KLAS Names Epic, NextGen Top EHR Vendors for Interoperability

Epic deep adopters reported the most interoperability with in-home patient monitoring technology compared to other top EHR vendors, KLAS found.

Among enterprise EHR vendors, advanced users of Epic reported the most health information exchange (HIE) connections, according to a KLAS report on interoperability. 

KLAS spoke with EHR vendor-identified “deep adopters” to examine the current state of interoperability in ambulatory and enterprise EHRs.

Overall, Epic received the highest score for interoperability among enterprise EHR vendors, followed by Oracle Health (Cerner). NextGen Healthcare received the highest interoperability score among ambulatory EHR vendors, followed by athenahealth.


Most EHR vendors have made significant progress connecting to national patient record exchanges and HIEs. Among respondents, advanced Epic users report the most connections. Epic also outperforms other vendors with connections to in-home patient monitoring technology.

Oracle Health (Cerner) customers reported leveraging FHIR application programming interfaces (APIs) and discussed progress in connecting to national patient record exchanges. athenahealth and MEDITECH customers said they are also beginning to leverage FHIR APIs more often.

Altera Digital Health (Allscripts), eClinicalWorks, and Greenway Health customers report less proactivity from their vendors in connecting customers to national patient record exchanges.


Overall, EHR vendors have progressed with making regulated data such as labs and PAMI (problem, allergy, medication, and immunization) available in the clinician workflow. However, data utility remains low. Unlike standards for PAMI data, standards for other data are interpreted by individual vendors, which limits the usability of the exchanged data.

“The individual interpretation at the vendor and provider level leads to manual efforts to find needed patient information and relevant progress notes in C-CDAs,” the KLAS authors wrote.

However, even with these challenges, NextGen Healthcare and athenahealth lead among ambulatory EHR vendors in enabling data access at the point of care. NextGen Healthcare customers consistently report functionality that deduplicates incoming data before clinical workflow integration.

Some athenahealth clients mentioned functionality that easily brings external PAMI and lab data into their workflow.

“The interoperability needs in an enterprise setting tend to be more complex, so customers of enterprise vendors are often more critical of their EHR’s ability to readily present relevant information versus making them search for what they need,” the authors explained.

Use Cases

EHR vendors have made the most progress in delivering clinical data to providers. The use of external data for transitions of care and analytics is still quite rare, the report noted.

While deep adopters of MEDITECH, Altera Digital Health (Allscripts), eClinicalWorks, and Greenway Health are receiving data, many have faced challenges in making the data more usable and accessible for different types of end users.

NextGen Healthcare and athenahealth have made progress with CCDs and Direct messaging to provide customers with better access to specific data types at the point of care. For several NextGen Healthcare clients, better access has led to more usable data during care transitions.

Epic and Oracle Health (Cerner) customers noted some improvements in interoperability use cases; however, Direct messaging and CCD volume in enterprise EHRs are much larger, requiring more workflow efficiency tools than ambulatory EHRs.


Most outcomes achieved today are related to data access for patient care decisions. However, some client bases report better information access than others.

Less than 25 percent of Greenway Health customers mentioned having access to external data that could impact their care decisions. On the other hand, at least 40 percent of NextGen Healthcare, athenahealth, Epic, and Oracle Health (Cerner) clients said they can reduce duplicate testing because of the integration of discrete external data at the point of care.

“This is notable, as reducing unnecessary medical costs is the only hard ROI measured and is a much-looked-for outcome of interoperability efforts,” KLAS wrote.

Epic, Oracle Health, and MEDITECH customers also noted increased patient access to the EHR through various apps. A focus on standardization has allowed customers of NextGen Healthcare, athenahealth, Epic, and MEDITECH to improve care transitions.

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