A new study from KLAS Research finds that although ambulatory care EHR vendors and their customers are making progress on connecting to external data sources, less progress has been made on making that data useful to clinicians at the point of care. In a recent interview with Healthcare Innovation, Paul Warburton, senior market research analyst for KLAS, described why most of these EHR customers are still expressing dissatisfaction.
Warburton, co-author on the study, noted that although KLAS interviewed “deep adopters” of several ambulatory and enterprise EHR vendors about interoperability issues, several vendors were given F grades in some areas, and the highest overall grades are in the B range. I asked him why that was happening.
He said many providers imagine interoperability will work like this: With a click of a button, discrete data will flow from fields in an external athenahealth record into a Cerner record, for example, in their system that is already in a hospitalist’s workflow. But when you talk to vendors about interoperability, what they're talking about is getting data to a place where it can be ingested, Warburton explained. The data sits in a holding bin and is marked “external.” On the provider side, just having to go to a different place to review it is seen as a burden that slows down the physician, he added.
A Cerner-based provider might have reached out through a health information exchange and received patient records from an Epic site and something from NextGen — they're now looking at three different things that are not reconciled, Warburton said. “Much of that data they don't even care about, because it doesn't deal with the specific challenge that they're seeing this patient about right now. It's not actionable or usable at the point of care,” he said. However, the vendors look at that and see it as a success. For them, interoperability means you have the data. But from the clinicians’ perspective, it's still not in a usable format at that point. Getting it to that last mile of usability is a challenge, and this is where you start to see the big variation in which deep adopters have resourced appropriately to take these records, ingest them and make them more useful to the clinicians, he said.
Does that raise the question of whether it is the EHR vendor’s job or the provider organization’s job to do that work of cleaning up the ingested data?
“That's a great point,” Warburton said, “because there are EMR vendors willing to say, ‘hey, for an additional price we will provide an IT consultant resource — someone who will help map the data flow and make sure it's more seamless than it has been in the past,’ but it isn’t cheap. It is further demonstrating that even among deep adopters and those who are really committed, this is still a very resource-intensive work. The health systems that are big enough and well-resourced enough will foot the bill to improve clinician experience and make it work seamlessly, but what you typically see is that most healthcare systems don't have those kinds of resources.”
As a follow-up, I asked Warburton if he had a sense of how big a consideration these interoperability issues are in EHR purchasing decisions compared to other features or issues.
“Of the big problems that providers are aggressively attempting to address, No. 1 would still probably be interoperability; No. 2 would be all things attached to revenue cycle, and part of that is tied to adopting technologies to help them take on downside risk,” he said. “And then No. 3 would be physician usability.”
I then asked him whether this focus on interoperability tends to drive customers toward the enterprise vendors because they have more resources and experience dealing with the interoperability issues?
“It certainly is a driver,” Warburton said. “However, there's really only one vendor that gets traction for their platform in ambulatory because of the interoperability benefits, and that is Epic.”
I wondered whether certain EHR vendors are doing better at FHIR API adoption to support interoperability, and whether the provider organizations say that it is important to them to see progress on that?
“Most of the vendors in this report have made significant investments in FHIR development, and have those APIs available for third-party connections. However, adoption on the provider end is actually pretty low, except for certain use cases,” Warburton said. “Really, what it's going to come down to is not just vendors building a FHIR API, but having a large chunk of your customers that need it for a certain use case. Today, the most common third-party use case that's getting traction is tied to a remote patient monitoring/telehealth solution. You need a sweet spot of a great use case between provider, vendor and the EMR data, and there are just not a ton of them out there where you kind of have that perfect intersection.”