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Patient Perspectives on Patient Engagement Technology 2020

Patient Perspectives on Patient Engagement Technology 2020

Authored by: Adam Cherrington and Dan Czech February 27, 2020 | Read Time: 14  minutes

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In recent years, provider organizations have increased their investment in patient engagement technologies, but the outcomes they report are often provider-centric and don’t necessarily benefit patients directly. It is becoming increasingly important for the patient voice to be at the center of vendor development and provider deployment efforts. To help support this focus, KLAS surveyed over 300 patients, asking them which patient engagement technologies have been most impactful to them and how they expect these technologies to impact them in the future.

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Key Findings

computer iconHelpful, patient-centric technology augments the collaborative relationships that providers seek to build with patients.

people iconProviders and vendors aren’t always aligned with patient desires.

message iconCurrent tools and future development should center around the vision of a one-stop-shop for patients that meets them where they are.


KLAS Patient Engagement Research Road Map

klas patient engagement research road map

Engaging Patients in Their Care


Patients in Collaborative Relationships More Likely to View Technology as Helpful

Patients who describe the relationship with their healthcare provider as “collaborative” are twice as likely as those with a “detached” relationship to find technology to be very helpful. They are also three times as likely to find value in technology-assisted patient/provider communication, which enables them to feel connected without face-to-face visits. And connected patients also tend to see more benefits from their patient portal. Patients with a “detached” provider relationship typically want to be autonomous in their care, looking more for transactional points of contact with their provider. The technologies these patients find most impactful are, for example, online bill pay, automatic prescription refill requests, provider search/matching, and self-scheduling. These patients are also twice as likely to want future development of price-transparency tools to help them find the best provider to meet their immediate needs.

dark orange quote“I would like a chat platform that I can use to communicate with my caregiver directly about questions and issues.”—Patient and caregiver of child, 30–49 years old, reports collaborative relationship with provider

dark orange quote“There should be tools that allow me to make requests for new medications or refills and change appointments without having to jump through multiple hoops. There is so much excess work in areas where things could be greatly simplified.” —Patient and caregiver of child, 30–49 years old, reports detached relationship with provider

helpfulness of technology in supporting patient/provider interactions

Definitions

Collaborative: Healthcare provider knows patient and patient’s family members well. A partnership in which patient’s goals and needs are understood and accommodated.

Reactive: Interaction happens as needed. Relationship is generally effective at resolving individual care needs as they arise.

Detached: Patient and provider have little to no ongoing relationship. Interactions are usually impersonal.

A Note about Bias:

Patients who participated in this study were invited to do so via social media and other technological means, so they are likely to be more technology savvy than the general public. The intent of this study is to point the industry (providers and technology vendors) toward patient needs and opinions, not offer a scientific representation of the voice of any and all patient groups. KLAS is considering doing a deeper analysis in the future about patients’ perspectives on engagement tools. If your organization is interested in partnering with KLAS on more in-depth patient research, please contact us at patientengagement@klasresearch.com.


Patient, Provider & Vendor Alignment

Patient Engagement Nirvana: Coordination and Education

patient engagement nirvana

A “nirvana” of patient/provider/vendor alignment happens when provider investments and vendor development match patients’ needs. Today, providers and vendors are highly aligned with patients’ needs for coordination and education. Coordination tools—typically in the form of appointment reminders and post-visit communication—help remind patients of needed care activities, and coordination tools are the only technology category that generates solid patient satisfaction today. Education tools—largely pre-visit and discharge education today—help patients manage health conditions and maintain wellness. Patients want to partner with clinicians in decision-making and are hungry to understand factors like symptoms, treatment options, and needed lifestyle adjustments.

orange quote icon“The best use of technology would be consumer health informatics—having a personal health record, mHealth, and an updated patient portal with a message section where the clinician can provide resources or links to recommended materials or websites with simplified information and videos. Clinicians would recommend websites or videos that show information about the surgery, and then we could discuss that information in the next visit. Providing the technology itself but not having a conversation about it and hearing the patient’s questions makes no sense.—Caregiver of child, 30–49 years old


patient provider and vendor alignment

Misalignment with Patients: Patient Account Management and Finding a Provider

Patients have a strong desire to understand their symptoms and healthcare needs and then find the right physician to help them. However, so far, provider investment and vendor development have not aligned with that desire. Only one in five patient engagement vendors measured by KLAS offers a triage/symptom-checker tool today. However, vendors may be headed in the right direction—vendors often partner with each other to offer their provider customers web-based provider search/matching capabilities. Patient account management is also important to patients. Provider investment in this area is moderate, but vendor development has lagged, especially when it comes to price transparency.

