on their screens or move through applications to find what they want. Patients feel heard. Outcomes improve.

With organizational interoperability, AI-based solutions can be integrated into EHR workflow. One example enables physicians to enter patient symptoms as they are reported. An AI-based engine ingests the symptoms and returns with useful insights. It may return a list of questions or suggest added tests to refine the diagnosis. Physicians do not have to use a drop-down to find an application that will provide the information. They do not need to toggle to a new window to view the information. 

When physicians select a course of treatment, the information is automatically placed in the patient’s EHR. Patient checkout is seamless. There’s no waiting while clinicians update the EHR with follow-up instructions. Physicians are not rushed to copy data from other systems, reducing the chance of error. Most importantly, healthcare professionals experience less stress as decisions flow securely through the system. Patient and physician experiences improve, resulting in better outcomes in patient care.

Achieve Organizational Epic Interoperability

Insiteflow’s differentiated EHR decision workflow platform eliminates the constant toggling and context-switching that plagues clinicians today—a primary driver of burnout and dissatisfaction. Our zero-click integration seamlessly embeds third-party insights, recommendations, and documentation capabilities as dynamic elements within clinicians’ active EHR sessions. This proactive surfacing of intelligence within established workflows ensures providers have immediate access to the data-driven recommendations they need, without disruptive application switching. If you’re struggling to reach level 4 interoperability with Epic, contact us to see how we can help.