Clinicians Looking for External Data on Patients Frustrated With Lack of EHR Interoperability, Finds KLAS

In this interview with healthsystemsCIO, Tommy Rowley, Senior Director of Customer Insights at KLAS, discusses the findings of the report “EHR Interoperability 2024: Clinician Needs Still Not Being Met.” Despite advancements, many clinicians still feel they are not receiving the necessary data to provide optimal patient care. Rowley highlights the need to improve usability, particularly when navigating large, unwieldy data sets, and shares four steps CIOs can take to move the interoperability needle in the right direction.

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Anthony: Welcome to healthsystemsCIO’s Interview with Tommy Rowley, Senior Director of Customer Insights with KLAS. I’m Anthony Guerra, Founder and Editor-in-Chief. Tommy, thanks for joining me.

Tommy: You bet, Anthony. Great to be here.

Anthony: The report we’re talking about today is called EHR Interoperability 2024: Clinician Needs Still Not Being Met. Sad but true. We have to deal with the realities of it, right. Tell me a little bit about your role, maybe some of the different things you’re covering at KLAS and then we’ll get into the report.

Tommy: Yeah, absolutely. I’ve been at KLAS for about 7 years. A lot of people know us from our Best in KLAS research where we interview CIOs across health systems and publish reports based on their anonymous feedback. I focus on end user satisfaction research as part of what we call the Arch Collaborative. I managed a team of analysts who help with that product line and serve those customers.

Anthony: Very good. The report highlights that internal sharing is pretty good. Obviously, that needs further definition in terms of what we mean by internal sharing. External sharing is the problem. It can be done well because some are doing it well, just not everyone. Some are having challenges. I’m going to let you jump in and then I’ll ask follow-up questions. Your major thoughts about what you found in the report.

Tommy: I appreciate it, Anthony. One thing I’ll say is we’ve been studying interoperability for a long time at KLAS. The industry has had this as a priority for a number of years. One of the things we tried to remind readers of is that in 2004, this was executive order by that administration. In the next 10 years we were going to be able to have access to data regardless of where that data originated, patient data access would be in a great spot. We’re now 20 years passed that and we’ve got less than half of clinicians feeling like they’re getting the data they need when they need it.

I don’t want to be too doom and gloom because we celebrate progress, and we want things to improve, but I think there is a call to action in this report. Making sure that everyone understands there’s a lot of work yet to be done and we’ve by no means arrived. I think that’s kind of the main headline of this report.

Anthony: Any thoughts on what you’re hearing – did you get into the impediments? Is this just clinicians saying we don’t feel like we’re getting what we need or is there any information as to why? I mean, it makes me think of fire, which a lot of people talked about as a very positive thing but then you would hear that there’s lots of flavors of fire. You have a standard and everyone says we have a standard, but then if you talk to people they say ‘well, there are about 8 flavors of the standard.’ I know that’s a very difficult issue. In terms of why we’re not getting where we want to be, any thoughts there?

Tommy: I think you nailed it with standards. Standards are great, but when they’re as broad as they seem to be now a lot of people can meet the standard. But if at the end of the day, you got physicians, nurses, you name the clinical role saying I’m not getting what I need to help this patient at this time, those standards clearly aren’t meeting the mark.

In our interviews with end users, that was one thing particularly from executive leadership where they felt we need more granularity and frankly, they feel like EHR vendors have a lot of ability to really help move the needle. We know that the different vendors are working on this. It was interesting to me how everyone that we talked to felt like they were meeting legal standards yet didn’t feel like those standards were moving the needle enough. I think more granularity there certainly is one thing that we can do.

Anthony: Do you have any more detail on what the clinicians say they’re not getting? Any more specificity on the type of data they want, what they want, that they’re not getting?

Tommy: It’s a great question. What’s interesting is that you have two different really broad categories.  When you have neighboring systems that are operating two different EHRs, that’s where you get into the problem of the data not showing up as much as we think it should. There’s that issue.