orange quote icon“I would like something that gives me knowledge about a physician before I visit so I can choose the best one. Also, there should be a tool that gives me a way to communicate my symptoms to a provider and request treatments or tests as needed.”—Patient, 30–49 years old


Looking Ahead to a One-Stop Shop

Patient Portals: Full of Promise but Missing the Mark

When patients were asked which technology best simplifies the healthcare experience and helps them participate in their care, their most common reply by far was the patient portal. Promotion of patient portals was originally driven by meaningful use incentives—though actual patient adoption is often limited—and portals have been the primary patient engagement tool for longer than most other technologies. Looking forward, patients hope to see development toward a consolidated, one-stop portal in which they can access results, pay bills, schedule appointments, contribute to the chart, and send secure messages. Patients have also seen recent improvements in patient/provider communication and want even more development in this area. Many would prefer to get care directions remotely and on demand instead of having to schedule a physical clinic visit.

green open quote“My portal app is helpful for billing and appointments, but it really has nothing to do with my actual care.”—Patient, 50–64 years old

green close quote“A good patient portal is ideal. Between me, my husband, and my kids, I have to deal with so many different logins and different user interfaces in different portals. It is hard to keep track of everything, not every portal has all the information, and the different portals don't communicate with each other.”—Patient and caregiver of child, 30–49 years old

technologies that are most impactful for patients today
technologies that patients would like to see focused on in the future

Telehealth: Meet Patients Where They Are

While the impact of telehealth is relatively low for most patients today, they are excited about its potential. Patients envision a future where the healthcare consumer experience is similar to that of other industries—where services are available when and where they are most convenient. This includes virtual visits and remote patient monitoring (through prescribed or patient-purchased devices), both of which allow patients to stay connected to their physician. Today, telehealth solutions are primarily offered through dedicated vendor products; they rarely exist as capabilities built into existing patient engagement solutions. Patients want more consumer-focused capabilities, including comprehensive mobile apps that let them take care of their health and wellness in one place and price transparency tools that let them make educated decisions about their care options.

green open quote“I want to have telehealth options to get care from my own care team rather than a third party. I also would like better online bill-pay tools. There are discounts that I can get if I call in payments, but I can’t get them when I pay on my app. Also, . . . it would be awesome to have a library with reliable online information that is linked with my mobile app and can also tie to messages with my provider.”—Patient, 30–49 years old

green close quote“We need true telemedicine. I want to be able to use an app at home to do blood tests, record my weight and blood pressure, and so forth without having to physically see the doctor for a routine check-up.”—Patient, 50–64 years old

Study Demographics


what is your role in interactions with healthcare providers what is your age how would you describe your relationship with your healthcare provider
when was your last interaction with a healthcare provider what is your affiliation with the healthcare industry how helpful has technology been in supporting your interactions with your healthcare provider

Additional Patient Comments on Patient Engagement Technology

transparent blue quote

Today's Reality


blue quote“I like to be able to get information without needing to have an appointment. I prefer to just quickly connect with the provider to discuss any questions I have. Then if a personal visit is necessary, I can easily book an appointment.”—Patient, 50–64 years old

blue quote“My provider often sends reminders for upcoming appointments I should set up for my kids. I should be able to access a portal for my kids’ healthcare information, but I struggled to access it the couple of times I tried. There was some sort of error on the provider’s end, and in frustration, I gave up on it after trying what they suggested and it not working. I decided it was not worth the effort.”—Caregiver of child, 30–49 years old

blue quote“I am able to message my child’s doctor with medical questions and receive quick responses about whether or not my child needs to be seen in the office.”—Caregiver of child, 30–49 years old

blue quote“I do like the patient portal; however, it would be very difficult to use if I weren't very technology savvy. I can barely figure it out.”—Patient, 50–64 years old

