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.