I think the other issue is that even if data is flowing, particularly if we’re going like for like, the other health system runs that same vendor we do, data might be coming in but sometimes, it’s actually the inverse where it’s too much. Sometimes, there’s this CCD that’s 30 pages long and if I’m looking for a very specific piece of information at the point of care, that’s not that helpful.

From an end user perspective, even though the data is being shared, in their mind it might as well be not being shared, right. We actually see a lot of commentary around that where people will admit that data is flowing back and forth but whether it’s really usable, whether it’s in their workflows, that’s really the next level that we haven’t wrapped our arms around as an industry.

Anthony: That sounds to me like more communication is needed between the CIOs and the clinicians, right. That’s where you get governance committees and these kind of things. Because, as you said, the CIO could be sitting back with their feet up saying ‘the data is coming in,’ and then the clinicians go ‘this is not what I need at all, it’s just useless,’ – the big data dump. That’s where you need that communication and that’s where end user satisfaction is more of a key than checking off a box in IT.

Tommy: Well said. One of the things that calls to mind is we saw in the report – we talked to some of those folks who had better satisfaction here and one of the things we looked at was some of the education metrics around interoperability. We asked end users, do you agree that your education has prepared you to leverage outside data? The people who agree that they’ve been taught how to do it, three quarters of that group feels like their EHR provides the interoperability they need.

But on the flipside, the people who are in that group that don’t feel like they’ve gotten the training they need, they haven’t been made aware of capabilities, are out there. Only a quarter of that group feel like their EHR is interoperable. That can be at the same system. They’re using the same EHR. They have the same capabilities, presumably, to share data back and forth. But that lack of awareness, that lack of education certainly seems to play a role, to your point.

Anthony: Right. Not enough to dump in the data and leave it there. You have to find out what exactly the clinicians want to see, deliver it and then educate your clinician population on how they access it in the way they’ve told you they want to see it.

Tommy: Absolutely. We talked to a lot of leadership groups across the country. I have no doubt that these folks are actively pursuing progress in this area. I really think the people are giving it their best effort. But yeah, that end user piece really is a valuable tool in the tool kit and if you don’t measure that, how do you know?

Because if you have this dashboard of indicators saying ‘hey, we pulled in this many tens of thousands of data elements this month, interoperability is great.’ Well, then you move on to something else because you feel like you’ve checked that box. But without that canary in a coal mine – I don’t know what the best analogy is, but without that end user piece, you don’t really know. Yeah, you’re spot on.

Anthony: The better CIOs will tell you that their job is to make the users’ lives better. They know that. If you lose sight of that and you think your job is to bring data into the organization and you sort of stopped there, you can really miss the mark. This is what your report is saying, that people are missing the mark in some way, shape or form, because the clinicians are frustrated and don’t feel they have the information they need in order to deliver the best care. They don’t have it in the way they want it, as easily as they want it. There’s work to be done.

The message from this report to the CIOs is you need to delve into this, there’s dissatisfaction there, figure out why, figure out if it’s a technical problem. Are you not bringing the data into the health system? Is it coming in but it’s too much or you’re not educated? It could be any number of ways but you got to dig into the weeds and find out why the dissatisfaction is surfacing in the report that you just did.

Tommy: Really, it’s hard work. When we talk about this next level of getting end users really satisfied and getting in the type of data they want, there’s not a ton of models out there to follow. We measured – we have over 500 measurements now. I think we got 17 of those where 70% of the end users felt like they were getting what they needed from interoperability.

This isn’t really an indictment on folks, this is a hard thing to do, and frankly, when we talk about the standards piece, they’re not being pushed to get to this level really. This really is people laser focused on end user and patient satisfaction, laser focused on solving their concerns whether or not they feel like those concerns are fair given the current landscape.

When we talk about governance, collaborating with neighboring organizations, identifying metrics that really matter, again, there’s not a ton of playbooks out there to do this. That’s why I think this is so critical to understand, it’s nice to know there’s at least a few organizations that are doing this and doing it well, can the rest of us get our hands dirty and do that difficult work to get into that next level.