blue quoteTechnology for scheduling is helpful. Calling in and working out appointments over the phone is the worst.”—Patient and caregiver of child, 30–49 years old

blue quote“Technology helps me communicate with my doctor via the portal and view all my records.”—Patient, 30–49 years old

blue quote“The best healthcare use case is providing accessible information such as records. Also, it is helpful for ease of scheduling and screening reminders.”—Caregiver of child, 30–49 years old

blue quote“I haven’t experienced a best use of patient engagement technology yet. All these tools have done is make the process more impersonal for office staff and providers alike.”—Patient and caregiver of child, 30–49 years old

blue quote“The best use of technology I have seen was the patient portal at my IVF clinic. It had a full record of my visits, I could access lab results online immediately, and I could email back and forth with the nurse.”—Patient, 30–49 years old

blue quote“I love being able to use email to contact my doctor and receive immediate results. Online scheduling is also important for me because I dislike waiting on the phone to talk to a human. And email reminders about appointments or needed tests or procedures are very helpful.”—Patient, caregiver of child, and caregiver of parent, 50–64 years old

blue quote“When I first come to the office to check in, I am given a tablet to do that, and that has been useful.”—Patient, caregiver of child, and caregiver of parent, 18–29 years old

blue quote“Nothing I have seen yet qualifies as a best use of technology that simplifies my experience. More patient-friendly technology would be good.”—Patient, 18–29 years old

blue quote“My provider is only just now getting online appointment scheduling. Almost everything is still done through mail.”—Patient and caregiver of child, 18–29 years old



transparent navy quote

Future Outlook


navy quote“I prefer a simple system with just telehealth, medical records, and provider messaging. I find and choose my doctors through my insurance, I use Google Maps to find the location of a facility, and I use scholarly articles to learn more about health conditions. I don't see much value in having these things duplicated in a health portal. It is better for the portal to stick to facilitating connections with data and providers in ways that can't be done better by other tools.”—Caregiver of child, 30–49 years old

navy quote“I would like a more user-friendly app that is used across the board so that all my medical information can be in one place.”—Patient and caregiver of child, 30–49 years old

navy quote“I want a single portal that allows me to make an appointment, check in online, view lab results, communicate with my physician, and so forth. The medical portal used by my physician is not very user friendly. It could use an overhaul.”—Patient, 30–49 years old

navy quote“Companies need to simplify the patient user experience online. It seems like there are disparate systems that are being used, and I as a patient have no idea which system does what.”—Patient, 30–49 years old

navy quote“We need the ability to communicate with providers via technology. Currently, it is extremely hard to contact providers without being in front of them in their office.”—Patient, 30–49 years old

navy quote“I want a patient portal that has everything in one place, including visit summaries, checkup reminders, and billing reminders.”—Patient, 18–29 years old

navy quote"There should be a single place that gives me access to all my medical records, test results, and so forth so I can own my health data and share it as needed with various providers."—Patient and caregiver of child, 30–49 years old

navy quote“We need something that combines the results of past appointments with scheduling for upcoming visits. Also, it would be helpful to get assistance navigating what type of doctor I should see. For example, for back pain, should I see a chiropractor, my general practitioner, a physical therapy provider, or someone else?”—Patient and caregiver of child, 30–49 years old

navy quote“There should be a single source of truth regarding my medical history. Why are providers still giving me paper forms to complete when I have already provided this information to their health system? Also, I should be able to ask questions about my care easily and get communication regarding test results in plain English.”—Patient, 30–49 years old

navy quote“People need a one-stop-shop type of resource that is easy to use and intuitive. Healthcare is really complicated and overwhelming for most people, and that results in a lot of people avoiding seeking care when they need it. That has been my experience.”—Patient and caregiver of child, 30–49 years old

navy quote“It would be great if my provider could figure out how to successfully let me manage my appointments and bill pay from one source. The portal my provider uses sucks eggs. Please let them know I said that.”—Patient and caregiver of child, 18–29 years old

navy quote“We need all-in-one apps for refilling medications, requesting appointments, asking questions of the provider, and sharing important data and lab results. Also, we should have full access to our own medical records.”—Patient and caregiver of child, 30–49 years old

KLAS 2018 Patient Engagement Framework—Patient-Focused Capabilities

While the framework below was used during the course of this research, KLAS and participating provider & vendor leaders have since revised and updated the Patient Engagement Framework. For the most up-to-date version of the KLAS Patient Engagement Framework, visit our website.

patient engagement framework access
patient engagement framework partnership
patient engagement framework navigation
Current Time Inside Cache Tag Helper: 11/28/2020 10:23:13 AM and Model.reportId = 1670

Key Findings

computer iconHelpful, patient-centric technology augments the collaborative relationships that providers seek to build with patients.

people iconProviders and vendors aren’t always aligned with patient desires.

message iconCurrent tools and future development should center around the vision of a one-stop-shop for patients that meets them where they are.


