The Information Exchange: Trends in EHR, Antitrust Law, and Prior Authorization
The Information Exchange: Lumon on Steroids - Health API Guy
Summary
The article discusses the competitive landscape and standardization efforts surrounding major systems of record like Epic Systems. Key focus areas include CMS's addition of a new category for electronic prior authorization (Prior Auth), its impact on FHIR/X12 standards, and the connection to antitrust law.
Details
This is a summary of a podcast episode covering broad topics in healthcare information exchange. Major points discussed include the shift in behavior from long-standing industry leaders like Epic Systems, noting their increased marketing efforts and media presence (e.g., Judy Faulkner's media tour). A key technical discussion highlights that counting APIs does not measure openness; instead, the developer experience offered by vendors like athenahealth is crucial for true interoperability. From a policy perspective, CMS announced electronic prior authorization as a new pledge category. The article analyzes the implications of this change on the X12/FHIR standards scales and which clinical data networks are involved (b.well, CommonWell, eHealth Exchange, Kno2). Furthermore, it discusses how prior authorization sits at the intersection of administrative and clinical processes, influencing standardization direction. Legally, the article delves into the antitrust litigation against Epic (AADJ v. Epic), emphasizing that information blocking and structural issues inherent in systems-of-record EHRs are critical points for plaintiffs. These developments provide insight into the evolving competitive environment and regulatory trends governing medical data exchange.
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