Ask an intake coordinator how they get a hospital’s records and, if the hospital runs Epic, the answer is usually EpicCare Link. It is a good answer. It is also an answer to a narrower question than the one the start of care actually asks, which is how to get the patient’s records, from everywhere they are, before the visit.
This is a plain comparison of the two routes a community provider has to a patient’s outside record: a portal account at each health system, or one query to the national networks. They are not rivals. Most agencies that have the first still need the second.
What EpicCare Link is
EpicCare Link is Epic’s web portal for organizations outside a health system that need to see its patients’ charts: referring physicians, post-acute providers, home health and hospice agencies, payers. Each health system runs its own instance and decides who gets in. A home health agency that takes referrals from that system applies for access, signs the system’s agreement, names a site administrator, and once approved can look up the patients referred to it and read the chart as the hospital’s own staff see it: notes, results, medications, the discharge summary as it is written.
Several things about it are genuinely good. The chart is live; a lab resulted an hour ago is there. Some health systems let community users place orders or send messages to the care team. And it costs the agency nothing but the paperwork.
What getting it involves
Everything about EpicCare Link is per health system, because every health system is its own Epic customer.
The application is the system’s own form. Several systems require the agreement signed in ink, with electronic signatures explicitly refused. The approval is the system’s own review, and the systems’ own pages put it at two to three weeks from a complete application, with incomplete applications and busy rollout periods taking longer. The account is the agency’s, not the user’s, with named staff added under the site administrator, so staff turnover means account maintenance at every system separately.
An agency that admits patients from four health systems does this four times. A referral from a fifth hospital means a fifth application and a wait, during which that patient’s records come the old way.
What the account shows, and what it cannot
The account shows that health system’s chart. All of it, for the patients the agency is linked to, and nothing else.
It does not show the independent cardiology practice that manages the patient’s heart failure, unless that practice happens to document inside the same Epic instance. It does not show the other health system across the county line, which is on its own Epic, or on Oracle Health, or on MEDITECH, and would need its own application. It does not show the pharmacy’s fill history, or the skilled nursing facility the patient was in for three weeks before the hospital admission. Each of those is a separate source with a separate route.
So the patient’s record, as the clinician needs it on the first visit, is still assembled by hand: one portal, one fax, one phone call per source, by an intake coordinator who has to know where to look.
What a network query is
Carequality and CommonWell are the two national frameworks through which hospitals, health systems, practices and other providers exchange patient documents with each other. Between them they connect most of the hospitals in the country and a large and growing share of ambulatory practices. An organization connected to either can, for a permitted purpose such as treatment, send a query for a patient and receive the documents the other connected organizations hold on that patient: continuity-of-care documents, discharge summaries, encounter notes, results, medication lists.
The query is by patient, not by source. The agency does not have to know that the patient was admitted to the other health system last spring. If that system is connected and the patient matches, its documents come back, named by the organization that released them and dated.
For a home health agency, the route to a network query is either an EHR that has a connection built in or a service that makes the query on the agency’s behalf under its treatment relationship with the patient. There is no per-hospital application, because the trust agreement is with the network, not with each system.
What a network query cannot do
Three things, stated plainly.
It returns documents, not images. A radiology report comes back; the study itself does not. It returns what connected organizations hold; a practice that is not on either network, or one that is connected but configured not to respond to outside queries, is a gap, and the gap shows as a source that returned nothing. And it is a document exchange, not a live view: it is a snapshot of what each source had when it answered, not a window into their system.
None of those is a reason not to use it. They are reasons to know what you are looking at.
When each one wins
EpicCare Link wins for the health system that sends the agency most of its referrals, when the agency needs more than documents: live results during the episode, the ability to message the hospitalist, or orders. One application for the dominant source is worth two weeks.
A network query wins for everything else, which for most patients is most of the record. The second health system, the specialists, the prior facility, the sources the coordinator did not know about. It is one request instead of five applications, and it is available the morning the referral lands rather than three weeks after the first referral from a new hospital.
Most agencies that are serious about starting care on time end up with both: the portal where the volume is, the query for the rest. What changes with the query is that the rest stops being a project.
What the record looks like when it arrives
A query that returns forty documents from six organizations is not yet a record a nurse can use. The useful form is organized for the decision in front of the agency: the face-to-face note, orders, discharge summary, history and physical and medications for a home health start of care; the diagnosis documentation, the history and physical, medications and the last discharge for a structured family caregiving first visit; the intake checklist’s four groups for a PACE enrollment. Each line carries its source and its date, duplicates released by two organizations are one entry, and the sources that have not answered are listed, so what is missing is as visible as what arrived. That is the part Vivlio does, on top of the query.
