Breaking Down Interoperability With Adam Gale, Part 1

It’s been a big couple of weeks for KLAS. In early October, the research company hosted the Keystone Summit, where leaders of 12 major EHR vendors agreed to objective measures of interoperability, marking the first time competing organizations have willingly committed to work together to solve perhaps the most pressing issue facing the industry. Three weeks later, KLAS published a study (Interoperability 2015: Are We Lifting Together?) conducted in partnership with CHIME that examined how providers rate their EHR vendors in terms of their ability to share patient data outside their organization. Recently, healthsystemCIO.com spoke with KLAS President Adam Gale about the most surprising findings from the report, the implications it holds for CIOs, and where the industry can go from here.

Part 1

• KLAS’ Inaugural Interoperability Report
• Partnering with CHIME
• A new tactic — “This is one of the deepest studies we’ve ever done.”
• Comparing private and public HIEs
• “The low effort, high return we’re all hunting for.”
• Data blocking — “We were curious to see if there’s a bad guy.”
• Epic under the microscope

Bold Statements

We said, if we’re going to tackle it, it needs to be in a very thorough way, and how do we push it to the next level? And so we thought the best way was partnering with CHIME and having them pushing us and saying, ‘look, here’s the biggest issue facing our members today — how do we connect these things together.’

That’s why we’ve had such a hard time getting interoperability off the ground — these tend to be high effort, medium to low reward projects. We’ve got to flip that on its head if we’re going to make progress.

We were curious to see if there’s a bad guy out there, and I think most often Epic is portrayed as the bad guy because they’ve connected so well to themselves.

We didn’t find a bad guy out there that said, ‘we don’t want to share.’ It was more, ‘it’s fourth or fifth on our to-do list, because we don’t see a great way to do it yet to get bang for our buck.’ And so it hangs out there as the fourth or fifth priority and never gets to the top. It’s more a question of how much effort do I put into this if my reimbursement really isn’t affected by it.

Gamble:  Hi Kent, thanks so much for taking some time to speak with us. I wanted to talk about KLAS’ interoperability report. A lot of interesting things came out of that. But before getting into specifics, can you talk a little bit about how all of this came together and the process for this specific report?

Gale:  Sure. It was fairly unique in terms of what we normally do. This was a joint research effort between KLAS and CHIME, and we haven’t really done that before. So there was actually a board from CHIME of six CIOs that built the question sets. This is the first time I can think of where KLAS didn’t actually build the measurements ourselves, but instead it was a provider panel that build the questions and tested the questions with their teams.

It’s interesting; we went all the way across the spectrum. The six started in one place, and as they wrestled with it for several days, got to a very different point of what they wanted to measure. So that was one of the biggest changes from what we normally do — the participation from the CHIME panel that helped put the questions together.

And we targeted a deeper sample than normal. We had 240 executives that we interviewed, and most of these interviews were about an hour. And when I say ‘an executive interview,’ typically it was the CIO with their CMIO and some interoperability expert. And so every interview ended up being two or three people, really wrestling on their side of the phone with what was going on. This was probably one of the deepest studies we’ve ever done, in terms of heavy-duty provider participation.

 

Gamble:  What led you to do it this way? Is it because interoperability is such a polarizing topic right now?

Gale:  It is a polarizing topic, and also, to be honest, one where it almost seems to daunting that they wouldn’t even want to measure it. Because it’s so hard to get a measurement that people can look at and understand and wrap their arms around, so we decided to tackle it. But we said, if we’re going to tackle it, it needs to be in a very thorough way, and how do we push it to the next level? And so we thought the best way was partnering with CHIME and having them pushing us and saying, ‘look, here’s the biggest issue facing our members today — how do we connect these things together.’ And so they were very anxious to do a deeper study than what’s been done in the past, and it just seems to line up.

But again, it’s such a daunting topic that it almost seems like there’s no answer and you want to throw your hands in the air and give up. Or you can say, let’s take a serious attempt at this, even if it’s not perfect. As we looked at this study, everyone at KLAS said there are 10 things we could have done better, but I don’t know that there’s something better out there today that we haven’t done.

 

Gamble:  Getting into the findings, one of the areas that was a big focus was the connections that bring the highest value. From what I saw, it looks like the EMR vendors’ private HIE was far out in front of the other methods.

Gale:  Yeah, that was fascinating. I can’t think of many times — at least in my history here at KLAS — where a project that was the least effort also brought the biggest return. It’s interesting, a lot of these providers would measure three of their biggest connections. They would describe what they’ve done with Epic or eClinicalWorks, as typically those were the two that had the biggest internal networks. And they said it didn’t take a lot of effort, but we got a big bang for our buck in terms of physicians having data at their fingertips that they can use in their workflow. They almost always reported it as a high return, low effort, and that’s something we’re all hunting for.

Then we got into other HIEs and direct projects, and typically those were high effort, medium reward. I think that’s why we’ve had such a hard time getting interoperability off the ground — these tend to be high effort, medium to low reward projects. We’ve got to flip that on its head if we’re going to make progress.

But it also potentially shows there could be a methodology here of let’s have these vendors connect to themselves through a network, and then let’s connect to the network. That could be one approach that might have some traction.

 

Gamble:  Is this something that is being reflected or might soon be reflected in the CIO’s strategy in terms of moving away from the public HIE and directing efforts more toward private HIEs?

Gale:  They want to do things that work, obviously. And that may be oversimplifying, but some of these states that have multiple HIEs that have failed, and you have a few that have been wildly successful. If you take my state, Utah, there is a lot of data being pushed into our state HIE, but not much is being pulled out by providers, and so it’s not at the point yet where you would call it a success. And I think people still want to gravitate to where there is success.

If athenahealth can make a broad network for their customers, if Cerner can strengthen their efforts to connect among their customers, all of a sudden you have large, large groups that it’s going to make sense to finally connect to. I wouldn’t be surprised to see more of that connecting network to network that seems to bring more value more quickly.

 

Gamble:  Let’s talk about information blocking, which is a term that’s been thrown around quite a bit lately, as you know. Is that something you really wanted to get to the bottom of with the research?

Gale:  Absolutely. We kept reading press about information blocking and issues coming up in Congress where they seem to be hunting for a bad guy. And so we were curious to see if there’s a bad guy out there, and I think most often Epic is portrayed as the bad guy because they’ve connected so well to themselves. And I think people are beating that drum that they’ve connected so well to themselves because they only want to do that, and I think it’s overshadowed the connections they’ve made to others. They haven’t made nearly the progress in connecting with others as they have internally, but it doesn’t mean that they’re not good at it. I’d say they’re at least even with the rest of the market if not in the top 25 percent of vendors that have connected to others, but it’s overshadowed by the fact that they’ve done so much work connecting with themselves.

So we don’t see that there’s a bad guy. Even with health systems, we didn’t see as much blocking as you might’ve expected. We asked the health systems, do you feel your competitors are blocking information, and if we asked your competitors if you do that, what would they say? It wasn’t surprising to see that there were people who said, ‘we don’t block, but we believe our neighbor does,’ and even then, there wasn’t a lot of that. So we didn’t find a bad guy out there that said, ‘we don’t want to share.’ It was more, ‘it’s fourth or fifth on our to-do list, because we don’t see a great way to do it yet to get bang for our buck.’ And so it hangs out there as the fourth or fifth priority and never gets to the top. It’s more a question of how much effort do I put into this if my reimbursement really isn’t affected by it. It’s just easier to say, ‘we’ll look into it next year.’

Part 2