EHR to EHR
EHR to EHR clinical information interfaces are typically used between two clinical systems looking to exchange patient-specific information. They include both the transport standards for clinical information exchange and the format and content of the information exchanged. Many of the interoperability requirements for Certified EHR Technology for Meaningful Use are covered by this section. Check out our supported standards to learn more.
Outgoing interfaces refer to interfaces in which the Epic system sends the message. Incoming interfaces refer to interfaces in which the Epic system receives the message.
Incoming Patient Discovery
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In this scenario, an external system has a patient that it is attempting to match in an Epic system. The external system sends a subset of patient demographics and if Epic can find a unique high-confidence match, it returns the matching patient. Epic implements all transactions required in the IHE Technical Framework to support the IHE Cross-Community Patient Discovery Profile as a Responding Gateway.
Outgoing Patient Discovery
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In this scenario, a patient presents to an Epic system, and a user needs to match the patient in an external system. Epic sends a subset of patient demographics to the external system, which responds with the patient who matches the query. Epic confirms the match, usually through the user, and then report back the user's actions. Epic implements all transactions required in the IHE Technical Framework to support the IHE Cross-Community Patient Discovery Profile as an Initiating Gateway.
Cross-Community Access (XCA) and Cross-Enterprise Document Sharing (XDS.b)
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The process of exchanging clinical documents is handled through a series of messages exchanged via standards-based SOAP Web services. Because organizations that use Epic software are often the size of regional HIEs themselves, interoperability with the Epic EHR requires no centralized infrastructure. Instead, the EHR acts as a document repository itself for point-to-point queries. Specifically, the EHR supports IHE XCA and IHE XDS.b Query-Response.
Current integrations include 
- ACS/Xerox
- Agilex
- Allscripts
- Apenimed
- Athena
- Caradigm
- Care Evolution
- Cerner, Cerner HIE
- Certify
- CodoniX
- Coldwater
- CONNECT (DoD, VA, SSA)
- Covisint
- dbMotion
- eClinicalWorks
- eHealth Data Solutions
- GE
- Greenway
- Harris
- ICA
- Inpriva
- InterSystems
- Magellan
- MDI Achieve
- MedFx
- Medicity
- Meditech
- Mirth
- MobileMD
- NetSmart
- NextGen
- No More Clipboard
- Optum Insight (Axolotl)
- Orion
- Qvera
Sending Clinical Documents (Direct)
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Epic's EHR supports document exchange via the
Direct protocol. Documents sent from an Epic EHR via Direct follow the XDR/XDM option, in which structured documents are sent in the message with structured metadata. Similarly, Epic receives structured documents to file to the appropriate chart. External provider directories containing Direct addresses can be imported into the Epic EHR using a
standard format. While Epic software supports the full SMTP+S/MIME stack, organizations using Epic can alternatively choose to delegate duties to an external HISP. Providers use the EHR to push data using Direct, and patients can use their portal to send structured clinical summaries to any arbitrary Direct endpoint with which the organization has established trust.
Clinical Document Architecture (CDA)
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When exchanging patient summary documents, we use Clinical Document Architecture (CDA) as the content standard. CDA is an XML-based markup standard defined by Health Level Seven (HL7), intended to specify encoding, structure and semantics of clinical documents for the purpose of exchange. Care Everywhere supports the exchange of document defined in the Consolidated CDA (C-CDA) framework, which is required for ONC 2015 Edition certification for Meaningful Use.
- Epic's EHR can consume any valid C-CDA or CDA document.
- Epic's EHR can create the following documents:
- HL7/ASTM CCD (HITSP C32 Implementation)
- HL7/IHE Consolidated CDA (CCD and Progress Notes Template)
Contact us if you have questions about our CDAs.
To facilitate closing the loop on referrals so referring providers can be kept up to date on the treatment received by their patients, Epic supports additional elements within Direct messaging using the XDR transport method. These additional elements indicate Direct messages which include a specialist report generated during the care of a patient who has been referred to an organization outside their primary care organization.
360X Closed Loop Referrals
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360 Exchange Closed Loop Referrals (360X) is an industry and government supported standard specification for referrals that allows the exchange of patient referral data between different EHR environments. Epic and non-Epic organizations whose EHR systems meet the specification’s requirements can exchange 360X referrals.
ImagingStudy (R4) and Endpoint (R4)
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Diagnostic Image Exchange allows electronic health record (EHR) and image exchange vendors to exchange of full diagnostic-quality DICOM® images for a shared patient. Responders use the HL7® FHIR® R4 ImagingStudy resource to describe the imaging studies available for a patient, and the Endpoint resource to tell the requester where to retrieve the images using WADO-RS. This service is available only for treatment, and only to organizations that have a point-to-point connection with a healthcare organization that uses Epic.
Diagnostic Image Exchange allows electronic health record (EHR) and image exchange vendors to exchange of full diagnostic-quality DICOM® images for a shared patient. Requesters use the DICOMweb™ WADO-RS Retrieve Instance transaction to retrieve individual DICOM instances from Epic. This service is available only for treatment, and only to organizations that have a point-to-point connection with a healthcare organization that uses Epic.
