Ambulatory and Enterprise EMR Interoperability 2023
Are Deep Adopters Close to the Ideal?

The question set used for this report was developed by healthcare leaders at the KLAS 2022 Interoperability Summit as a means for assessing EMR vendors’ progress toward enabling interoperability (read the summit white paper here). The findings showcase what is possible today in real care settings but may not reflect customer bases as a whole.

Market Overview: Moving Forward Will Require Cooperation between All Stakeholders

In most cases with interoperability, health systems and clinics report significant progress over what they previously had, especially in terms of the ability to connect to data exchanges and receive data. Today, connections can be made more easily, data can flow more readily, and PAMI data has been better codified and is more useful. Even so, to reach an ideal state of interoperability, both vendors and provider organizations have a lot of room to improve and can make exchanged data consistently useful. End users at provider organizations are often slow to adopt what is available, and vendors reportedly still work in silos that don’t always allow for broad, consistent data exchange. The provider organizations seeing the most success have to invest additional time and resources into making things work. At this point with interoperability, moving past the current interoperability challenges will require collaboration between EMR vendors and wider spread adoption from provider organizations.

Connectivity: Epic and Oracle Health (Cerner) Customers Lead in FHIR API Adoption to Support Third-Party Connectivity

Most EMR vendors have made significant progress in connecting to national patient record exchanges and HIEs. Among respondents, the advanced Epic users report the most connections. Many of these connections are more nuanced, such as connections with national payers. Epic also outpaces other EMR vendors with connections to in-home patient monitoring technology, partly due to their work with APIs. Oracle Health (Cerner) customers report they are leveraging FHIR APIs and also discuss the progress they have made in connecting to national patient record exchanges. athenahealth and MEDITECH customers are also starting to mention leveraging FHIR APIs more often. Altera Digital Health (Allscripts), eClinicalWorks, and Greenway Health customers report less proactivity from their vendors in getting customers connected to national patient record exchanges.

Utility: Duplicate Data a Major Issue; NextGen Healthcare Has Made Notable Progress

Overall, vendors have progressed with making regulated data (e.g., PAMI and lab data) available in the clinician workflow, but utility remains one of the lower-scoring pillars overall. Unlike standards for PAMI data, standards for other data are interpreted by vendors individually, which allows them to meet requirements but limits the usability of the exchanged data. The individual interpretation at the vendor and provider level leads to manual efforts to find needed patient information and relevant progress notes in C-CDAs. Even with these challenges, NextGen Healthcare and athenahealth are leading out among ambulatory EMR vendors at enabling data to be accessed at the point of care. NextGen Healthcare customers consistently report functionality that removes duplicate information from incoming data before it is integrated into the clinician workflow. Some athenahealth customers note functionality that easily brings key external data (i.e., PAMI and lab data) into their workflow. The interoperability needs in an enterprise setting tend to be more complex, so customers of enterprise vendors are often more critical of their EMR’s ability to readily present relevant information versus making them search for what they need.

Use Cases: NextGen Healthcare Leading in Making External Data Actionable; Altera Digital Health (Allscripts), eClinicalWorks, and Greenway Health Falling Behind

Vendors have made the most traction in getting clinical data to clinicians; use of external data for transitions of care and analytics is still quite rare. While deep adopters of MEDITECH, Altera Digital Health (Allscripts), eClinicalWorks, and Greenway Health are getting data, many have struggled to make the data more usable and accessible for different types of end users. Because of this, they have fewer customers reporting that they use external data to make care decisions. NextGen Healthcare and athenahealth have made more progress with CCDs and Direct messaging and provided their customers with better access to the specific types of data needed at the point of care. NextGen Healthcare is the only vendor to show strengths in all four measured areas, as seen in the chart below. For several NextGen Healthcare customers, better access has led to more usable data during transitions of care and to quality improvement tools. NextGen Healthcare and athenahealth respondents consistently have clinicians leveraging external data thanks to the tools physicians can access and the referral tools for care coordinators. Epic and Oracle Health (Cerner) customers have noted some improvements; however, the volume of Direct messaging and CCDs in enterprise EMRs is much larger, so they need more workflow efficiency tools than ambulatory EMRs. At least half of Epic and Oracle Health respondents are not consistently leveraging external data; customers are primarily focused on the clinical use cases rather than operational use cases.

Outcomes: Organizations Starting to See Real Outcomes as Interoperability Advances

The majority of outcomes being achieved today is related to data access for patient care decisions, but some customer bases report better access than others. Fewer than 25% of Greenway Health customers mention having access to external data that could impact their care decisions. On the other hand, at least 40% of NextGen Healthcare, athenahealth, Epic, and Oracle Health (Cerner) customers are able to reduce duplicate testing because of better integration of discrete external data at the point of care. This is notable, as reducing unnecessary medical costs is the only hard ROI measured and is a much-looked-for outcome of interoperability efforts. Epic, Oracle Health, and MEDITECH customers also point to the outcome of increasing patient access to the EMR through various apps thanks to multiple connections being built over the last few years. A focus on standardization has allowed the customers of NextGen Healthcare, athenahealth, Epic, and MEDITECH to improve their transitions of care. For NextGen Healthcare and Epic customers, this has translated into improved relationships with exchange partners.

Interoperability Advancements in the Last 12 Months

Ideally, EMRs would be able to send and ingest data discretely and automatically. This is not yet the reality, and progress toward this goal varies from vendor to vendor. The table below shows customer perceptions of what improvements have occurred recently.

About This Report

The question set used for this report was developed by healthcare leaders at the KLAS 2022 Interoperability Summit as a means for assessing EMR vendors’ progress toward enabling interoperability (read the summit white paper here). For this report, KLAS conducted deep interviews with leaders from organizations who were identified by the vendors as deep adopters (the exception being eClinicalWorks, who did not provide a list). The findings showcase what is possible today in real care settings but may not reflect customer bases as a whole.

Respondents were asked questions about four aspects of interoperability: (1) connectivity, (2) utility, (3) use cases, and (4) outcomes. For each question in the survey, respondents were asked to rate their agreement or satisfaction on a Likert scale, with the options being Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree, and N/A. Each option on the Likert scale received a point value: Strongly Agree/Agree=1, Neutral=0, Disagree/Strongly Disagree=-1. N/A responses were removed from the denominator for the questions. Based on the percentage of possible points earned, vendors received a grade in each area as well as an overall grade that represents an average of the four areas.

A note about breadth of adoption: Vendors that meet both of the following two criteria receive a check mark in this area: (1) the vendor had to provide a list of at least 30 unique customer organizations identified by the vendor as deep adopters, and (2) KLAS had to be able to conduct interviews with at least 10 of these organizations. Altera Digital Health and eClinicalWorks did not meet the criteria and are therefore designated as limited data.