The Current State of Healthcare Interoperability

For more than a decade, the interoperability space has maintained high energy. As provider organizations have expanded their ability to exchange data, their optimism has increased as well.

Our recent EMR Interoperability 2020 report highlights many of the strides we have taken as an industry toward achieving more meaningful interoperability. When KLAS last published a report on this space in 2017, there were a lot of hopes as to what we would be able to accomplish with interoperability. However, the CIOs we interviewed for that report felt the push toward impactful data exchange was stuck.

But a lot has changed in the last few years, and as KLAS takes another look, we feel like we’re on the cusp of a huge leap forward!

Access to Data

KLAS defines deep interoperability through these four categories:

1. Consistent access to outside data

2. Can easily locate patient records

3. Can view outside data inside the EMR workflow

4. Experience frequent, positive impacts on patient care

Two of the biggest strides made toward meaningful interoperability have come in that first category, the first being the massive amount of people who are saying they have electronic access to outside data.

Looking back to our 2017 data, 28% of respondents said they had electronic access to what they needed. Today, that has increased to 67%. As an industry, we have made great strides to ensure that we have the data we need in front of clinicians.

Secondly, satisfaction is increasing across the board for data exchange, both for exchange between the same vendor and with different vendors.

There are a couple of factors that could contribute to this increased satisfaction. Third-party vendors, such as CommonWell and Care Quality, are taking a lot of the technical burden off of the shoulders of providers. Also, the data that is being exchanged is mostly within the EMR, making it closer to being in the clinician workflow instead of taking them out to a separate portal.

However, what is not in the report is a comparison of the number of outside vendors being connected right now. There has been a consolidation of EMR vendors, but providers are connecting with more outside EMRs than ever before.

In the 2017 report, providers were maybe connecting with one other EMR, but providers are now listing two or three EMRs. Even though the EMR world is getting smaller in terms of who controls what, the interconnectedness is actually going up.

It feels like the industry as a whole is starting to lift together. Data availability is much higher than it has been historically. There is more data being passed around, and providers are having more success with that data. We are definitely making progress.

Vendor’s Role

Our report uncovered another key finding, mainly, that vendors have had a big hand in pushing their customers to actively work on interoperability in healthcare.

The vendors who are progressing most are the ones who make the adoption of various interoperability capabilities more automatic. Instead of relying on provider initiation, these vendors have thought through everything that needs to happen, including the legal and data-sharing issues. Now, implementations and upgrades are already turned on, and the provider would have to choose not to do it instead of internally having to make that happen.

In particular, vendors like Cerner, Epic, and NextGen Healthcare all made significant strides. All of these vendors are heavily focused on taking down barriers of interoperability for their customers.

Vendors have the advantage of seeing how their solutions work at hundreds of locations rather than the clients’ limited view of their own organizations. Vendors can be amazing support systems or partners that push the provider forward to reach that next step.

Expanding the Conversation

The interoperability conversation is expanding beyond  patient record exchange. Moving patient records from one provider to the next is almost a given at this point. We are starting to research how interoperability is helping to  accomplish other things we need to do as an industry.

For example,  engaging patients, , population health, and being successful in value-based contracts. In our expanding view of interoperability, we are shifting our measurements to be more complete.

Not only will we measure CCDA exchange; we will also include APIs, interfacing, usability workflows, and more. We will also expand beyond EHR solutions to other HIT solutions that are part of a provider’s ecosystem like population health and patient engagement.

API Adoption

In organizations over 2000 beds, early adoption of the FHIR API is starting to take hold, but the connection needs to mature. The resources or data elements that are supported through the FHIR standards now is relatively small. Over the next few years, there should be a more robust data set and a bigger picture of what is happening.

Right now, provider organizations report that the intended ROI hasn’t come to fruition, especially in smaller organizations. A third of FHIR API users say that they are too early in their journey to even rate their satisfaction with these connections.

Defining and realizing the value of APIs will have widespread impact on data liquidity. While we can get the data to transfer now, a FHIR standard would make patient data discrete and more usable. We expect to see patients shift into deeper into a consumer mindset as APIs drive more effective interoperability.

The Next Steps for Interoperability

Even though the providers have access to the data they need to, now we need to make sure that this data is meaningfully impacting care for patients which is not  happening as often as it should yet. It happens in some pockets but not everywhere.

Interoperability still needs to become standardized. Many of the CCDA documents are not standardized, so the data breaks down within the EMR. There is quite a bit of variation in how the data appears, and that causes problems.

Read the full EMR Interoperability 2020 report to learn about specific vendor feedback and more.

Photo Credit: Adobe Stock, thodonal