Building Integrations with Epic EHR: Navigating Complexities

Continuing from our deep dive into healthcare interoperability, it’s time to focus on Epic’s Electronic Health Record (EHR) platform. Epic is a cornerstone in the US healthcare industry, known for its extensive functionalities and widespread adoption. However, integrating Epic with other web-based software presents unique challenges and opportunities. Epic EHR uses some dated solutions for interoperating, and each instance of it may behave differently, and offer different interfaces. Depending on the developer’s market strategy, they need to decide whether to build a direct integration to Epic, or connect through an integration engine such as Redox.

This blog post will guide you through the challenges of building integrations with Epic, providing valuable insights for those looking to enhance their healthcare systems through seamless data exchange.

Epic’s Legacy and Technological Backbone

Epic Systems Corporation, founded in 1979, has been a stalwart in healthcare technology for decades. This long history translates into a wealth of experience but also perpetuates a reliance on legacy technologies, particularly the HL7V2 standard. HL7V2, a messaging standard for healthcare data exchange, predates modern internet protocols like HTTP. This means Epic’s integration ecosystem is deeply rooted in a technology that, while mature, can be inflexible to use and hard to maintain due to its dated, non-human-readable formats.

HL7V2’s complexity lies in its message structure, which can be difficult to parse and integrate with web-based systems that use newer, more flexible standards like JSON or XML. Despite this, HL7V2 remains widely used because of its established presence in the healthcare sector. Epic’s reliance on this standard requires integrators to have a deep understanding of HL7V2, along with the ability to translate these messages into more modern formats compatible with contemporary web technologies.

Recognizing the need for more modern interoperability standards, Epic developed the "Epic on FHIR" interfaces. FHIR (Fast Healthcare Interoperability Resources) is a newer standard designed to facilitate easier and more efficient data exchange. FHIR has made data exchange easier and more efficient in several ways:

Standardized Data Formats: FHIR uses modern data formats like JSON and XML, which are widely understood and easier to work with compared to the more complex HL7V2. This simplification reduces the learning curve for developers and improves interoperability with other web-based systems.
RESTful APIs: FHIR leverages RESTful API principles, making it easier to integrate with modern web applications. RESTful APIs are stateless, scalable, and can be easily consumed by any system capable of making HTTP requests, facilitating seamless integration.
Modular Resources: FHIR is built around modular resources that represent granular pieces of healthcare data (such as patients, observations, and medications). This modularity allows developers to access and manipulate only the specific pieces of data they need, improving efficiency and reducing the complexity of data exchange.

However, the Epic on FHIR endpoints are currently limited primarily to search and read operations. This limitation means that while developers can easily retrieve data from Epic systems, they face significant challenges when attempting to perform more complex operations like writing or updating data. Thus, while FHIR represents a step forward in modernizing Epic's integration capabilities, in most integrations, some use cases will need to be solved through the less modern and standardized but highly customizable HL7V2 interfaces.

Customization and Variability in Epic Instances

One of the unique aspects of Epic is that each customer—be it a hospital, clinic, or healthcare organization—operates its own unique instance of the software. These instances are highly customized to meet the specific needs and workflows of the individual organization. This customization extends to the interfaces used for integration, meaning that no two Epic instances are ever exactly alike.

This variability poses significant challenges for integration work:

Developers must tailor their solutions to the specific configurations and requirements of each Epic instance.
Testing environments can often only simulate the integration for one particular instance, making it difficult to generalize the solution for other instances, and their future developments which may not be backwards compatible
Thus any solution developed against a specific instance of Epic, is tied to it and cannot gain market share until integrations with other Epic instances are developed (never mind competing systems!)

For developers looking to test integrations with Epic, there are a few options available.

Open.epic provides a public sandbox that primarily offers the FHIR interfaces, allowing developers to experiment with and understand the basics of Epic's FHIR capabilities. However, this public sandbox is limited and does not provide the full range of Epic's integration capabilities, particularly the HL7V2 interfaces.
Vendors registered with Epic, for a fee, gain access to a private test instance. This private environment is capable of offering custom HL7V2 interfaces, providing a more comprehensive testing platform. However, it's important to note that even these private test instances might not fully represent the interfaces that all customers of Epic have available. The specific configurations and customizations of each customer's Epic instance can result in significant differences in how integrations function, necessitating additional testing and adaptation for each unique deployment.

Direct Integration vs. Using Integration Engines

When developing a solution intended to integrate with a single Epic customer or partner, direct integration can be a viable approach. This allows for tailored, specific solutions that leverage the unique capabilities and configurations of that particular Epic instance. However, if the goal is to create a solution that works across multiple Epic instances, the complexity and cost of maintaining direct integrations can become prohibitive.

In such cases, utilizing an integration engine like Redox becomes a cost-effective and scalable solution. Redox serves as a middleware layer that standardizes data exchange between Epic and other web-based applications. By handling the complexities of different Epic instances and their unique interfaces, Redox allows developers to focus on building functionality rather than dealing with the challenges of each Epic integration. This approach not only reduces development time and costs but also enhances maintainability and scalability, ensuring that the solution can adapt to future changes in Epic’s systems or the broader healthcare interoperability landscape.

Light-it has acquired experience both building integrations directly against individual instances of Epic EHR, as well as connecting applications to Epic and other instances in a generic way, using integration engines like Redox. Get in touch if we can help you find the best solution for your use case.

Conclusion

Integrating with Epic EHR presents both challenges and opportunities. Epic’s reliance on legacy technologies like HL7V2 requires a deep understanding of these standards, while the customization of each Epic instance demands flexible and adaptive integration strategies. For solutions targeting a single Epic instance, direct integration can be effective, but for broader applicability, using an integration engine like Redox is often the most efficient approach.

By keeping these points in mind and adopting the right strategies, developers and healthcare organizations can build robust integrations with Epic, enhancing interoperability and ultimately improving patient care. As you embark on your journey to integrate with Epic, consider the unique requirements and challenges discussed here to ensure a successful and sustainable integration.