Only 6 percent of healthcare providers reported that information accessed from exchange partners on a different electronic medical record (EMR) is delivered in an effective way that facilitates improvement to patient care, according to KLAS’ Interoperability 2016 report.
Using the interoperability measurement tool defined and agreed upon by both healthcare providers and health IT vendors in October 2015, KLAS was able to publish their 2016 interoperability findings last week. In sum, more than 500 interviews revealed, in detail, something that most clinicians know today: between-organization sharing of medical records is happening only in pockets and is often frustrating for clinicians. This report, “Interoperability 2016: From a Clinician View - Frustrating Reality or Hopeful Future” focused not on the number of records shared, but on whether clinicians have the interoperability they need.
Clinicians are quick to report that interoperability is more than just access to outside patient records. For interoperability to move the needle on better care, outside records must be (1) available, (2) easy to locate, (3) within the clinician workflow, and (4) delivered in an effective way that facilitates improvement in patient care. In reality, a provider might reach any one of the four “bases” independent of the others, but a true “home run” is a best-case scenario in which all four criteria are met.
To this end, the KLAS research found that the low rate of impactful exchange starts with availability; respondents reported reasonable access only 28 percent of the time. When the aspect of easy-to-locate available records is included, the affirmative response rate drops to only 13 percent, and when the requirement of receiving and locating that data in the clinician’s workflow is added on, 8 percent of providers remain. Considering the challenges associated with access, location of records and ease of use within the workflow, the 6 percent rate of providers meeting all the previous criteria and positively impacting patient care is easier to understand, the KLAS researchers noted.
Researchers also questioned healthcare providers about their experiences with CommonWell and Carequality, initiatives designed to promote data sharing. Providers reported optimism about the potential of these initiatives to dramatically improve nationwide interoperability. These organizations reported nearly universal optimism that CommonWell is a game changer. Each initiative claims thousands of participating providers, while KLAS validation efforts indicate a relatively small subset of providers are actively sharing data today.
Further, effective sharing of information happens, on average, six times more between organizations on the same EMR product than between organizations with different EMR products. Every provider in this report who has achieved successful sharing has had less success exchanging with providers who use different vendors than their own. Some reasons for this stronger performance include compatibility, familiarity, and shared access.
What’s more, both acute and ambulatory care settings see significant and strikingly proportional deficits in usable, useful information exchange. According to the researchers, some might think that the broad scope of the acute care setting’s exchange needs compared to the more narrow focus for ambulatory care would lead to different overall success in record sharing. However, 2016 results show that clinicians in ambulatory care view interoperability to be nearly as poor as clinicians in acute care. One exception is how they view the perceived impact on care—ambulatory facilities place high value on low volumes of specific data, such as results and discharge notes.
From a vendor standpoint, reporting unmatched results in “home runs,” Epic customers are in a league of their own when it comes to sharing with each other; success is average when exchanging with different EMRs. athenahealth and Cerner customers also show a higher level of success with same-vendor sharing, according to the data. Meanwhile, customers of athenahealth and Greenway—the two vendors whose customers report the most success sharing with different EMRs—achieve less than a 15 percent home-run rate.
The ability, or inability, of providers to reach certain bases is not always tied to EMR vendor performance. In this study, satisfaction ratings for how well vendors support interoperability were some of the lowest in any area KLAS measures. Even vendors with above average same-vendor interoperability ratings are just average when it comes to sharing with different EMRs. athenahealth has the strongest overall showing, topping the list in sharing with different EMRs and earning comparatively high marks for sharing between customers. Users of most other vendors consistently report getting less help in accessing data from different-vendor EMRs. Epic shows the most dramatic difference between the two types of sharing; this is more the result of high same-vendor success than low different-vendor experiences, according to the research.
Finally, when providers are asked what key solutions or services are facilitating exchange beyond their EMR, the most frequent response is some form of public HIE. Although public HIEs are the most prevalent, they are not the most satisfying. As a group, public HIEs are rated the lowest of the major facilitators. Providers cite challenges with integration, record location, and cost. Usage varies—some hospitals can only send data out, and clinics are sometimes unable to locate the data they need. Other exchange options, such as interface engines and HISPs, are often not top of mind but are appreciated for their simplicity and reliability. Overall, facilitator vendors are rated higher than EMR vendors for supporting interoperability.
“There is widespread agreement that a high level of interoperability across different EMRs is imperative to improving patient care. This report illustrates the considerable amount of work that still needs to be done in order to achieve impactful record exchange. We learned that challenges related to effective sharing, especially with a different EMR vendor than your own, are experienced across all facility types and across all vendors,” said Bob Cash, vice president of provider relations at KLAS. “No vendor community stood out as exceptional in consistently and effectively sharing with partners using a different EMR. The good news? Vendors and providers seem committed to working through challenges identified in the study, and this year’s findings will serve as a baseline for tracking progress in coming years.”