Despite a reputation of being a vendor that is difficult to work with others, Epic rated positively for its interoperability strengths, according to a new report from the Orem, Utah-based KLAS.
In the inaugural report, “Interoperability 2015: Are We Lifting Together?” healthcare providers strongly encourage better coordination among vendors, timely location of patient records and greatly improved parsing capabilities as three of the most needed improvements for interoperability of electronic medical records (EMRs). KLAS interviewed more than 200 healthcare professionals (customers, non-customers, and vendors) during a three-month period for this study. All participants identified barriers to interoperability. However, neither providers nor vendors mentioned technology as a missing ingredient, stating instead that lack of agreement on the use of standards and willingness to share information are more likely causes.
To date, most respondents are disappointed with poor coordination among vendors, difficulty locating records, and limited parsing abilities. A majority of respondents have little optimism about the future of public health information exchanges (HIEs), reporting limited value.
As such, providers want invisible, effortless connections that provide high patient are value. Connections via EMR vendors’ private networks are the closest match today, with Epic clients in the Care Everywhere network composing more than 80 percent of such connections and enjoying immediate benefits once live. This was in response to the question of which connections bring the highest value,
Demonstrating the success of clear governance and standards, Care Everywhere is successful due to clear client governance, Epic’s large footprint, and an almost effortless activation process, according to the report’s findings. Epic’s network does not solve the critical need for heterogeneous connections built through vendor collaboration, however. In the absence of such collaboration, many are hopeful that Direct messaging will provide a valuable plug-and-play connection between vendors.
Interestingly, 44 percent of providers with no or very limited Epic experience report a perception that Epic struggles the most with interoperability. Contrary to this perception, Epic customers, providers connecting into Epic, and even other vendors give Epic high marks for interoperability strengths
Who do customers, non-customers, and vendors say is easiest/most effective to connect to? It depends on who you ask, KLAS found. Customers rating their own vendors tag athenahealth and Epic as easiest to connect to. Vendor peers list Epic as most effective to connect to and MEDITECH as least effective, followed by Cerner. Providers connecting with foreign EMRs pick athenahealth and Cerner as leaders in connection ease.
What’s more, regarding the highly-talked about topic of information blocking, providers overwhelmingly report their vendors to be willing to help them share but say business revenue models and lack of technical resources often get in the way. McKesson’s, eClinicalWorks’, and Allscripts’ dedicated interoperability/HIE offerings have some reporting frustration that their interoperability requires a license and connection fees to the HIE offering. No provider has reported a circumstance in which a vendor contractually or otherwise willingly impeded information sharing, aside from the business models around profitability. Most vendors have changed or are changing these models to more cost-effective approaches (e.g., CommonWell clients report minimal cost barriers and Epic eliminated a per-transaction fee).
Specifically, 98 percent of providers mention that they are willing to share, but only 82 percent report their main competitor to be similarly willing. Either way, most providers are starting to see data sharing as inevitable, but resistance remains. Smaller ambulatory practices are the least likely care providers to want to share their own records.
To this end, smaller ambulatory and single-physician practices report the highest frustration with interoperability and the lowest willingness to share their own data, due to perceived risks. With limited resources, costs are often a barrier to effectively connecting with surrounding providers. Ambulatory-focused vendors receive some of the lowest marks from their customers, for inconsistent performance, untenable costs, and unacceptable turnaround times. eClinicalWorks is highlighted as one of the most challenging vendors to connect to, yet participants report more point-to-point connections with eClinicalWorks than with any other vendor, according to the report.
As such, with competing standards and collaborations, providers watch for what will make the most difference. Direct connections are often difficult to set up and seemingly of limited value, yet many are optimistic that Direct sharing will soon improve. FHIR (Fast Healthcare Interoperability Resources) was voted by providers and vendors as the standard that will be of highest future value, while prominent collaborations CommonWell and The Sequoia Project (also known as Carequality or Healtheway) are considered by providers as significantly less likely.
Further, healthcare leaders reported their costs for recent connections, and though the costs were difficult to normalize and compare in detail, real differences were confirmed across the industry. Providers point to McKesson and Allscripts as requiring more investment in dedicated interoperability platforms (RelayHealth and dbMotion) and requiring licensing and individual connection fees. athenahealth stands out as generally requiring no added costs for interoperability, a reflection of the different business models in the industry.
Finally, KLAS found that interoperability does not impact EMR buying decisions today. “As KLAS closely monitors EMR buying trends, we have yet to see EMR decisions hinging on which vendor is better at externally sharing health information data. Healthcare organizations are unclear about vendor differences when it comes to external connectivity and so cannot use this as a decision criteria,” the report stated.