Guest Article: In a world of cloud services, are HL7 interface engines dead?

May 8, 2012

I spend a good deal of time with clients these days who are trying to connect web services, implement service oriented architecture (SOA), and moving to the cloud. All these requirements are focused on integration of multiple, sometimes legacy sometimes modern, systems but most of them still require lots of HL7 interfacing. Some of my clients start their integration efforts hoping that there is something better or more modern than HL7 but the truth is that HL7 and interfacing remains the backbone of health system integration. Choosing an integration tool is time consuming so I reached out to Craig Cunic, the Product Director of Interface Engine Team at Iatric Systems, to get some advice on how to choose an interfacing engine. Iatric has been solving complex health IT problems for a while so it’s worth following’s Craig’s advice on the Dos and Don’ts for Interface Engine Consideration. Here’s what he said:

It has been suggested that due to the advent of web services, Service-Oriented Architecture (SOA), and cloud computing, interface engines no longer serve as the proper tool for system integration. Is the interface engine dead? Yes, it is, if the interface engine does not have the necessary feature-set to support the growing number of data standards and if it can’t exchange data with today’s diverse healthcare systems and devices.

Today’s interface engine is an advanced integration engine.

The interface engine is not dead. Today’s interface engine is alive and well…and it is one with advanced features that turn it into a mighty integration engine. It is one that has extensive security and privacy features and the scalability to grow with your increased interface needs. Today’s interface engine also integrates clinical portals and medical devices, achieves other complex integration situations and supports Meaningful Use mandates. And, an advanced integration engine is easy on your IT budget: it helps control the budget because there are no ongoing interface costs.

If you are considering upgrading your current interface engine to an advanced integration engine or want to move away from point-to-point interfaces, here are the dos and don’ts to consider when researching and evaluating different integration engines:

  • Do consider engines built on modern platforms such as .NET or J2EE. These will have a leg up on the competition in terms of being able to fulfill many of the requirements mentioned above.
  • Don’t overlook the potential barriers in data sharing. Look for an engine that can simplify these types of communications: direct to database (ADBC, OLE, DB, Oracle and SQL), transfer types MLLP, TCP/IP, folder shares FTP (SFTP and FTPS) and SOAP.
  • Don’t select any engine that is built on outdated technology. Look for engines built on advanced architectures to ensure scalability and extensibility and to support new formats and new demands as they arise.
  • Do look beyond the engine’s interface capabilities – look into its ability to monitor all activity in real time and deliver exception notifications automatically. Engines using a visual IDE are best. Monitoring performance and sending problem alerts are critical for minimizing downtime, which has a negative effect on healthcare.
  • Do analyze the vendor that is offering the solution and evaluate the level of customization that the vendor provides to meet your specific security needs. Also look at how much support the vendor provides in terms of minimizing IT effort at your organization.
  • Do make sure the engine supports all major standard messaging data formats (delimited, fixed length, HL7 2.x and XML).
  • Do consider the time that must be dedicated to set up each interface, train users, record updates and generate useful reports.
  • Don’t forget that modern systems need to integrate using scripting languages such as PHP, Ruby, Perl, and Python. While .NET and J2EE are kinds of the enterprise world, scripting and glue languages are the yeoman of the integration world.

Interface engines are a core element in today’s healthcare environment, and are a requirement to achieve interoperability and meet Meaningful Use. The interface engine you choose should not only streamline your healthcare organization’s ability to share medical data with providers, patients and the community, but also minimize the IT efforts necessary to accomplish this sharing.

{ 4 comments }

What I learned at the HIMSS Conference about developments in Health IT for the rest of 2012

March 27, 2012

Like many of you, I made the annual pilgrimage to the HIMSS Conference last month but I didn’t write much publicly about it (I mostly wrote private analyst reports for specific clients). There’s so much noise at such a big conference that I like writing about HIMSS gatherings after a little time has passed and I can discuss the market landscape with vendors outside the craziness of the conference. Here’s what I learned while I was in Vegas and my takeaways for the rest of the year.

Major developments in Health IT for the rest of 2012

It was discussed a lot in the educational sessions and vendors didn’t talk about it much, but the new realities of complex business models (like PCMH and ACOs) mean that standardization of clinical workflows won’t really be possible for a while. The open secret is that most EHRs are not up to the task of handling the complexities of new business models, though. I believe the big shift to cloud computing and mHealth will mean that smaller and more nimble “apps” (both web based and mobile) will start to shoulder more of the burdens that are being thrown in by new business models. When you add more services (like smaller cloud apps and mHealth apps) more and more orchestration across services and apps is necessary (not larger apps).  The common wisdom is that there will be fewer EHRs as consolidation occurs but that’s not going to happen – interfacing, interoperability, and real service based platforms will be created that can handle the next level of more sophisticated requirements. We’ll move from basic record keeping and document management to more refined patient management, patient engagement, social electronic health records, and collaboration-driven software. The older vendors will start to hear the collaboration siren songs and jump on board pretty quickly.

