Less than half of healthcare providers say their electronic medical record (EMR) vendor cooperates well with other vendors, and only one-fifth are optimistic about multi-vendor industry initiatives such as CommonWell, according to a recent report on interoperability from the Orem, Utah-based KLAS research.
Additionally, 82 percent of the 220 interviewed providers reported feeling at least moderately successful achieving interoperability, but a mere 6 percent of those providers reported having achieved an advanced state. Specifically, Cerner, Allscripts, and Siemens customers mentioned complex, multifaceted connections but did not always rate overall success as high. In contrast, athenahealth, MEDITECH, and NextGen customers feel successful but described common interfaces and less sophisticated capabilities.
What’s more, less than half of providers said their vendor cooperates well with other vendors. Athenahealth was the exception, with almost 85 percent giving above average marks. Epic has recently been scrutinized in the media, but they are among the next five highest performing vendors, along with Allscripts, Cerner, GE Healthcare, and MEDITECH. All had 50-60 percent of customers say they cooperate well. With this backdrop, it’s no surprise that providers are putting little thought or stock into cross-vendor initiatives like CommonWell and Carequality, according to the report’s authors.
Furthermore, some vendors demo fantastic capabilities and wonderful outcomes, but behind the curtain it takes a tremendous amount of work to build and maintain interfaces. Instead of plug-and-play wizardry, providers get to lay bricks. Allscripts, athenahealth, and Epic do the best job of facilitating interfaces and keeping costs down. Vendors rated highest for limiting interfacing costs had only about 55–65 percent of their customers say they did so well or very well, the report found.
The report— "EMR Interoperability 2014: Where Are We on the Yellow Brick Road?"—might come as surprise to some, as healthcare organizations often cite lack of interoperability as one of the main challenges they face. "There has been a lot of public discussion about the lack of interoperability among EMR vendors," said report author Colin Buckley. "The truth is that most providers feel at least moderately successful with interoperability today, but most say that success is due to their own efforts. They wonder how well prepared their vendor will be for the future."
Following the release of the report, Healthcare Informatics spoke further with Buckley about the deeper significance of the study’s findings and the collective state of the industry regarding interoperability. Below are excerpts from that interview.
What are your main takeaways from the comments given by 220 provider organizations on the state of interoperability?
There are two dimensions when it comes to the state of interoperability. From the broadest point of view, a lot of the people we talk to feel pretty successful with what they’ve been able to accomplish so far. And because they are also not working off of a standard of perfection, it’s about what they need to accomplish for today, meaning some sort of internal goal, such as clinical integration or meaningful use. And they feel like they are progressing—more on their own doing than their EMR vendor—but we didn’t see a lot of terrified providers out there.
Most of what we hear regarding interoperability is not very positive. Are you surprised by this study’s findings?
I am. One of the reasons we did this study was to take the temperature of providers. That doesn’t mean there isn’t concern or pressures as they look down the road, however. There is a fair amount of confidence in themselves, but not as much in the technology to meet their needs when they’re ready.
More than 80 percent of providers you interviewed felt at least “moderately successful” achieving interoperability. What do you think that means?
It’s really in the eye of the beholder, but it can be broken up by types of organizations. For example, the EMR vendor you are using can factor into that feeling. For some organizations, their needs for interoperability are fairly modest, and they might be happy with the state of their interfaces, and say that they’re successful. Other organizations have more demanding needs and are trying to reach out to providers in their area and neighboring hospitals, so it’s harder for them to accomplish what they want to.
In terms of vendor rankings for interoperability, what was most significant?
Looking at specific vendors, in the commentary we got back from providers, Cerner is a vendor that had some of the more complex interoperability [problems] going on with their customers. Maybe it’s not surprising, but the overall feeling for success for Cerner is not as high as some others. It’s easier to feel successful when you have a simpler problem to solve.
One of the leaders is someone that would surprise some folks, when you think about public discourse. 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. 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.
A lot of this comes down to the relationship and support that the vendor gives the provider. With Epic, those providers have a lot of confidence in the vendor. Epic might not be leading in every technology, but they are steady and show a lot of concern for the success of their customers, rather than dropping technology off at the door.
Another thing that was interesting with Epic, was that when we asked providers to rate their vendors in how well they cooperate with other vendors, they ranked in the middle of the pack. That might surprise you if you just listen to the press and commentators. That’s a metric where one vendor stood out, and that was athenahealth. So it shows how hard it is for vendors to look outside their own world.
What role did health information exchanges (HIEs) play for the providers you interviewed?
We talked to them about their overall success and satisfaction, but also asked them to rate three particular areas of interoperability—interfacing, HIE (if their EMR vendor offered that in its ecosystem), and then Direct messaging related to meaningful use. HIE was named as the top interoperability platform currently used to impact patient care. When it came to satisfaction with HIE, Epic ranked highest. And there is discussion if that’s really an HIE, but again, in the eyes of customers, in terms of meeting needs, they’re quite happy.
Not much stock was put into the cross-vendor initiatives such as CommonWell. Why do you think that was?
Well, what does success really mean? Providers are focused on their own needs, so when it comes to this, they aren’t holding out for something magical to come down and solve interoperability for the whole world. Instead, they’re busy getting their needs met day after day. Many might not have been familiar with these initiatives or have an opinion, or it might not have been really in their world of concern. Those who were thoughtful about it were skeptical, and that’s because they have seen promises like this come and go.
Overall, do you sense more optimism or skepticism/negativity regarding the state of interoperability?
I would say realism, so in the middle. There is no hope or expectation that things will become easy anytime soon, but most providers feel like they will accomplish their specific tasks. They aren’t waiting for someone else to solve it for them, necessarily.
From your research, what do you think needs to happen to achieve greater interoperability?
It goes back to the idea of vendors being willing to cooperate with each other, and providers are ramping up the pressure for that. Hopefully some of the issues in terms of standards for interoperability will help resolve some of that. In a way, some of these things make the providers’ voice a bit louder. If you take meaningful use, Direct messaging, and continuity of care documents (CCDs), they solve part of the problem, but they actually expose more of the pain and discomfort. It might be a miracle that we are able to exchange a CCD, but when that CCD gets to the other end and the data is difficult to see or import into another system, that raises the problem to a more advanced level. It gives you something more specific to focus on.