Anthony: It makes me think how critical that CMIO is to a health systems’ success. To me, it’s so huge. You have to have the right person in that position to bridge that gap between the clinicians and IT.

Tommy: There has to be an advocate, right. I think CIOs have a lot on their plate. A lot of these people are managing application suites that get into the hundreds. They have a lot that they’re trying to monitor and get the best out of the systems they’re leveraging. Also, you have all these M&A activity across the country, and you’ve got organizations coming together and some might think that interoperability is like the finishing work. It’s like ‘hey, I’m bringing on 2,000 users by this point next year and so I’m focused on this implementation.’ It’s a tough thing to do. But you’re right, having that clinical IT hybrid role is essential, whether you call it a CMIO or something else.

I think one of the things we’ve noticed in the best CMIOs we talk to is when they hear the frustration from physicians and nurses. These are people that are not quick to get defensive, to not feel like ‘hey, you’ve impugned my character, you don’t feel like we’re doing enough for you.’ These are people that just want to solve the problem. They really do advocate for those end users, and that’s a major personality trait I think in these people that they make progress here.

Anthony: You have identified best practices in the report. There are four steps with a number of items under each one. I don’t know what level of detail you want to get into that, but what are your thoughts that you want to communicate around these best practices?

Tommy: We looked at several hundred organizations and came up with a little over a dozen that were doing this really well. We interviewed some of those top performers and we didn’t have any preconceived notions as to what the right way was to do this is. We really left it to them to explain in their own words what they’re doing to move the needle. What was really interesting is that there really were a handful of items that started to emerge in every one of these conversations. As we’ll go through this, I think people might listen to this and say ‘okay, that’s no duh.’ Of course, if I did that, it will lead to this outcome or I think I’m already doing that already. But I thought it was really interesting.

Step one was really seeking out as much connection as you can. I think a lot of people are connected to regional HIEs. A lot of people feel like they’ve turned on whatever sharing settings they can within their systems. This is one where vendors can also help too. Not all vendors default those sharing settings. One of our CMIOs was really empathic about this. He said “we’re not all on and we need to all be on for this to work at all.” I think there’s this kind of first level of okay, am I really committed to sharing everything I possibly can, am I actively seeking out everything in our geographic region, everything my vendors are offering.

One of the other messages of the report is across every one of these steps is the vendors are critical partners. If I’m an Epic customer, am I utilizing “Happy Together.” Meditech just came out with “Traverse” which is their package of interoperability products and items. Am I really trying to push the envelope on this? That’s I think is step one.

The next step is am I committed enough that it’s very clear at our organization what our interoperability goals are. Have we documented that? Do we meet regularly on that? Is this just something that we put in a chart or somewhere and left to the side? Or are we actively thinking about this as an organization?

Once you’ve come into that stage, one of the things that was really interesting when we talked to these folks – they said, it’s really daunting to share 100% of data with 100% of people out there. Getting our arms around complete interoperability seems like a tall task but what if we could just identify where 85% of our data goes and the 10 or 12 regional partners where that happens, and what if we started meeting with them once a quarter, once a month, and develop shared standards and practices.

We talked about how standards can be so vague to the point where people can interpret them different ways. What if we just took that on ourselves to say “okay, 10 organizations in this region, we’re agreeing to this, this and the other to really get out the needs.” That’s really step 2, is finding your cohort that you can work with. We would say that step 3 is really within that subset of people, can we agree on the most pertinent measures that we want to be sharing back and forth. We talked to one system they said ‘listen, whether it’s hep screenings, hemoglobin A1c,’ some of these really key metrics that we follow all the time to manage our patient populations.

We want that and if we can laser focus on a few metrics, then we can start saying okay, let’s do the deep work of getting this into workflows that you shared earlier.  Maybe we can get everything, we don’t have the resources to get everything perfectly within clinical workflows but could we take a handful that we feel are the most important and make them in line with what a clinician is doing every day.

