KLAS: Epic Outpaces Competition in Achieving ‘Deep Interoperability’

Dec. 23, 2020
The report also looked at API adoption and value, even though the market as a whole is in the early stages

While all health IT vendors have ample room to improve, Epic Systems stands out as the market leader when it comes to achieving interoperability, according to a new report from KLAS Research.

In this update to KLAS’ 2017 interoperability research, KLAS took a close look at how healthcare organizations perceive their electronic health record (EHR) vendors’ efforts to help them achieve meaningful EHR interoperability. While all vendors have room to improve, some have proven more willing to work with other EHR vendors, have been more successful in enabling record exchange that impacts patient care, and have done better at providing and supporting meaningful API (application programming interface) connections, according to the report.

KLAS currently measures interoperability in four stages. The last stage, “deep interoperability,” exists when providers meet these four qualifications, according to researchers:

  • Have consistent access to outside data
  • Can easily locate patient records
  • Can view outside data inside their EHR workflow
  • Experience frequent, positive impact on patient care

Using this criteria, the report showed that 63 percent of Epic customers were able to achieve deep interoperability. The next vendor who scored the highest in this area was Cerner, with 28 percent of users reporting deep interoperability achievement, followed by NextGen Healthcare (19 percent), Allscripts Sunrise (18 percent), athenahealth (17 percent), and eClinicalWorks (14 percent).

Regarding Epic, the researchers concluded, “Epic is the first vendor to make significant progress toward ubiquitous patient-record sharing. Almost 100 percent of customers report data is available, and two-thirds report it impacts care (i.e., deep interoperability). Records from exchange partners are presented fairly automatically, allowing clinicians to make better use of data at the point of care. This success is tied to satisfaction improvements with outside-record sharing and increased participation in Carequality, as well as Epic’s proactive approach to progressing interoperability. Both Epic and non-Epic customers feel the vendor’s commitment to outside sharing has grown.” The report also noted that most progressive customers are challenging Epic to move more quickly on APIs.

Cerner, meanwhile, “has made notable progress on deep interoperability—in 2020, nearly four times as many customers report deep interoperability than in 2017,” the report stated. “This progress comes from significant improvements to how fluidly records are presented in the clinical view. Increasingly, records are fully integrated or in a separate EMR tab. Another contributing factor is increased use of CommonWell. When it comes to making initial connections to outside EMRs or national networks, customers have started to see more proactivity from Cerner; in the past, organizations didn’t see much progress without investing significant internal effort.”

Similarly, when asked how often a given EHR vendor makes interoperability harder, 80 percent of Epic customers—individuals, not organizations—said “almost never” or “rarely.” NextGen was the next highest vendor in this category, with 63 percent of the company’s customers answering almost never or rarely to the same question. Interestingly, Greenway Health was the only other vendor that had a 50 percent or higher positive response rate to making interoperability tougher. Even Cerner did not score well in this category; less than half of customer respondents said that the company rarely or never makes interoperability difficult.

Regarding API adoption and value, with the market as a whole in the early stages of API adoption, Cerner stands out, especially for FHIR APIs, the report found. Customers report Cerner has been working to promote more openness, and large customer organizations have been pushing the needle. The primary API use cases for Cerner customers are patient record exchange and clinician-enabling tools. Researchers said, “The perceived value of Cerner’s APIs could be increased if Cerner were in the driver’s seat; today customers often feel their own organizations are driving progress forward.”

Epic, meanwhile, “has been fairly selective about what vendors they will work with to connect, slowing progress. Available APIs (mainly proprietary rather than FHIR) frequently drive meaningful outcomes for customers. These outcomes are mostly clinical; some customers report improved operational efficiency. In general, APIs are less of a focus for Epic; while the vendor is willing to help customers set up these connections, they aren’t leading out,” the report concluded.

For athenahealth, while use of APIs among its customers is not as broad as among some other customer bases, what they are doing is driving value, the report found. “Perceptions of value are largely driven by the fact that athenahealth is putting in a lot of work, tipping the effort-to-value ratio to the benefit of customers. athena’s communication with both customers and third-party vendors and their willingness to own issues brought to them are noted as strengths.”

Similarly, NextGen Healthcare customers have primarily adopted proprietary APIs, with only some using FHIR for patient-record exchange. Customers say NextGen Healthcare’s proactive help has led them to feel they are deriving value from APIs, according to the report. On the other hand, eClinicalWorks customers “indicate the vendor has been hesitant to go down the FHIR APIs road and has only made progress because of federal law. eClinicalWorks’ lack of technical expertise is a barrier to achieving meaningful API connections,” KLAS concluded.

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