EHRs far from interoperable -- still

New research finds interoperability capabilities in EHRs evolving too slowly
By Bernie Monegain
08:29 AM
Road signs

The most valued patient data resides in the EHR, yet EHRs are architected to perpetuate data silos. Because of the lack of interoperability, healthcare providers can't achieve true care coordination.

To date, EHR vendors have turned a blind eye to this critical flaw, and according to a new report from Boston-based Chilmark Research, there is no sign they will change anytime soon.

The rapid expansion of value-based reimbursement is exposing unmet needs for active coordination – care, financial and administrative – within and between healthcare organizations, say Chilmark executives in a news release announcing the findings.

"Most EHR vendors regard their core clinical systems as comprehensive and inviolable – few readily admit that provider needs are have long outstripped existing EHR feature sets and ongoing development efforts," Chilmark researchers conclude in the report.

At the same time, they note, healthcare end-users have elevated expectations based on consumer-facing application ecosystems or "app stores" – built on the technical foundation of open APIs in a cloud-based environment.

The EHR market is ripe for the development of an application ecosystem to rapidly extend functional capabilities and remedy usability deficiencies, they say. But first it needs open APIs and a Platform-as-a-Service for developers.

The research found that independent software vendors have mixed opinions about the capabilities offered by EHR vendors.

"Some survive, and even thrive, but always at the sufferance of major EHR vendors," the report asserts. "Others survive in the shadows, taking pains not to attract any attention from EHR vendors for fear of being shut out."

The report characterizes the interoperability capabilities of prominent EHR vendors. Current technology interfaces that provide data after the fact, non-disclosure agreements, data access fees, and the lack of reasonable software tools for developers are all obstacles to the development of extensions for developers.

Open APIs as solution

The report describes how the leading candidate for open APIs in healthcare – HL7 Fast Healthcare Interoperability Resources, or FHIR – is being implemented by EHR vendors. This new technology offers the most potential to provide real-time access to data across applications and organizations and may ultimately give rise to Platform as a Service-based ecosystems, according to Chilmark Research analyst Brian Murphy, lead author of the report.

[See also: Epic defends interoperability bona fides.]

"Open APIs will ultimately form the basis for the interoperable health records that patients and providers are demanding," Murphy said in a statement. "The work being done by the major vendors to support FHIR is only the beginning. In the next year, we expect healthcare technology contributors – IT vendors, payers, health information organizations and others to move beyond endorsement to actual implementations."

As Murphy sees it, FHIR APIs will eventually replace much of the data exchange technology painstakingly assembled over the last 30 years with modern ideas of open, distributed computing. Programmers will access data where it lives rather than where it has been staged, leading to rapid improvements in IT functionality, usability and genuine choice in applications to use.

[See also: Everyone backs interoperability, but... and ONC calls for interoperability by 2017.]

The report concludes that the healthcare market is "quite ready" for API-driven extensions to clinical and financial applications.

Leading IT vendors will need to API-enable their core products if they wish to foster a PaaS ecosystem that accelerates their ability to address unmet needs of end users, Murphy concludes.

"EHR vendors are better positioned than any other HIT vendors to become true platform vendors as they are still at the center of physician workflow, hold the keys to clinical patient data, and still command the lion’s share of IT resources and subsequently attention from HCO C-suites," he says. "This is their opportunity to lose if they fail to innovatively create a true ecosystem around their offering."

The report provides a snapshot of several EHR vendors’ interoperability capabilities, or lack thereof, as well as a review of their nascent API programs.

A similar report, to be published in late 2015, will provide a similar analysis of what other IT vendors serving the healthcare sector are doing to enable their own PaaS strategy. This second report will also include an analysis of how other well-known providers of interoperability solutions (i.e. CommonWell and the Sequoia Project (formerly HealtheWay)) are contributing to the development of a more platform-centric approach that can deliver an application ecosystem to healthcare.

[See also: Epic, Cerner, others join HL7 project.]