Not all health information exchanges have successfully bridged the interoperability gap. A recent KLAS report on HIE vendors evaluated how well they deliver on their promises.
KLAS's first report focusing on the health information exchange market -- Health Information Exchange 2012: Muddled in the Interfaces -- found that about 38 HIE vendors provide such services, and the top 11 hold about 80% of the market. The study looked to 208 providers who use these vendors to gauge their performance and how poised they are for success in the future.
"The HIE market has reached a sort of awkward adolescence -- looking forward to the future but still not fully developed on connectivity, its primary purpose," read the report. "Little progress has been made in the variety of data types being carried, and most users still view information via a portal rather than integrated with their own EMRs."
In fact, many are frustrated with less-than-timely new interfaces that aren't cost-effective or supportive of workflows. Some vendors lag behind in development and support as well, resulting in vendor performance ratings falling in the last year -- from 83 to 79 out of 100, according to the report. Additionally, the "primary development request" from respondents was for HIE vendors to provide better EMR integration. Coincidentally, most HIE vendors scored low for connecting disparate systems.
Some healthcare systems admitted to KLAS that part of the problem isn't their HIE vendor but their own lack of standards and EMR vendors' unwillingness to provide timely, cost-effective interfaces. At the same time, though, "some vendors are just making the grade better than others," according to the report.
"In some ways, comparing two HIE vendors is still like comparing apples and oranges -- both are sweet, but both are very different. However, even if the solutions are not directly comparable, satisfaction levels are." The top-rated HIE vendors, the report continued, have reputations for progressive development and, at the same time, minimizing interface issues. "By delivering on connectivity, they are in a better position to meet more strategic needs, like analytics and patient engagement."
Overall, some of the top-rated HIE solutions include Siemens MobileMD, which is known for "high satisfaction primarily driven by excellent service," and Epic Care Everywhere, which was the top-rated tool according to KLAS's survey. Passing grades were given to Medicity, which has long led the HIE market, and Cerner, which is the only vendor whose performance score has risen since last year.
KLAS declares the Cerner Hub a "good HIE product" for exchanges in the Cerner network, particularly when it comes to outpatient networking. It was the only HIE vendor with scores that improved since the previous year's report, and it saw increased ratings in support and development. Users described active engagement from Cerner on developing a better patient portal and bidirectional exchange. The Cerner Hub also saw improved ability to exchange with non-Cerner EMRs when working with its partner, Certify Data Systems. Providers use the Hub primarily to share laboratory and radiology results, but it does need development around bidirectional orders and analytic capability, according to the report.
Medicity has been a leader in the HIE space as an "EMR-agnostic" vendor, according to KLAS. The company has experience with good connectivity, yet their satisfaction scores dropped in the past years due to delays in development and support. The percentage of clients including Medicity in their long-term plans dropped from 93% to 76%, according to the report. In addition, many users use only Medicity's older Grid technology and have a hard time moving to the next level of its HIE capabilities. Some clients, however, use the more comprehensive functionality available through the vendor's ProAccess, MediTrust, and iNexx components, which include a Web portal, a full enterprise master patient index (EMPI), and easier care coordination.
Customers turned to eClinicalWorks to exchange information between predetermined eClinicalWorks sites, according to the report. Connectivity is apparently "excellent" for those sites, but clients want the product to do better support sharing with non-eClinicalWorks facilities. Additionally, over the past year, KLAS scores have drifted down for the HIE tool, primarily due to support concerns. Clients described communication with the tool as "difficult," and they complained of missed deadlines and unclear fee for interfaces. According to the study, one user described the product as "robust" and said it meets needs, but dealing with the vendor's interface team is "brutal....they are difficult to communicate with, have difficulty with deadlines, and generally aren't accountable to the customers."
KLAS ranked the Epic Care Everywhere platform as the top product in its research, scoring highest for customer relationships and functionality. According to the report, Epic hospitals have "virtually no setup" -- the functionality is built into the Epic EMR software and is easy to turn on, use, and connect with other Epic providers without additional expense. The report added that Epic works well for Epic-to-Epic exchanges, but its ability to share data with other EMRs isn't widely adopted and it doesn't work well with non-Epic systems; some Epic customers supplement with other HIE solutions. One user explained to KLAS that patients referred to specialists can't have their record reviewed by the referring physician, since the community isn't "Epic-focused," and, in turn, they need to see records outside the Epic system. The report mentioned clients would also like to see improvements in some functionality, including patient consent and better analytic capability.
According to KLAS, dbMotion is "winning clients on a platform designed for data aggregation and analytic reporting." Scores from a few live sites had been positive, but, the report continued, only a few have fully implemented the platform. Clients are excited about the "innovative" technology and described the application as easy to use. The tool can also take significant time to normalize multiple EMR vendors' data, and some clients felt support is insufficient once they go live with the HIE. One client said dbMotion is "trying" and has a good product, but the vendor's implementation services and after-install support "left them wanting… [T]heir product is newer technology, so we are early in the adoption curve, and dbMotion's project implementation techniques are not good."
Siemans acquired MobileMD in 2011. According to the report, early customer feedback describes high satisfaction, primarily driven by service and proactive engagement with physicians. The system's group is known to directly support physicians for health systems and work one-on-one to ensure adoption. Often, the report added, satisfaction scores drop once an acquisition occurs, but MobileMD's scores have remained high and haven't suffered. One client, according to the study, reported that the vendor still feels like a "niche vendor" and maintains a focus on being active with training and support. Additionally, clients say the connectivity is good, but implementations can take longer than expected. Clients would also like to see better reporting.