Interfacing requirements continue to evolve. Whether you are ready or not, the healthcare industry is in full flight and there are many new challenges to be met while we are jetting along.

We must now consider the challenges of electronic communication outside the walls of the traditionally secure fortress of our healthcare entity. Once upon a time we were concerned with coordinating the care of our internal patient business. This involved systems for patient identification, departmental systems, devices and reporting/analysis. As business demands, consolidation and meeting customer expectations increased, more and more sharing of electronic information came to be” In-Network”. Added to this was the necessity to manage multiple EMR systems and differences in Terminology.

Now we are facing what to do with Out of Network sharing. Internally and In network the demands continue to mount due to the increased pressure for bedside instrumentation integration and other clinical solutions that bring into consideration all of the standards beyond HL7v2 and their battle for supremacy. Our biggest challenge may very well be the protection of PHI and how effectively we address the daunting task of consent management. Of course, with all of the additional availability of case management information from all socio economic and geographically diverse populations, the tools that we use to retrospectively review our clinical and financial decisions that drive our intervention approaches of the future, decision support, reporting and analysis, must be flexible enough to address the dynamic growth of our industry.

As healthcare continues its precipitous journey towards providing the newest, most innovative solutions to patient care, the foundations upon which this entire transformational journey rests, is your integration strategy. But have you applied the required focus on the building blocks of connecting systems (EMR/HIS, Departmental Systems) and capturing the data, sharing the data throughout the healthcare continuum, and transforming this data into information that will improve clinical process, drive down costs, and increase efficiency?

New data formats are complicating integration. For example, lab systems are now generating microbiology, pathology and other reports in RFT, PDF and other formatted text documents. XML based documents and formats are becoming prevalent: CCR, CDA, HL7 3.x. These have more complex data structures to implement. Not all systems can receive and display the new data protocols and types.

EMR’s

There are over 300 EMRs in the market. Until consolidation occurs there is a huge integration effort which is complicated by the EMR vendor integration knowledge lagging behind the in house hospital vendor knowledge. The understanding of HL7 2.x lags. While bidirectional interfaces between the physician practices and hospitals for orders, results, scheduling, etc. are desirable they are not easily implemented due to some of the following issues:

1. Patient Identification due to EMRs and hospital using different Patient IDs. EMPIs need to be able to handle multiple sources of data.

2. No industry wide order and results codes.

3. No presentation standards.

4. Provider ID issues

5. Reflex and follow-on results

6. Multi-routing of results based on Ordering, Attending, Consulting, etc.

7. No standards for text based reports like Pathology that allows providers to quickly ascertain the major issues in the report.

Even when all data is available and in the correct data fields it is not presented to the end user in an efficient form. Integration techniques can be used to reformat the data into an end user friendly format. Another aspect to consider is the results integration where you have both textual and discrete results. What happens when a free text result field is requested to be turned into a formatted report on a destination system? Report formatting and processing is one of the most complex sides of systems integration and typically takes 80% of a new system installation integration cycle.

Creating the initial system integration strategy is the hardest part of a project. You have to have the forethought to include what's coming next and what systems may be retired or replaced. These items lead to new requirements for integrations and can lead to a spider web of connections from peer to peer. These issues can exist within the middleware if steps are not taken to create a scalable environment that can easily accept new connections and messages from old system with new data requirements. We see issues day to day where initial implementations are complete and functional but not scalable as they connect various applications of a specific vendor.

There is so much work to be accomplished in preparing to begin the journey towards “Meaningful Use” that if ignored, you could be left behind. Santa Rosa Consulting can help you to ensure that you are in the best possible position to ensure that you make your flight. Call us to find out how we can do assist you or go on line at www.santarosaconsulting.com for more information.