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
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 Care Everywhere can find a unique high-confidence match, it returns the matching patient. Care Everywhere 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
In this scenario, a patient presents to an Epic system, and a user needs to match the patient in an external system. Care Everywhere sends a subset of patient demographics to the external system, which responds with the patient who matches the query. Care Everywhere confirms the match, usually through the user, and then report back the user's actions. Care Everywhere 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
- Care Evolution
- Cerner, Cerner HIE
- CONNECT (DoD, VA, SSA)
- eHealth Data Solutions
- MDI Achieve
- No More Clipboard
- Optum Insight (Axolotl)
Sending Clinical Documents (Direct)
read the spec
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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Care Everywhere is used to exchange patient data with other healthcare institutions, HIEs, and government agencies during point-of-care treatment and care coordination workflows. 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)
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.
Incoming External Clinical Data
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As organizations extend Epic to affiliated practices in their communities, there has been an increasing need to convert historical patient-level data from other vendors' systems into Epic. This interface allows organizations to load patient-level data from organizations that do not otherwise support standards-based data exchange.