Interoperability capabilities limited, don’t improve care

Current interoperability capabilities of information technology don’t go nearly far enough to help clinicians improve their delivery of care.

The ability to exchange information between different vendors’ electronic health records falls woefully short of what’s needed by clinicians, and new initiatives like Carequality and CommonWell hold promise, but are not widely used at present, according to results of a report issued today by KLAS.

The healthcare IT research organization released “Interoperability 2016,” part of a series of efforts this year to assess the state of interoperability among U.S. providers.

KLAS research, based on more than 500 interviews with clinicians, indicates that the ability to exchange patients’ health data between systems is limited and isn’t pervasive, limiting the extent to which patient care is affected.

The ability to share records between organizations “is happening only in pockets and is often frustrating for clinicians,” the report notes. Clinicians say it’s not a matter of the number of records shared, “but whether clinicians have the interoperability they need.”

There's widespread belief that interoperability is needed to help the industry improve delivery under value-based care models, says Bob Cash, vice president of provider relations at KLAS. "This report illustrates the considerable amount of work that still needs to be done in order to achieve impactful record exchange," he adds.

The survey measures capabilities against the interoperability measurement tool defined and agreed upon by both healthcare providers and healthcare IT vendors last October to measure capabilities in exchanging information between systems of different vendors.

Using a baseball as a metaphor, KLAS says true interoperability needs to hit a home run by making effective use of patient records from outside the EHR system used by their organization. To do so, outside records must be available, easy to locate, delivered within the clinician workflow and “delivered in an effective way that facilitates improvement in patient care.” Achieving any one of the goals is helpful, but care is only improved if all four criteria are met, KLAS contends.

Leveraging those measures, KLAS says only 28 percent of respondents indicate that clinical information from outside organizations is readily available; 13 percent say information is easy to find; 8 percent say it’s integrated into clinicians’ workflow; and only 6 percent say their experience of interoperability hits the home run of being able to have an impact that significantly benefits patient care.

Also See: AMA-led coalition lambasts current level of interoperability

KLAS research suggests that effective sharing of information happens, on average, six times more between organizations using the same vendor’s EHR product than between organizations using different 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,” report writers conclude. “Some reasons for this stronger performance include compatibility, familiarity and shared access.”

The report concludes that, without outside sharing, no vendor’s customers report consistently report receiving “available, locateable, viewable and impactful information,” and KLAS says that its research shows that satisfaction with support in “cross-EMR sharing is low for customers of all vendors, with athenahealth achieving the highest satisfaction from customers and their exchange partners.

While exchange between different vendor systems is low—less than 15 percent of respondents report interoperability that results in benefits to patient care—results are better when records are exchanged between providers using the same records system, KLAS says. Best performers in that area are led by Epic, athenahealth and Cerner.

Initiatives such as Carequality and CommonWell are engendering optimism, with each “claiming thousands of participating providers, but a relatively small subset are actively sharing data today,” KLAS reports.

CommonWell, a vendor-led collaboration that offers federated health information exchange services, claims to have more than 1,000 actively exchanging customers, “finding these organizations is difficult since meaningful adoption is very low today,” KLAS says. “These organizations report nearly universal optimism that CommonWell is a game changer.”

Carequality, an association of vendors, providers and agencies that have established a legal, technical and governance framework, has only been live since early July; some early adopters “report high exchange volumes, and all report high optimism for the future,” KLAS says.

KLAS research also finds a role for public health information exchanges, although respondents say they still question the value of these initiatives in current environment. “Although public HIEs are the most prevalent, they are not the most satisfying,” KLAS researchers say. “As a group, public HIEs are rated lowest of the major facilitators. Providers cite challenges with integration, record location and cost.“

In assessing public HIE capabilities, “some hospitals can only send data out, and clinics are sometimes unable to locate the data they need,” KLAS reports.

With regard to different care settings, “both acute and ambulatory care settings see significant and strikingly proportional deficits in usable, useful information exchange,” KLAS concludes.

Cash believes there's good news, however. "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," he adds.

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