A KLAS examination of 420 healthcare organizations has revealed that while the number of providers engaging in “deep” interoperability has increased, the overwhelming majority are still not reporting interoperability success.
As defined by KLAS executives, “An organization is counted as having reached ‘deep interoperability’ if they indicate one of two optimal responses in all four interoperability stages. The deep interoperability rate refers to the percent of interviewed organizations within each vendor’s customer base that (1) often or nearly always have access to needed data through any interoperable means; (2) are able to easily locate specific patient records or have them automatically presented to clinicians; (3) have the retrieved patient data fully integrated into the EHR’s (electronic health records) native data fields or in a separate tab or section within the EHR; and (4) believe retrieved patient data often or nearly always benefits patient care to the extent that it should.”
The report found that the percentage of healthcare organizations reporting deep interoperability when sharing data with disparate EHRs has more than doubled, from 6 percent in 2016 to 14 percent in this year’s update. But, importantly, the remaining 86 percent have yet to report this success. Even the most successful customer base, that of athenahealth, sits at only 23 percent.
When sharing with organizations using the same EHR, Epic customers are easily the most advanced, with 51 percent reaching deep interoperability. In general, regardless of vendor, organizations sharing data with others using the same EHR maintain a head start; 26 percent have achieved deep interoperability—up 2 percent from last year, according to the KLAS data.
When sharing data with organizations on the same EHR, Epic’s 51 percent deep interoperability rate ranks significantly ahead of the next best vendor, athenahealth (34 percent). And when sharing data with providers on disparate EHRs, athenahealth’s 23 percent deep interoperability rate slightly ranks higher than the next two on the list—GE Healthcare (22 percent) and Greenway Health (20 percent).
KLAS has been tracking interoperability progress for a few years now. In last year’s report, they key finding was that just 6 percent of providers reported that information accessed from exchange partners on a different EHR is delivered in an effective way that facilitates improvement to patient care. The research last year found that the low rate of impactful exchange started with availability; respondents reported reasonable access only 28 percent of the time. In this sense, it’s noteworthy that providers are now reporting that reasonable access has become easier.
Bob Cash, vice president of provider relations at the Orem, Utah-based KLAS Research, says that while the 6 percent to 14 percent jump is noteworthy, the more significant takeaway is probably that 86 percent of surveyed providers still are not experiencing full interoperability. “We did see tremendous progress in access [to data], and I find that really interesting,” Cash says. “So the opportunity for deep interoperability has increased, and that’s good news. The bad news is that it has not translated readily into an impact on care. And the most obvious reason for that is that people are frustrated that the data they are getting is not as useful as it could be. There is either too much, too little, or it’s unwieldy. So the challenge is now getting that information into a form that is useful,” he says.
Cash brings up the idea that providers’ interoperability expectations have increased, from even just a year ago. “Providers are probably thinking, ‘We have been at this for a while, so we ought to get information that’s more impactful. It should be easier than it is,’” he says.
Breaking Down the Vendors
Cerner, a vendor that is considered a top rival to Epic, rates seventh among all vendors for deep interoperability when providers are only using the Cerner system, while rating 8th among all vendors when providers are using disparate EHRs. That being said, Cerner and athenahealth clients have the most consistent access to outside data from different EHRs. KLAS researchers noted that some increases here have come for non-technology reasons, such as organizations joining existing HIEs (health information exchanges), establishing new exchange agreements with competitors, or increasing adoption by clinicians.
Indeed, as in previous years, public, private, and vendor-sponsored HIEs continue to be important methods for sharing data. In 2017, two complementary initiatives, CommonWell and Carequality, have brought new energy to this topic. While most EHR vendors have been long-time members of either or both initiatives, this is the first year that a significant number of provider organizations reported being live participants.
Cash says he was surprised that Cerner rated on the low end, once again pointing to users’ increased expectations with limited results to date. However, he notes that there is “still a lot of hope from Cerner customers around CommonWell. And you saw from the top-of-mind responses from folks, Cerner has far and away the most providers already using or anticipating to use CommonWell. You can tell from those conversations that some vendors or promoting these options more than others, and the difference in terms of the experience is just not prevalent yet,” Cash says.
Certainly, vendors have made a difference by providing access to new networks via CommonWell or Carequality (athenahealth, Cerner, Epic), offering multiple sharing options (Allscripts, Cerner), or simplifying interoperability workflows (athenahealth, NextGen Healthcare). Due to cost, a lack of EHR development, and insufficient vendor support, eClinicalWorks and McKesson customers saw the lowest levels of improved access, per the data.
To this point, as providers gain increased access to outside data, they begin to hit a wall in terms of the value of that data. Some customer bases that have been the most successful in gaining access, including those of athenahealth, Epic, and GE Healthcare, are less likely to feel that patient data is consistently helpful than they were in 2016. Time-pressed providers say the overwhelming volume and cumbersome format of shared data—which typically takes the form of CCDs/C-CDAs and static documents—make searching for needed data impractical. In reaction, providers identify insufficient industry standards and poor usability of tools as today’s top barriers to interoperability. Allscripts and NextGen Healthcare customers “buck the trend” of higher access resulting in low impact; Allscripts customers tout dbMotion’s facilitation of care, and NextGen Healthcare’s clients give a broad range of reasons for the strong impact they achieve.
Other recent research has also pointed to the fact that few providers are able to engage in deep interoperability. A paper recently published in Health Affairs from notable health IT researcher Julia Adler-Milstein, Ph.D., and others, revealed that only about one-fifth of U.S. hospitals were engaged in all four of interoperability’s primary domains—electronically finding, sending, receiving and integrating information into EHRs. It should be noted that for this research, the data that was used was from 2014 to 2015, making it more outdated than this latest KLAS report.
This paper also concluded that, “It is also possible that the one-fifth of hospitals engaging in the four primary interoperability domains included a unique set of early adopters and that remaining hospitals are moving slowly because of limited health IT capabilities or weak incentives to share patient data.”
When asked if KLAS will dig deeper into studying the business incentives around interoperability, both from a provider standpoint and a vendor one, Cash says there are no plans in place to do so, but adds that a key point has to do with the type of provider. He explains: “If I am in an urban market and I have to interface with a lot of different healthcare organizations using different EHRs, then [interoperability] is more important. I will have more interactions and touch points, and I will have a large clinician population who uses different EHRs to interact with. That will be more prevalent in an urban setting, and less so in a rural setting,” he says. He also points out that some ambulatory setting providers still prefer using an e-fax, or even a phone call to share patient information. “So yes, the business incentive point is a valid one, but a real part of this is that we haven’t made it easy enough,” he says.