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Navigating Through the Muddy Interoperability Waters

October 16, 2014
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Early last week, the Orem, Utah-based KLAS Research released a much-anticipated report on provider organizations’ journeys towards greater interoperability. Certainly this has been a hot topic of late in the health IT space, as many in the industry have been growing increasingly frustrated with the lack of progress in that area.

In fact, you don’t have to look far to sense the industry’s dissatisfaction. Most recently, the eHealth Initiative’s 11th annual data exchange survey found that health information exchange (HIE) organizations are still struggling with interoperability issues. Another survey from Software Advice found that more than half of users surveyed (56 percent) responded that integrating their EHR with other systems presented a "major" or "moderate challenge." And in the Office of the National Coordinator’s (ONC) annual report that it filed to Congress this week, it touted an enhanced focus on interoperability, but admitted that “electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.”

It doesn’t stop there. A recent New York Times piece essentially singled out Epic Systems for the industry’s lack of EHR interoperability. Our Senior Editor Gabe Perna captured this “blame game” point excellently in his blog, stating that due to the current culture of accountability in today’s society, there must be a scapegoat for everything that goes wrong or doesn’t work.

Now, back to the aforementioned KLAS report, which found that 82 percent of the 220 interviewed providers reported feeling at least moderately successful achieving interoperability, with just 6 percent of those providers reported having achieved an advanced state. However, less than half of providers said their vendor cooperates well with other vendors, instead attributing interoperability success to their own doing rather than their EHR vendors.

What’s more, in the NYT piece, the author—despite focusing mostly on the barriers to the sharing of digital medical records—actually mentioned the KLAS report. “In interviews with nearly 200 providers for a study that will be released in early October, executives at the research firm Klas said Epic’s scores were “as good or better than most of the other vendors” in its ability to share information with other systems. Moreover, at the request of Epic executives, several customers, including the Cedars-Sinai Health System in Los Angeles, the Yale New Haven Health System, and New York’s Mount Sinai Hospital, sent emails to The New York Times saying they were able to share records through Epic.”

If you’re confused, I don’t blame you. I was too. I asked myself, how could providers be so frustrated with interoperability, yet report success? Why would the NYT point a finger at Epic, but then bring up the fact that its customers are mostly satisfied with its ability to integrate with other systems?  After talking to Colin Buckley, lead author of the KLAS study, the muddy interoperability waters started to become a little clearer for me.

Specifically, Buckley had one quote that really stuck out: “Often we think about what interoperability should be, theoretically, but the more important question is, what are the needs of providers? That’s s a key in all this.” That tells me that “success” is relative—it depends on the size and type of the organization, its goals and expectations, and most importantly, its individual needs.

Listen, I’m not going to tell you today that interoperability isn’t a significant challenge for many patient care organizations—it is. Nor will I say that the frustration we have seen from so many doesn’t have validity—it does. But it’s important to keep a rational viewpoint, and realize that if the vendor’s customers are satisfied, that probably means more than what the rumor mill might be telling us or what we read in the mainstream media.

Buckley adds, “Epic gets a lot of criticism for having a walled garden, but when you actually talk to their customers, they feel pretty successful. And some of the things they’re doing are not as complex as a Cerner, but the customers’ needs are being met.”