- Cerner Corporation and Epic Systems trail athenahealth as the easiest, most effective EHR technology to connect to for EHR data sharing purposes, according to the latest KLAS performance report on EHR interoperability.
The October report — Interoperability 2015: Are We Lifting Together? — scores Epic and athenahealth equally at 3.8 out of 5 among healthcare providers across eight interoperability measures, but that's where perceptions of the two EHR vendors start to drift apart.
On the subject of establishing interoperability between different EHR technologies, athenahealth outpaced Epic among customers rating their own EHR systems as well as providers connecting with external EHR technology for its ease of integrating with other systems. Conversely, EHR vendors gave the nod to Epic for its effectiveness in establishing EHR-to-EHR connections. Among its non-customers, Cerner came in between athenahealth and Epic.
According to KLAS researchers, EHR customers credit athenahealth with its handling of EHR integration costs, particularly in "choosing not to pass along many additional integration costs to customers." Additionally, the EHR company headquarters in Watertown, Mass., received high marks for incorporating patient data conveniently into clinical workflows and the ability to connect to multiple physician practices through its cloud-based platform.
Both Epic and Cerner likewise received praise from those surveyed by KLAS — as well as criticism:
EPIC: Data sharing among Epic clients is pervasive across the country, and sharing is solid via point-to-point and HIE connections to organizations with foreign EMRs. Epic customers share with other Epic customers in order to receive the same, often forcing competitive health systems to share whether they want to or not. Once Epic agrees to an integration project, their strong service is a significant benefit. Some non-customers voice frustration with Epic’s strict adherence to self-imposed standards.
CERNER: Cerner and non-Cerner customers report Cerner to be easy to connect to and effective at a broad range of complex connections. Cerner is rated lower by clients for higher integration costs and the lack of a simple switch to turn on sharing with other Cerner clients. Reports from vendor peers of Cerner being less effective to work with are tied to software versions, costs, and licensing outside the CommonWell conversation.
Not faring well among both EHR customers and non-customers average interoperability and ease of connecting were Allscripts, eClinicalWorks, Greenway, MEDITECH, and NextGen.
The KLAS performance report on EHR interoperability also explores the prevalence of information blocking and finds that instances are rare. This comes despite federal interest in the willful practice of preventing health information exchange, most recently by the Office of Inspector General (OIG).
Providers, however, are not reporting information blocking activities by vendors but instead point to financial and technical factors:
"Providers overwhelmingly report their vendors to be willing to help them share but say business revenue models and lack of technical resources often get in the way," the report states. "No provider has reported a circumstance in which a vendor contractually or otherwise willingly impeded information sharing, aside from the business models around profitability. Most vendors have changed or are changing these models to more cost-effective approaches (e.g., CommonWell clients report minimal cost barriers and Epic eliminated a per-transaction fee)."
Another barrier reportedly is the unwillingness of some providers to willingly share data. Almost all provider respondents (98%) indicated a willingness for data sharing but a large number (82%) claimed their main competitors to be unwilling.
"Either way, most providers are starting to see data sharing as inevitable, but resistance remains. Smaller ambulatory practices are the least likely care providers to want to share their own records," KLAS researchers write.
Other takeaways from the report range from the importance of customer service and the rise of application programming interfaces (APIs) to advance EHR interoperability.
First, superior service levels differentiate athenahealth and Epic from competitors because of their ability to work with both their EHR end-users and others to enable data connections. Despite its high interoperability scores in the KLAS performance report, Epic has a perception of struggling in this area.
Second, Fast Healthcare Interoperability Resources (FHIR) is emerging as a competitor to CommonWell and Carequality as a potential solution to point-to-point connections between different EHR technologies. " FHIR was voted by providers and vendors as the standard that will be of highest future value, while prominent collaborations CommonWell and The Sequoia Project (also known as Carequality or Healtheway) are considered by providers as significantly less likely to improve future interoperability," the report states.
Lastly, despite variation in costs for establishing connections with other EHR platforms and providers, it is not a leading factor among EHR end-users in their EHR selections. "Healthcare organizations are unclear about vendor differences when it comes to external connectivity and so cannot use this as a decision criteria," the report concludes.