How the role of EHRs will change

The best EMRs will be those that become the central “dashboard” around the most complex healthcare workflows and begin to really become “coordinators” amongst multiple systems instead of a monolithic application. Clinicians really need to understand that their EHRs need to be their patients’ social health record and relationship management system and not just their chart management system. The role of the EMR must and will change to being the patient-centric collaboration and engagement driver and will just happen to store documents, charts, and MU records as a byproduct. When retrospective documentation becomes a byproduct of more collaborative care systems then we all win.

Developments in coordinated care

I’m not sold on coordinated care technologies “writ large” – the problem is that the government and vendors are making it sound as if this is the first time care has been coordinated. In reality, care has always been (at least minimally) coordinated in the physical realm – e.g. referrals have been used to coordinate care for decades. The level of technology coordination and the amount of measurements that have always been tough to define, implement, and secure continue to remain just as difficult. The good news is that we’re all in agreement that we need to coordinate care; the bad news is that we don’t really know what that means but we’re seeing vendors say they have systems that support it (which means they’re either misleading customers or they don’t know what they’re talking about). Care coordination is about clinical integration as opposed to record sharing and we have a long way to go to really implement seamless coordination even though we have the basic technologies available to do so now (the basic technologies are social media, e-mail, and the web, not EHRs).

Security challenges need more thought and attention

The privacy rules are getting tighter and tighter but the relationships between care providers are expanding farther and deeper. For example, now all IT vendors that used to be just contractors are in some respects HIPAA business associates – there are tons of implications for vendors that they’ve not started to grasp yet. Also, think about PCMH and ACOs – they create new business relationships and care models that create significant headaches for security professionals. The healthcare world, while it’s getting more complicated, wants to get more secure at the time and it’s not reasonable to think you can make business models more complex and at the same time have more security – something’s going to give.

Don’t think HIPAA means security

At HIMSS people kept tying security and HIPAA – as I reminded my readers last year, HIPAA is not really a security standard – it’s a compliance framework and provides general guidance. I continue to recommend that organizations expand their focus from HIPAA when constructing their healthcare security policy, and model their documents off of NIST (National Institute of Standards and Technology) and other resources. NIST actually provides measures, security controls, risk frameworks, and standards that can be followed. If you follow general NIST guidelines and have really secure systems based on NIST suggestions then meeting HIPAA regulations are a piece of cake.

Biggest HIT-related and healthcare changes that physicians should prepare for

HIPAA 5010, ICD-10, and MU Phase 1/2 will keep everyone busy; start to worry about converting all your vendors into HIPAA business associates and become experts at data integration and connecting multiple software systems. Forget your focus on vertical (e.g. EHR) applications and start to focus on best of breed, smaller apps, and integrating multiple apps.

Role of payers in setting technology solution standards

The role of payers in setting technology standards is growing and will be significant and consequential – in fact, without the payers driving the train nothing will really happen. Now that Medicare has taken the lead, the big payers will be right behind. The beneficiaries of ACOs are likely to first be payers, not just patients. I’ll be writing more about this in the future.

Now that we’ve had a month to think about it, what is your follow up advice from the HIMSS’12 Conference? Drop me a note below.

{ 11 comments }

Take new practice management technologies to the bank as patients push for online services

March 25, 2012

I was recently interviewed for a nice article on why and how private physician practices should push for new technologies. Andrea Downing Peck did a pretty good job putting together a collage of views from me and some of my well known colleagues online: Mary Pat Whaley, David Henriksen, Dr. Jaan Sidorov, Shari Crooker, Rosemarie Nelson, David Harvey, David Williams.

Here are some of my favorite quotes (taken directly from the article):

  • Mary Pat Whaley: "Patients are saying, ‘If I can’t register for your practice online or ask for an appointment or get a prescription online, I really don’t want to work with you. If the convenience isn’t there, [they] don’t have time in [their] lives for a physician who is not going to offer these things."
  • About Data safety remaining a concern with cloud computing, Dr. Sidorov say: "Is all that patient information really secure being stored on some server in Singapore? Will it be easier for some hacker to [break] into that particular database? Maybe I don’t know. It’s probably better than storing patient information on a local server in a closet next to a water heater in a typical physician’s office."
  • David E. Williams: "The physician’s office is one of the last places you can go into where, if you’re Rip Van Winkle and have been asleep since the 1950s, you’ll feel comfortable there seeing all the colored tab folders with the patient records and so on.”
  • Shahid Shah: “As long as we have insurance, any PCP, especially those dealing with the elderly, are probably safe not being super advanced," he says. "But if you’re a practice that wants to go after the high-end, high-value profitability patient, you’re signing your death warrant if you are not [technologically] advanced.”
  • Dr. Warwick Charlton suggests modular technology solutions: "If your system is monolithic…it’s very hard to get that incremental gain that dedicated modular systems can get. Over the long run, it’s a less scalable, less technologically adaptable answer."

