Ecosystem Chart

Is Our Healthcare Interoperability Ecosystem Growing?

In Utah, the aspen trees grow in clumps along the mountainsides and paint the landscape a beautiful golden yellow this time of year. The interesting thing about aspen groves is that they are actually one interconnected organism. All of the trees are connected by a network of roots that share resources where they are needed. 

This seems to be what the ONC has envisioned for our healthcare system’s interoperability—to be one interconnected organism that shares data freely with each of its parts. From my conversations with hundreds of providers over the past several years, I would say that interconnectedness is the number one issue before us.

We (KLAS) just finished our first report on the state of interoperability. In the report we tried to go beyond industry generalization to compare EMR vendor performance in areas like interfacing, HIE, direct messaging, and cooperation with other vendors. The findings were really interesting and leave me both sober and optimistic. Some quick personal thoughts are below.

1. Interoperability roots are growing, but they are young, tender, and fighting through rocky soil.
The government and vendors are working on standards and providing incentives. Providers are hacking away at interfaces and setting up HIEs, but by and large we are really just getting started. The biggest problem is that we still do not have incentives aligned, so competition (which should make our healthcare system better) actually makes interoperability progress slower. Once we get our incentives aligned, we can start competing on things that will make us great, like driving clinical outcomes.

2. There are some interoperability groves, but they come with caveats.
Sharing data widely with disparate systems is happening, but it is rare and more often the result of determined providers than of technology or government interventions. In addition, there are groves of Epic hospitals and clinics that share freely with each other. This accomplishment should not be understated as no other EMR vendor has provided this capability widely to their customer base. However, no region will ever be all Epic, and outside of the Epic-to-Epic sphere, data sharing is just like everywhere else – harder and less robust.

KLAS Image: EMR Interoperability Chart

3. Interoperability is not turning the healthcare landscape golden—yet.
As we talked with providers, they were slow to say that any interoperability product or feature had positively impacted patient care. Twenty percent of providers did list HIEs as having an impact, making HIEs the most specified solution. However, more providers (one-third) said that nothing was impacting patient care yet. This reflects two things—that interoperability is really hard and that many providers’ initial attempts at interoperability have been more targeted at putting a check on the meaningful use Stage 2 list. Most have not yet taken the step of really trying to share and use data in a meaningful way.

​Get the EMR Interoperability 2014 Report.  I would love your feedback and thoughts.