KLAS Patient Engagement Research Road Map

klas patient engagement research road map

Engaging Patients in Their Care


Patients in Collaborative Relationships More Likely to View Technology as Helpful

Patients who describe the relationship with their healthcare provider as “collaborative” are twice as likely as those with a “detached” relationship to find technology to be very helpful. They are also three times as likely to find value in technology-assisted patient/provider communication, which enables them to feel connected without face-to-face visits. And connected patients also tend to see more benefits from their patient portal. Patients with a “detached” provider relationship typically want to be autonomous in their care, looking more for transactional points of contact with their provider. The technologies these patients find most impactful are, for example, online bill pay, automatic prescription refill requests, provider search/matching, and self-scheduling. These patients are also twice as likely to want future development of price-transparency tools to help them find the best provider to meet their immediate needs.

dark orange quote“I would like a chat platform that I can use to communicate with my caregiver directly about questions and issues.”—Patient and caregiver of child, 30–49 years old, reports collaborative relationship with provider

dark orange quote“There should be tools that allow me to make requests for new medications or refills and change appointments without having to jump through multiple hoops. There is so much excess work in areas where things could be greatly simplified.” —Patient and caregiver of child, 30–49 years old, reports detached relationship with provider

helpfulness of technology in supporting patient/provider interactions

Definitions

Collaborative: Healthcare provider knows patient and patient’s family members well. A partnership in which patient’s goals and needs are understood and accommodated.

Reactive: Interaction happens as needed. Relationship is generally effective at resolving individual care needs as they arise.

Detached: Patient and provider have little to no ongoing relationship. Interactions are usually impersonal.

A Note about Bias:

Patients who participated in this study were invited to do so via social media and other technological means, so they are likely to be more technology savvy than the general public. The intent of this study is to point the industry (providers and technology vendors) toward patient needs and opinions, not offer a scientific representation of the voice of any and all patient groups. KLAS is considering doing a deeper analysis in the future about patients’ perspectives on engagement tools. If your organization is interested in partnering with KLAS on more in-depth patient research, please contact us at patientengagement@klasresearch.com.


Patient, Provider & Vendor Alignment

Patient Engagement Nirvana: Coordination and Education

patient engagement nirvana

A “nirvana” of patient/provider/vendor alignment happens when provider investments and vendor development match patients’ needs. Today, providers and vendors are highly aligned with patients’ needs for coordination and education. Coordination tools—typically in the form of appointment reminders and post-visit communication—help remind patients of needed care activities, and coordination tools are the only technology category that generates solid patient satisfaction today. Education tools—largely pre-visit and discharge education today—help patients manage health conditions and maintain wellness. Patients want to partner with clinicians in decision-making and are hungry to understand factors like symptoms, treatment options, and needed lifestyle adjustments.

orange quote icon“The best use of technology would be consumer health informatics—having a personal health record, mHealth, and an updated patient portal with a message section where the clinician can provide resources or links to recommended materials or websites with simplified information and videos. Clinicians would recommend websites or videos that show information about the surgery, and then we could discuss that information in the next visit. Providing the technology itself but not having a conversation about it and hearing the patient’s questions makes no sense.—Caregiver of child, 30–49 years old


patient provider and vendor alignment

Misalignment with Patients: Patient Account Management and Finding a Provider

Patients have a strong desire to understand their symptoms and healthcare needs and then find the right physician to help them. However, so far, provider investment and vendor development have not aligned with that desire. Only one in five patient engagement vendors measured by KLAS offers a triage/symptom-checker tool today. However, vendors may be headed in the right direction—vendors often partner with each other to offer their provider customers web-based provider search/matching capabilities. Patient account management is also important to patients. Provider investment in this area is moderate, but vendor development has lagged, especially when it comes to price transparency.

