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Post–Acute Care 2018
Providers' Simple Request: "Help Me Connect"

author - Paul Hess
Paul Hess
April 3, 2018 | Read Time: 4  minutes

After five years of tracking the status of EMR interoperability between acute care and ambulatory environments, leading providers, vendors, and other industry stakeholders urged KLAS in a new direction: measure post–acute care organizations’ ability to share patient records across the continuum of care. Based on 160 interviews, this report represents an initial “spot check” for homecare and long-term care organizations using leading post–acute care EMR vendors. It reveals an environment very different from acute care and ambulatory settings in terms of expectations, progress, and quite simply awareness of EMR interoperability strategies among both providers and vendors.

Post–Acute Care Interoperability Is Far Behind the Modest Success of Acute Care/Ambulatory Settings

According to homecare and long-term care providers, post–acute care interoperability is well behind the modest gains found with acute care and ambulatory EMRs. Without the compelling incentive of past meaningful use requirements, homecare and long-term care providers remain in a world where fax machines and remote logins are the unchallenged norms for data sharing.

how post acute providers access outside data

Common Interoperability Experiences in Acute Care/Ambulatory versus Post–Acute Care Settings


Electronic Access to Outside Data

Ability to Locate Individual Patient Records

Ability to View Received Data Inside EMR Workflow

Acute Care/Ambulatory

Most organizations have some basic document exchange through Direct messaging or HIEs.

When available, public, private, and vendor-supported HIE connections allow querying across multiple provider organizations.

Clinicians often view received documents inside EMR tabs. Some can import selected data elements directly into EMR data fields.

Post–Acute Care

Most organizations rely on faxes and logging directly in to the EMRs of referral partners.

Patient-specific records are delivered as part of referral and admittance process. Missing data results in phone calls, faxes, and delays.

Manual effort is often required to scan, download, upload, and hand-enter patient information into EMRs.

Impact on Patient Care

Neither setting has resolved usability issues with scanned or CCD-based documents. Manual data entry in post–acute care settings sidesteps usability challenges, but frustration may grow as interoperability spreads.

Vendor Strategies Inhibit Progress in Post–Acute Care Interoperability

Vendors’ failure to guide customers and treatment of interoperability as an optional, added-cost capability throw up barriers to provider adoption. With the exception of Epic, a “spot check” among post–acute care providers paints EMR vendors as highly variable in the interoperability support they provide, not just in comparison to each other, but also within their separate customer bases. Half either rated their vendor’s support as 1 out of 9 or refused to provide any rating due to lack of experience. Even leadership at post–acute care organizations regularly expressed uncertainty about what EMR-based interoperability tools they might or might not be using—a clear sign that vendors can improve communication around this important topic.

vendor score distributionfor strength of support in receiving patient data

Proactive Service Leads to Interoperability Confidence with Epic, MatrixCare, PointClickCare, and Thornberry Customers

Provider feedback says no one vendor can claim triumph in the race to interoperability. Customers who gave higher-than-average interoperability ratings sometimes did so even when not using interoperability tools from their vendor. With little else to go by, some based interoperability satisfaction on their broader vendor relationship. Customers indicated that Thornberry has proven themselves as a proactive partner and thus earned confidence in meeting future interoperability needs. Higher ratings from some MatrixCare and PointClickCare customers reflect hope for new interoperability tools still in development. Epic’s success in helping customers with integration inside their health systems often contributed to more positive perceptions around interoperability in general.

proactive service vs receiving patient data

Providers Say They Are Ready & Willing; Readiness Gaps Widest for Casamba, Netsmart, and MEDITECH

Overall, providers rate their own preparation and willingness to move forward higher than they rate the interoperability support from their vendors. Customers of Epic, MatrixCare, and Thornberry suggest they have greater alignment between their readiness and their vendors’ capabilities. Early feedback from Casamba, Netsmart, and MEDITECH customers suggests wider gaps, representing an interoperability vacuum unfilled by their vendors. In many cases, provider demands are not complicated. Many wish their vendor would simply take the initiative to inform them of their options. Too often the provider experience is similar to that of one Change Healthcare client, who said, “They tend to just drop a project in our lap and walk away instead of sitting down at the table with our partners and their vendors.”

provider readiness vs vendor capability

Thornberry and Epic Most Likely to Limit Added Interoperability Costs

Preliminary feedback from respondents suggests that vendors’ widespread strategy of charging incremental fees for interoperability represents a barrier to progress. Customers of Brightree, Netsmart, American HealthTech, and Homecare Homebase were most likely to say interoperability costs (often in the form of interfaces) were prohibitive. In contrast, Thornberry users described costs as “reasonable,” and Epic customers described formal efforts to minimize added costs.

vendors ability to help limit costs

Post–Acute Care Vendors Not Yet Following Acute Care/Ambulatory Lead in Removing Barriers

Post–acute care vendors that most want to distinguish themselves might follow the lead of major acute care/ambulatory vendors by embedding interoperability tools and governance into their EMRs. CommonWell and Carequality represent untapped potential for delivering widespread “plug-and-play” connectivity through nationwide networks. Nine of the vendors in this report officially participate in one initiative or the other, but in 160 interviews, providers mentioned CommonWell only once (by a Change Healthcare customer) and Carequality only once (by a Netsmart customer).


A multivendor health information exchange network


American HealthTech (CPSI)



Change Healthcare




A framework of interoperability standards that enable sharing between different HIE networks





author - Natalie Jamison
Natalie Jamison
author - Robert Ellis
Project Manager
Robert Ellis
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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. © 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.