Then, step 4, to your point, would just be that education and awareness piece of do all of our end users know where to go and what to do or is this knowledge kind of trapped in the CMIO’s head and a few others. Anyway, there is a lot there but those are the four steps if I were to summarize.

Anthony: What I see as a big problem here on the ground is don’t worry if you’re in New Jersey, don’t worry about sharing with the health system in California, that one extreme use case. Let’s not build our way around that, let’s build it in our region where we will see the most patients from other health systems. It makes sense. But these are also your competition, right.

That’s where the rub comes in. It’s like we pretend that there’s no competition but there is. There’s severe competition. You talked about M&A. What is M&A? M&A is competition. It’s gobbling up your competitors usually. There’s this idea that healthcare would be so much better, clinicians would be so much happier and patients would be healthier if we did the regional work and we sat around the campfire and we all exchange data, but there are our most fierce competitors. Any thoughts on that?

Tommy: I don’t disagree necessarily that that’s part of the equation and maybe I’m naïve, but I do talk to these providers everyday and I am pretty blown away by their level of wanting to coordinate. I understand that if you’re an EHR vendor and you’ve got proprietary technology and you feel like this is a competitive advantage to have people sharing information your way, I still don’t think that’s the right way to go about it. I think that we should be more open.

But on the provider side, I don’t get that sense that hey, I want to keep this close to the vest, because I think in their minds, they feel ‘I want to get as much as I can and I’ve got to give to get.’ Personally, that’s the way I have interpreted those conversations. I’ve been really impressed by people’s willingness. It’s really hard. It takes a lot of effort to get together and to dive into what are the exact reasons why this didn’t show up.

We’ve got a clinician who works at these two locations and he says that he entered this one day, worked at the other place, couldn’t find it. It’s really just how hard it is rather than a lack of willingness, I think.

Anthony: Well, let’s have a fun little debate, not a long debate but I would say that the people you’re talking to are not the ones that are going to have that competitive agenda.

Tommy: Frankly, the people we’re talking to, particularly in the Arch Collaborative, these are people that are all in – all boats rise together. This is an industry issue we need to come together on. You’re right. It does kind of self select for people who maybe want to collaborate and coordinate more than a typical leadership team. I wouldn’t discount that.

Anthony: Who knows right? Who knows if that some factor in a lack of regional exchange? It may play some role but we don’t know. Any final message for the CIOs? I think we covered a lot of it.

The takeaway for me is a reminder, a red flag to the CIOs and the CMIOs. They need to uncover at their own health system what their users think about the interoperability you are delivering or not delivering, how do they feel about it, regardless of how you feel about it. You have to find out how they feel about it and if they’re not happy, why and then address that, right?

Tommy: Maybe this is not the best analogy, I don’t know, but if my spouse comes to me and says “I’m unhappy.” It doesn’t do a lot of good for me to try to convince her that she’s not that unhappy. Usually, it’s a lot more productive to try to understand what’s going on and what could be changed or done differently. But I think that’s something that number one, you got to know. If you’re not measuring this, you don’t have to use our tool. There’s a lot of ways to ask people how they’re doing. But if you can formally measure this, that’s step one.

Tied to that, one of the things that we noticed in the report is we asked a lot of questions that are not free form but we do have a few open text common questions. When we asked physicians what’s the number one thing that you would fix in the EHR tomorrow if you could, their top thing is interoperability. When you’ve got your most expensive resource who is delivering world class care and you’re trying to keep these people, you talked about competition, keeping physicians is a pretty important thing and that group is literally telling you hey, this is a top priority for us. I would hope that that would be a wake-up call.

The only other thing I would say is I hope people don’t discount the best practices as common sense. I think we all know isn’t that common and being humble enough to say, okay, are we actually doing that best we possibly could across these four or five steps. That would be the other thing I would ask people to do.

Anthony: All right, Tommy, that’s great information. Interesting report. Certainly concerning results that everyone should focus on but that’s why you do the reports, it’s to let people know what’s up. I want to thank you so much for your time today.

Tommy: Thanks for having me on, Anthony. I really appreciate it.