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Interoperability 2020 (Acute/Ambulatory)
Adoption and Usability Differ Significantly Between EHR Vendors
Author
Coray Tate
Author
Jonathan Christensen
The national interoperability networks of Carequality and CommonWell Health Alliance have become some of the primary means by which patient records are shared between healthcare organizations in the US. However, the number of organizations connected to these plug-and-play networks and the usability of the shared data vary significantly depending on the EMR in use. This report—a follow-up to research published in early 2019—examines adoption and usability among advanced users of the main acute and ambulatory care EMR vendors.
Note: This report focuses on the usability of shared patient data brought in via connections with Carequality and CommonWell. Data on other means of interoperability, such as custom interfaces and HIEs, is excluded.
Epic, NextGen, and Cerner Best at Making Outside Data Usable
Progress among Other Vendors Slow
Based on the expectations healthcare organizations reported in early 2019, KLAS had expected to see progress from a larger number of vendors. However, little has changed for customers of Allscripts, athenahealth, CPSI, eClinicalWorks, Greenway Health, or MEDITECH.
NextGen Healthcare is the only ambulatory-specific EMR vendor to provide a strong usability experience for all interoperability workflows measured in this report. Over the last 18 months, NextGen has made significant progress in enabling data reconciliation and the ingestion of progress notes and lab data. Epic and Cerner are also leaders in enabling access to outside data. Epic has continued to enhance the end-user experience; their Happy Together solution provides the most natural integration of outside data into the clinician workflow, including the recent addition of basic lab trending. Cerner delivers strong capabilities for accessing and incorporating a wide variety of outside data into the patient record. Customers say Cerner is currently building functionality to automatically ingest progress notes and lab data. Customers of both Cerner and Epic say the next step is for the vendors to reduce the duplication of problems, allergies, medications, and immunizations (PAMI).
Duplicate PAMI Data a Growing Problem; NextGen Customers the First to Report Significant Improvement
As more organizations have connected to the national framework, duplicate medication data has become more prevalent, and provider organizations are becoming increasingly frustrated by the amount of manual effort required to reconcile it. NextGen Healthcare is the only vendor whose customers report significant improvement in this area. The NextGen EMR is able to filter out duplicate medications, even for inexact matches (e.g., Tylenol vs. acetaminophen). While other solutions may be capable of flagging duplicate information and removing some of it, customers say the process is often still very manual.
Cerner and NextGen Make Significant Strides in Connecting Customers
Cerner has been encouraging customers to adopt the CommonWell connection for some time, and over the past 18 months, the number of customers live has doubled, meaning a majority of clients are now connected. Cerner has removed barriers to adoption by standardizing data-sharing governance (so customers don’t have to shoulder this) and including the connection as an automatic part of recent upgrades (customers must opt out, rather than opt in). Additionally, through the CommonWell-Carequality connection, Cerner customers can share with Epic exchange partners, opening up access to a large volume of data. NextGen Healthcare has also continued to advocate for the adoption of Carequality among their customer base. Like Cerner, they have removed adoption barriers by including the connection in upgrades. Customers report value from increased data sharing with critical exchange partners and have good satisfaction with the data’s usability. eClinicalWorks customers have been actively connecting; their usability experience remains similar to what it was in the past. athenahealth and Epic continue to lead in overall adoption, with nearly all customers connected.
MEDITECH Adoption Slow; Allscripts’ Connections Just Getting Started
Connection to CommonWell is available to all of MEDITECH’s C/S, 6.x, and Expanse customers, but MEDITECH has not included the connection in their upgrades or initial Expanse implementations, leading to slow customer uptake. Since early 2019, many organizations have implemented Expanse, but adoption of CommonWell among MEDITECH customers has increased only slightly (from two customers to eleven). Allscripts was a founding member of CommonWell in 2013 but never connected. After multiple delays and a shift to Carequality, they connected their first customer (via dbMotion) in the second half of 2020. Going forward, Sunrise and TouchWorks customers will connect to Carequality via dbMotion.
Vendor Bottom Lines
Allscripts │ Originally publicly committed to connect the Sunrise and TouchWorks EMRs to Carequality by Q1 2019. First customer recently went live second half of 2020, via dbMotion. No direct EMR connection available.
CPSI │ Has made little progress with adoption (still ~15%) or usability in last 18 months. Connection provides access to outside data; processes for querying and patient matching mostly manual. Customers want ability to better manage lab data, histories, and notes.
Greenway Health │ Connection to CommonWell easily established; only a small portion of those connected actively use it and find high value. Usability of data is weak—while information may be available, most searching and reconciliation is done manually.
NextGen Healthcare │ Significant progress in customer adoption (~33% connected to Carequality) thanks to removal of barriers. Usability and workflow have improved; ingestion of PAMI, lab data, and progress notes largely automated, and duplicate medications automatically removed. Users must select data to import, notes are not placed in native fields, and lab data must be searched in CCD.
athenahealth │ A leader in Carequality/CommonWell adoption (>97% of customers). Usability progress customers expected in 2019 has been slower than expected—dust still settling from merger with Virence Health. Recent update did not significantly improve challenges with deduplication of data.
eClinicalWorks │ Adoption has progressed; KLAS estimates over one-third of customers connected to the national networks. No significant usability enhancements since 2019 report. Reconciliation functionality strong. Participation is easy, with no cost. Improvements needed for ingesting labs, histories, and notes.
MEDHOST │ No significant change since 2019 report. No evidence so far of serious plans to connect to CommonWell despite membership. Is now the last major acute care EMR vendor to not be connected to either CommonWell or Carequality.
Cerner │ Over the last 18 months, has almost doubled adoption by removing key barriers (e.g., connection is now opt out vs. opt in). One of the strongest usability experiences. Ability to filter and organize notes is helpful (with MPages providing additional utility). Customers want outside data to automatically flow into native fields.
Epic │ Continues as a leader in adoption and usability; provides most natural integration of outside data into clinician workflow. For additional improvement, more widespread industry standardization is needed. Customers are highly comfortable and competent using shared data; would like reconciliation of duplicate data to be more automated.
MEDITECH │ Adoption of CommonWell connection slow, increasing from two customers in early 2019 to eleven (~2%) in Q3 2020. Hospitals connecting today will be among the early adopters. PAMI data reconciliation may be done in EMR workflow; no automated way to search/import lab results or progress notes.
Writer
Elizabeth Pew
Designer
Natalie Jamison
Project Manager
Mary Brown
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.