Epic plans to overhaul its app market, opens new Connection Hub for developers. Here are key things to know

Epic has launched a new online directory for developers while it plans to overhaul its app market to keep up with rapid growth of third-party vendors.

The electronic health record giant announced Dec. 9 that it plans to temporarily shut down its app market and relaunch it later in 2023.

In its place, Epic is launching a Connection Hub, an online directory for vendors to share their ability to interoperate with Epic software.

Software vendors and analysts largely applauded Epic's launch of the Connection Hub as a move to improve interoperability. Epic executives say the new approach will help end users find the "signal in the noise" of a crowded tech market.

The new site, which opens Jan. 9, will allow any vendor with a connection to Epic to list their app and self-report if they have achieved successful data exchange. Site visitors, including Epic customers, can see information provided by the vendor, such as app descriptions and links to websites, according to company executives.

Epic will also launch a vendor services program to provide access to Epic’s newsletters, detailed tutorials, expanded testing sandboxes and technical support.

Connection Hub represents another step in Epic’s ongoing support of open standards, according to Sumit Rana, Epic’s senior vice president of R&D, in a press release.

In 2014, Epic launched its first wave of standard-based application programming interfaces (APIs) through open.epic.

The company now maintains a portfolio of 450 Fast Healthcare Interoperability Resources (FHIR) APIs across 55 resources including the latest R4 version, one of the largest FHIR API portfolios provided by a major EHR developer.

“Epic has a long history of exchanging data with applications,” Rana said. “And Connection Hub expedites vendors’ ability to show Epic customers that their apps can exchange data with Epic.”

Connection Hub will be open to all vendors, while the app market, called the Epic app "orchard," is currently limited to app market participants. 

"There was this misconception and market confusion around what did it mean to be in the app market. Some folks thought it was co-development with Epic, or a seal of approval from Epic or a recommendation from Epic. It never really was meant to be to that level," Nate Bubb, technical services lead at Epic, said in an interview.

"What customers really wanted to know is which vendors and which products have actually gone live with another Epic customer, so I'm not the first one. The Connection Hub is open to all. If you've connected your product to Epic, you can report that you've done so on the new listing. That's the main goal, to give customers that information about who is live and who has gone before. You don't have to be in a program with Epic. As long as you've connected your software to Epic, you can go ahead and self-report your connection there for the world," he said.

While the app market is paused, vendors currently in the app market will automatically transition to vendor services.

According to Epic executives, no connections will be impacted and vendors receiving services, APIs and testing tools in the app market will continue to do so via vendor services. For those vendors currently listed with a live connection in the app market, Epic will provide a simple way for them to transfer their existing information to the connection hub.

More than 1,000 vendors will move over to the Connection Hub program, Bub said.

"Whenever we get to reopening the app market, I think it'll be a smaller, more focused program," he said. "Today, we have over 800 groups in the app market. I think it'll be a smaller, more focused community. So we can spend a little bit more time with groups in that program."

Epic launched the "app orchard" store in January 2016 to enable third-party vendors to connect with Epic customers like hospitals and health systems. A revamp of the app orchard is now necessary as more applications have connected to its API.

"When we first started in the first year or two, it was a handful of groups. And actually, it was customers," Bubb said. "Something about the 'app orchard' and app market history that some folks didn't realize is we created the original app orchard for customers to share their own custom apps and content with other Epic customers. It was just a small group. Once we grew to 800-plus now at this point, the scale just became too large."

Healthcare executives wanted clarity on third-party apps that connect to Epic, and launching the Connection Hub provides more information, he noted. 

"I think the challenge has been on CIOs and CEOs that are trying to do best for their health system. And they say, 'I just see a world of noise out there of different apps and who's innovating, who's not.' And I think the brass tacks question that usually is helpful to give more signal to our customers is 'Has this group connected their product to another Epic system?' And that's really what the Connection Hub serves for."

Revamping the app market as a "smaller, more focused" program helps clear up the ongoing market confusion, Bubb noted.

Epic hasn't yet determined which apps will get selected for its renovated app orchard.

"We'll be talking to different customers and we'll be talking to vendors, getting feedback and gauging the industry and the market. I don't know if we'll focus on a particular market segment. It's still a bit up in the air," he said.

Rather than a tightly curated collection of developers that Epic has worked closely with and was willing to vouch for, Epic's app market has exploded in size, noted Alex Lennox-Miller, lead healthcare analyst at CB Insights.

As healthcare becomes more digitized and the federal government, through recent regulations, is pushing for the industry to open up access to patient data, Epic is confronting the realities of interoperability and its ability to control the ecosystem, Lennox-Miller noted.

"Epic has been struggling against the tides of interoperability for years, instead trying to keep their walled garden and maintain their control over data. This changeover represents Epic's concession to the realities of the health IT ecosystem going forward," he said in an interview. "In general, this is a good thing."

Epic is taking steps to set up more "rational governance criteria" for the tens of thousands of developers who want to connect to Epic's EHR and to end users such as hospitals and health systems, noted David Lareau, CEO at Medicomp, a healthcare tech company that provides point-of-care solutions.

He added, "Epic has been accused of not wanting to interoperate with other systems for years. I think this is a great answer to that accusation. It remains to be seen how it plays out but I'm very encouraged by what I've seen so far."

However, with the new Connection Hub and a revamped app market, Epic will establish a "strict boundary between generic interoperable apps, and their chosen app partners," Lennox-Miller noted.

"With the self-reporting elements of the Connection Hub, Epic customers will need to do significantly more careful due diligence, ensuring that apps have the kind of privacy and data security they expect from healthcare vendors," he said. "With recent revelations about the use of reporting pixels in virtual care vendors, healthcare organizations are confronting the fact that relying solely on HIPAA and existing regulations isn’t enough to protect patient data."

Market forces are pushing EHR companies to become more interoperable with third-party developers, noted 

A healthcare regulation that went into effect last year gives patients easier access to their digital health records through their smartphones. The regulation requires health IT vendors, providers and health information exchanges (HIEs) to enable patients to access and download their health records with third-party apps. Under the rule, providers can't inhibit the access, exchange or use of health information unless the data fall within eight exceptions.

The Department of Health and Human Services' (HHS') Office of Inspector General finalized penalties of up to $1 million per instance of information blocking by HINs, HIEs and certified developers of health information technology. However, civil monetary penalties for provider organizations that engage in information blocking have not been defined, creating an “enforcement gap.” 

At the same time, software giant Oracle bought Epic competitor Cerner this year, and Chairman Larry Ellison has made it clear that he wants to evolve Cerner into a nationwide clinical data platform.

"Everybody in the industry has to up their game to open up their architectures so people can add functionality to the platforms that they provide," Lareau said in an interview. "We stopped thinking about Oracle Cerner and Epic and Meditech and CPSI as EHRs and instead think of them as a platform for patient care."

He added, HHS is now "forcing people to open up their systems for interoperability and not just the exchange of data, but for very specialized uses of this data."

With the new connection hub and vendor services, Epic is putting in the structure to "become a healthcare platform, not just a billing-type platform," he noted.

"We're very encouraged by it, and I certainly will open up great possibilities for people to add functionality to these systems," Lareau said.