Editor’s Corner—Why the Biden-Faulkner exchange over EHR access touched a nerve

Joe Biden
Biden's contentious (or cordial) exchange with Epic CEO Judy Faulkner showed just how much EHR access has become a basic priority.
Evan Sweeney

It’s hard to say exactly what transpired at that January meeting between then-Vice President Joe Biden and Epic CEO Judy Faulkner.

What we do know is that it triggered a visceral online reaction over the importance of interoperability and access to health data—and even some Twitter threads on the nuances of HIPAA. But that might be more telling about where the industry currently stands and the direction it’s quickly heading.  

It began last week when Politico recounted the exchange between Biden and Faulkner as told by the vice president’s aide Greg Simon, who now serves as president of the Biden Cancer Initiative. The short version: Faulkner reportedly asked Biden why he wanted 1,000 pages of medical records to which Biden retorted, “None of your business.”

“It went downhill from there,” Simon said.

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The story developed more on Monday, when former White House Chief Technology Officer Aneesh Chopra told CNBC the meeting was cordial and there “was a motivation and desire to work together to improve data access.” An Epic spokesperson told Health IT News that the company “supports patients’ rights to access their entire record,” adding that Biden was “consistently polite and positive” during the meeting.

By then, Twitter had worked itself into a full lather. Many were particularly incensed at Faulkner’s insinuation that that length and complexity of a medical record somehow rendered it useless to patients.  


Other’s argued that there was a bigger issue at play regarding the ecosystem of EHRs.

The reactions to Biden’s exchange with Faulkner may say more about the state of health IT than the interaction itself that was either contentious or cordial, depending on who you ask. There’s still a lot of frustration over the amount of money invested in EHR adoption and the fact that interoperability is still a challenging task.

At the same time, the vast majority of the industry is embracing the concept of replacing medical paternalism with patient-centered care, and more healthcare consumers are recognizing the benefits of having all of your health information at your fingertips.

In other words, demand is growing, but healthcare is still short on supply. That might explain the visceral reactions.

This week, Chilmark Research analyst Brian Eastwood argued that the debate over patient access to data revolves more around culture than software, and that’s probably true. Embracing the idea that patients should be able to access their medical record is a basic hurdle before anyone can tackle the technology that can make that happen.

But the heated debate that followed shows how much people across the healthcare industry see this as a core priority. It may not have infiltrated every corner of the ecosystem, but it touched a nerve that was far more basic than the technical minutia of interoperability or data standardization. It’s clear that the broader notion that patient records aren’t just the property of the health system—or even the software vendor—is carving out a substantial role in healthcare’s ongoing transformation. Any insinuation to the contrary is seen as shortsighted.

Clearly, it's not ubiquitous yet, but there’s a strong undercurrent pushing the industry beyond the question of why patients might want their data and into the how. Perhaps that's a small measure of progress. - Evan | @DB_Sweeney@FierceHealthIT