Probably the single best advice came in the paragraph below (make sure to get the integration with advanced functionality):

Describing the practice’s first go-round with an EHR as "disastrous because it was so complicated and expensive," McMahon has made paramount selecting the right EHR/PM this time around. Her wish list for a cloud-based integrated EHR/PM system makes ease of use a priority along with features such as voice dictation, e-prescribing, integration with scanners and fax machines, interfaces with existing medical equipment, and a patient portal that offers appointment reminders and bill payment options.

When looking for integrated solutions, though, be sure to heed Dr. Charlton’s advice and go modular and not monolithic. Over the long run, no single solution will fit your bill so you need to prepared to become an integration specialist.

{ 16 comments }

Join me on Friday afternoon for the Military EHR Conference in Arlington, VA

March 14, 2012

The Military Electronic Health Records Conference is being held at the Holiday Inn Rosslyn in Arlington, VA on Thursday and Friday this week. Military EHRs are a complicated topic and I have been invited to deliver a talk called Using Connected Medical Devices to Improve Military EHRs & Integrating Social Media into Military EHRs. I will be presenting on Friday afternoon at 1:45p but should be around at the conference before and after as well if you’d like to meetup.

Answers to some of the key questions that participants will learn about include:

  • What are the goals and objectives of the DoD EHR Way Ahead Program?
  • What is the future of AHLTA? What are the lessons learned in EHR implementation? VLER installation?
  • How will the introduction of Service-Oriented Architecture tools and technologies facilitate interoperability among DoD and VA EHR Systems?
  • How do you measure EHRS effectiveness? Ensure security and privacy? How are Web-based hosting and Cloud Computing changing the approach to EHRS?
  • What new capabilities are being developed in EHRS data mining and global, mobile EHRS?
  • How do we tie military and private systems into the National Healthcare Information Network?
  • What new opportunities and projects will becoming available?

{ 2 comments }

Guest Article: Do’s and Dont’s of RFID in Hospitals

I’ve written and presented recently on a number of “Do’s and Dont’s” around medical device integration, mobile health, EHRs, and various related topics. Some of you have asked if I could do something similar on the subject of RFID. Since I’m not an expert on the topic, I reached out to Yedidia Blonder, a Product [...]

6 comments Read the full article →

Meaningful Use Stage 2 NPRM means new opportunities for Medical Device and non-traditional Health IT Vendors

Last week at the HIMSS Conference ONC announced Meaningful Use Stage 2 Notice of Proposed Rule-Making. Many of you have asked me for a quick opinion of what it means to health IT and medical device vendors so I wanted to take a few minutes to share my initial thoughts. Meaningful Use Stage 1 was [...]

9 comments Read the full article →

Tips from Real Users on How to Succeed with Electronic Medical Records

There are important differences between the health care providers who truly reap the benefits of switching to EMR, and those who don’t. I’ve covered some of these differences before and I was pleased to see that Katie Matlack, Medical Analyst at Software Advice, actually went a step further and interviewed representatives of three health providers [...]

1 comment Read the full article →

Guest Article: Techniques for matching patient record data across disparate EHRs and other systems

Some of the most frequent questions I receive these days surround data interoperability and integrating multiple health IT systems. One of the biggest problems in connectivity is matching patient record data and ensuring that the same patient data in different systems is linked properly. Given how many times this topic comes up, I reached out [...]

1 comment Read the full article →

Join me in San Francisco on Monday where I’m talking about Using Android in Safety-Critical Medical Device Platforms

The Linux Foundation has invited me to speak about how to use Android in Medical Devices on Monday, February 14 at the Android Builders Summit. If you’ll be at the Summit or are in the San Francisco area and would like to meetup at or near the event, please reach out to me via speaking@shahidshah.com. [...]

1 comment Read the full article →

I’m speaking at NIH Clinical Center on Why Meaningful Use (MU) and EHRs are Insufficient for Evidence Based Medicine (EBM) and Comparative Effectiveness Research (CER)

If you’re in the DC area near NIH please join me tomorrow as I lead a discussion on why MU is insufficient for EBM and CER. Here are the details: When:  3:30 – 5:00 PM, Thursday, February 9, 2012 Where:  NIH Clinical Center (Building 10 North), Hatfield Room 2-3330 Abstract: Comparative Effectiveness Research (CER), which [...]

2 comments Read the full article →

← Previous Entries