Small enough to care, big enough to get the job done
Kirkland, WA
Joined September 2018
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Drug prices are about to show up before a prescription is sent, not at the pharmacy counter. Planned for summer 2027.
Affordability is becoming part of the clinical conversation.
2027 is the year prior auth stops being a portal job.
Payer APIs are due January 1. The API alone won't fix it. The workflow around it has to work.
Open@Epic wrapped up last week in Verona.
Most of it was for developers. The direction it points to lands on hospitals.
What came out of it, and what to do before 2027:
The vendor ships the core. The hospital owns the edges:
→ every connected app, its access, its logs, its owner
→ billing and payer handoffs for prior auth
→ clinical decision support and third-party tools
→ rules and monitoring for AI agents
Your EHR has a plan. Make sure everything around it has one too.
Full recap and predictions: itirra.com/blog/open-epic-20…
The EHR vendor sets the roadmap.
What's connected around it is still the hospital's job. That part never shows up in the keynote.
Keeping the EHR isn't automatically cheaper.
Compare configuration, an existing module, an intermediary and a custom build on cost, fees, IT effort and who supports it after go-live. Sometimes the right fix isn't new software.
A certified FHIR API is a door, not a promise.
Reading got much easier. Writing back still has to be checked, one EHR and one configuration at a time.
Every manual handoff has a cost you can count: hours on hold, days a referral sits unanswered, pages faxed.
And one that never shows up in a report: the person who stays late to finish it.
Friday, late afternoon. The patient has been ready to leave since morning. The case manager has faxed the same packet to every facility on the list.
Someone down the hall says it: we need a new EHR.
Usually, you don't. Here's why.
Where it gets hard: smaller platforms, heavily customized builds, data that lives outside the EHR, writing back instead of just reading, and approvals before go-live.
Better to find those in discovery than three months into the build.
The EHR isn't going anywhere. The fax machine can.
Full breakdown, with the limits and a discovery checklist: itirra.com/blog/ehr-workflow…