orange quote icon“I would like something that gives me knowledge about a physician before I visit so I can choose the best one. Also, there should be a tool that gives me a way to communicate my symptoms to a provider and request treatments or tests as needed.”—Patient, 30–49 years old


Looking Ahead to a One-Stop Shop

Patient Portals: Full of Promise but Missing the Mark

When patients were asked which technology best simplifies the healthcare experience and helps them participate in their care, their most common reply by far was the patient portal. Promotion of patient portals was originally driven by meaningful use incentives—though actual patient adoption is often limited—and portals have been the primary patient engagement tool for longer than most other technologies. Looking forward, patients hope to see development toward a consolidated, one-stop portal in which they can access results, pay bills, schedule appointments, contribute to the chart, and send secure messages. Patients have also seen recent improvements in patient/provider communication and want even more development in this area. Many would prefer to get care directions remotely and on demand instead of having to schedule a physical clinic visit.

green open quote“My portal app is helpful for billing and appointments, but it really has nothing to do with my actual care.”—Patient, 50–64 years old

green close quote“A good patient portal is ideal. Between me, my husband, and my kids, I have to deal with so many different logins and different user interfaces in different portals. It is hard to keep track of everything, not every portal has all the information, and the different portals don't communicate with each other.”—Patient and caregiver of child, 30–49 years old

technologies that are most impactful for patients today
technologies that patients would like to see focused on in the future

Telehealth: Meet Patients Where They Are

While the impact of telehealth is relatively low for most patients today, they are excited about its potential. Patients envision a future where the healthcare consumer experience is similar to that of other industries—where services are available when and where they are most convenient. This includes virtual visits and remote patient monitoring (through prescribed or patient-purchased devices), both of which allow patients to stay connected to their physician. Today, telehealth solutions are primarily offered through dedicated vendor products; they rarely exist as capabilities built into existing patient engagement solutions. Patients want more consumer-focused capabilities, including comprehensive mobile apps that let them take care of their health and wellness in one place and price transparency tools that let them make educated decisions about their care options.

green open quote“I want to have telehealth options to get care from my own care team rather than a third party. I also would like better online bill-pay tools. There are discounts that I can get if I call in payments, but I can’t get them when I pay on my app. Also, . . . it would be awesome to have a library with reliable online information that is linked with my mobile app and can also tie to messages with my provider.”—Patient, 30–49 years old

green close quote“We need true telemedicine. I want to be able to use an app at home to do blood tests, record my weight and blood pressure, and so forth without having to physically see the doctor for a routine check-up.”—Patient, 50–64 years old

Study Demographics


what is your role in interactions with healthcare providers what is your age how would you describe your relationship with your healthcare provider
when was your last interaction with a healthcare provider what is your affiliation with the healthcare industry how helpful has technology been in supporting your interactions with your healthcare provider

Additional Patient Comments on Patient Engagement Technology

transparent blue quote

Today's Reality


blue quote“I like to be able to get information without needing to have an appointment. I prefer to just quickly connect with the provider to discuss any questions I have. Then if a personal visit is necessary, I can easily book an appointment.”—Patient, 50–64 years old

blue quote“My provider often sends reminders for upcoming appointments I should set up for my kids. I should be able to access a portal for my kids’ healthcare information, but I struggled to access it the couple of times I tried. There was some sort of error on the provider’s end, and in frustration, I gave up on it after trying what they suggested and it not working. I decided it was not worth the effort.”—Caregiver of child, 30–49 years old

blue quote“I am able to message my child’s doctor with medical questions and receive quick responses about whether or not my child needs to be seen in the office.”—Caregiver of child, 30–49 years old

blue quote“I do like the patient portal; however, it would be very difficult to use if I weren't very technology savvy. I can barely figure it out.”—Patient, 50–64 years old

blue quoteTechnology for scheduling is helpful. Calling in and working out appointments over the phone is the worst.”—Patient and caregiver of child, 30–49 years old

blue quote“Technology helps me communicate with my doctor via the portal and view all my records.”—Patient, 30–49 years old

