Interoperability 2019
Vendor Success in Making Outside Data Usable

Note: KLAS published an initial look at the state of plug-and-play networks (Carequality and CommonWell) in March 2018 and a follow-up report on the progress of vendor connections to these networks in December 2018. This third report focuses on the usability of the data brought in via those connections. Data on custom interfaces and HIEs is excluded.

Allscripts

No current connection to Carequality; committed to deliver in Q2 2019

MEDHOST

Has not connected to CommonWell despite being a member for several years

Epic and Cerner stand out from other EMR vendors in making less-structured data, like labs and notes, more usable. In the Epic EMR, problem, allergy, medication, and immunization (PAMI) data from any vendor flows directly into native fields to be reconciled. Notes and labs from Epic sites also flow automatically, while non-Epic sites need to be individually configured for the same automation to be achieved. Cerner users must select documents to bring in, and then the system automatically organizes the data into a summary view and shows it in the chart. Both Epic and Cerner enable clinicians to access any outside data with a search bar, which saves clinicians from needing to sort through CCDs.

“The issue depends on how the data was packaged by the EMR or the source on the other end. Cerner packages their data in a certain format. MEDITECH does data differently, and Epic does data differently. Everybody packages a little differently. There are standards for CDAs and C-CDA documents, but not everybody follows those standards in the same way.” —CMIO, Cerner customer

Greenway Health Lacks Meaningful Adoption; CPSI Has Most Manual Processes

Though KLAS has validated connections to CommonWell, no Greenway Health customers report actually using outside data, often because they struggle to find organizations to exchange with. CPSI offers only basic support for using outside data and is the only vendor that requires customers to match all patients manually.

Even vendors who deliver fairly strong usability still have plenty of work to do. athenahealth, eClinicalWorks, NextGen Healthcare, and Virence Health (GE Healthcare) are all still working to make notes and labs easier to consume. Customers of all vendors report they sometimes have to deal with redundant data from multiple sources.

Epic Customers Benefit from Long Experience with Outside Data

Epic customers’ long-time use of Care Everywhere has given them an advantage in data sharing—they are the only customer base comfortable with outside data flowing directly into the patient chart without prior human screening. Most other vendors’ customers worry about the trustworthiness of outside data and its potential to cause liability issues. Many Epic customers went through this universal learning curve as they used Care Everywhere, and other vendors’ customers will have to do so as well. Setting up a connection is a good first step, but there is no magic bullet that will replace training and time with the data. This is evidenced by the fact that among some customer bases, many organizations are connected but not actively consuming outside data. Organizations must use training to build user trust in the data, but building that trust will still take time.

Expect Multiple Documents from Epic 

Most vendors send summary CCDs that include all data on a patient in one document. Epic is the only vendor today who sends a separate CCD for each encounter; this enables the more-automated consumption of contextual data into the EMR between Epic organizations, but the two initial non-Epic sites accessing Epic data through the CommonWell-Carequality connection were caught off guard by the number of documents they received and the need to sort through multiple documents. This problem is not as frequently mentioned by non-Epic organizations that access Epic data through Carequality. There is movement among vendors connecting to CommonWell and Carequality to support both summary and encounter-based CCDs, but until all vendors are able to support filtering of encounter-based CCDs, consuming this data will feel cumbersome.

Allscripts

dbMotion is primary method of sharing data. Requires traditional, point-to-point interfaces, which are expensive and laborious. Mostly used as read-only data; not imported into EMR. Publicly committed to connect to Carequality in Q2 2019.

eClinicalWorks

Strong functionality around reconciliation. Participation in sharing is easy, with no cost. Needs to improve in ingesting labs, histories, and notes.

MEDITECH

Two customers now connected to CommonWell; too early to validate experience with usability of outside data.

athenahealth

Leader in Carequality/CommonWell adoption (>95% of customers). Usability is strong for reconciliation of PAMI data; customers expect additional enhancements. Next challenge is progress notes.

Epic

Leader in usability of shared data. A wide range of outside data appears directly in native EMR fields. Room for improvement in pulling summary data from other vendors. Customer base has become highly comfortable and competent with use of shared data.

NextGen Healthcare

Provides strong reconciliation of PAMI data. Next challenge is managing progress notes and labs.

Cerner

Ability to filter and organize notes has been helpful to users. MPages allows for meaningful use of data. Overall, one of the strongest usability experiences. Cerner working hard to improve adoption of CommonWell connection (currently about 35%) throughout customer base.

Greenway Health

Low meaningful customer use of outside data makes it difficult to validate claims on capabilities. No validations of customers actively using data. Despite Greenway Health’s long history with CommonWell, customer base falling behind.

Virence Health

(GE Healthcare)

Autoquery available in Hospital Connect 2.0. Once data is pulled, process for reconciliation is good, and notes are organized in a way that makes information easy to find.

CPSI

First community EMR vendor to connect to CommonWell. Customers appreciate initial functionality of connection. Still has most manual up-front processes, such as querying and patient matching. Needs to expand to better manage labs, histories, and notes.

MEDHOST

Currently only sharing through traditional connections (i.e., HIEs, point-to-point interfaces, etc.). Pressure rising in community space to provide interoperability. No evidence so far of serious plans to connect to CommonWell despite membership.