Interoperability 2016
From a Clinician View - Frustrating Reality or Hopeful Future?

Only 6% of providers are successful with all four interoperability bases. Reliable access to outside data in different-vendor EMRs has been achieved by 28%, but many are still not achieving high-impact interoperability because specific patient records are difficult to locate, view, and navigate. Many organizations with limited or no access to outside records say that access is all they need; and certainly there is value in having access to outside information. However, conversations with clinical end users indicate that access is only the first step to interoperability that improves patient care.

Both acute and ambulatory care settings see significant and strikingly proportional deficits in usable, useful information exchange. 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. Surprisingly, 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.

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.

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 are 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,

Early adopters of both CommonWell and Carequality are quick to report optimism in the potential of these initiatives to dramatically improve nationwide interoperability. Each initiative claims thousands of participating providers, but a relatively small subset are actively sharing data today.

CommonWell: While participating vendor organizations have reported over 1,000 actively exchanging customers, finding these organizations is difficult since meaningful adoption is very low today. These organizations report nearly universal optimism that CommonWell is a game changer. One athenahealth customer reported, “As long as the patients have consented to share their information, I get the CCDs. What system the data is coming from is kind of irrelevant. The connection works as I expected it to work. I haven’t actually had to work with vendors. CommonWell Health Alliance manages the connectivity.”

Carequality: Carequality has been live only since early July 2016; some early adopters report high exchange volumes, and all report high optimism for the future. One CMIO reported, “We have bidirectional exchange with the large ambulatory group in our area. We are exchanging C-CDAs that can be parsed. We are viewing each other’s clinical notes. . . . We are very excited about Carequality."

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.