blue quote“The best healthcare use case is providing accessible information such as records. Also, it is helpful for ease of scheduling and screening reminders.”—Caregiver of child, 30–49 years old

blue quote“I haven’t experienced a best use of patient engagement technology yet. All these tools have done is make the process more impersonal for office staff and providers alike.”—Patient and caregiver of child, 30–49 years old

blue quote“The best use of technology I have seen was the patient portal at my IVF clinic. It had a full record of my visits, I could access lab results online immediately, and I could email back and forth with the nurse.”—Patient, 30–49 years old

blue quote“I love being able to use email to contact my doctor and receive immediate results. Online scheduling is also important for me because I dislike waiting on the phone to talk to a human. And email reminders about appointments or needed tests or procedures are very helpful.”—Patient, caregiver of child, and caregiver of parent, 50–64 years old

blue quote“When I first come to the office to check in, I am given a tablet to do that, and that has been useful.”—Patient, caregiver of child, and caregiver of parent, 18–29 years old

blue quote“Nothing I have seen yet qualifies as a best use of technology that simplifies my experience. More patient-friendly technology would be good.”—Patient, 18–29 years old

blue quote“My provider is only just now getting online appointment scheduling. Almost everything is still done through mail.”—Patient and caregiver of child, 18–29 years old



transparent navy quote

Future Outlook


navy quote“I prefer a simple system with just telehealth, medical records, and provider messaging. I find and choose my doctors through my insurance, I use Google Maps to find the location of a facility, and I use scholarly articles to learn more about health conditions. I don't see much value in having these things duplicated in a health portal. It is better for the portal to stick to facilitating connections with data and providers in ways that can't be done better by other tools.”—Caregiver of child, 30–49 years old

navy quote“I would like a more user-friendly app that is used across the board so that all my medical information can be in one place.”—Patient and caregiver of child, 30–49 years old

navy quote“I want a single portal that allows me to make an appointment, check in online, view lab results, communicate with my physician, and so forth. The medical portal used by my physician is not very user friendly. It could use an overhaul.”—Patient, 30–49 years old

navy quote“Companies need to simplify the patient user experience online. It seems like there are disparate systems that are being used, and I as a patient have no idea which system does what.”—Patient, 30–49 years old

navy quote“We need the ability to communicate with providers via technology. Currently, it is extremely hard to contact providers without being in front of them in their office.”—Patient, 30–49 years old

navy quote“I want a patient portal that has everything in one place, including visit summaries, checkup reminders, and billing reminders.”—Patient, 18–29 years old

navy quote"There should be a single place that gives me access to all my medical records, test results, and so forth so I can own my health data and share it as needed with various providers."—Patient and caregiver of child, 30–49 years old

navy quote“We need something that combines the results of past appointments with scheduling for upcoming visits. Also, it would be helpful to get assistance navigating what type of doctor I should see. For example, for back pain, should I see a chiropractor, my general practitioner, a physical therapy provider, or someone else?”—Patient and caregiver of child, 30–49 years old

navy quote“There should be a single source of truth regarding my medical history. Why are providers still giving me paper forms to complete when I have already provided this information to their health system? Also, I should be able to ask questions about my care easily and get communication regarding test results in plain English.”—Patient, 30–49 years old

navy quote“People need a one-stop-shop type of resource that is easy to use and intuitive. Healthcare is really complicated and overwhelming for most people, and that results in a lot of people avoiding seeking care when they need it. That has been my experience.”—Patient and caregiver of child, 30–49 years old

navy quote“It would be great if my provider could figure out how to successfully let me manage my appointments and bill pay from one source. The portal my provider uses sucks eggs. Please let them know I said that.”—Patient and caregiver of child, 18–29 years old

navy quote“We need all-in-one apps for refilling medications, requesting appointments, asking questions of the provider, and sharing important data and lab results. Also, we should have full access to our own medical records.”—Patient and caregiver of child, 30–49 years old

KLAS 2018 Patient Engagement Framework—Patient-Focused Capabilities

While the framework below was used during the course of this research, KLAS and participating provider & vendor leaders have since revised and updated the Patient Engagement Framework. For the most up-to-date version of the KLAS Patient Engagement Framework, visit our website.

patient engagement framework access
patient engagement framework partnership
patient engagement framework navigation
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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. © 2020 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.