When you visited the doctor, an administrative assistant no longer “pulled your chart.” The typical doctor appointment today involves the doctor typing while they talk to you. This raises a completely new set of inquiries: How much time does the doctor spend with you as opposed to filling out paperwork? Was the doctor’s (or the scribe’s) understanding of your information accurate, or was it merely a summary?
When you visit an emergency room or a specialist outside of your regular doctor’s office, who most likely does not have access to your primary doctor’s medical information, the problem is exacerbated. Every doctor you see requires you to regurgitate the same background information.
What can then be done by organizations involved in health and health tech, ie those in charge of putting in place the health IT systems on which we rely, to lessen the inefficiencies present in the current environment?
Prior to now, the digitalization of medical records for single organizations was the main emphasis of health providers and the software businesses that support them. The HITECH Act of 2009, which encouraged the adoption of electronic medical records (EMR) in hospitals and physician offices, is partly responsible for this concentration in the US; nonetheless, the idea of communication between healthcare professionals was all but absent. The initial stage in implementing data interchange between hospitals was supposed to be the Health Information Exchanges (HIEs) formed as part of the HITECH Act, but the HIEs were only regional, and participation was not mandated, leading many organizations to not participate.
Interoperability and the accessibility of data to the individual patient have received more attention recently with the enactment of the 21st Century Cures Act of 2016 in the US and the adoption of the Recommendation for a European Electronic Health Record interchange format by the European Commission.
Of course, there are standards that are designed to make integration and interoperability between health software easier, most notably Health Level 7 (HL7) and Fast Healthcare Interoperability Resources (FHIR). These standards govern the use of common APIs to transfer health data between software products and, in the case of FHIR, what the data format should be.
The application of these standards, particularly HL7, is the issue; many of the main EMR suppliers have their own ways, which leads to less-than-ideal techniques for vendor integration.
Additionally, although these standards specify the data’s format and technique of integration, they do not specify how or where the data should be integrated. The only options left are point-to-point communication between healthcare practitioners or one of the few HIEs that are currently in operation.
We should be able to give patients and doctors access to patient-level health information regardless of which doctor or provider is being seen, as EMR implementations are now widespread and standards are available for connecting amongst EMR providers. In the sections that follow, we’ll look at three strategies that health software businesses can use to enable the exchange of patient data between provider organizations.
Integrate with an EMR vendor and their health information exchange, according to Approach 1.
Major EMR companies supply providers and patients who use their software with their own HIE solutions. No matter which doctor the patient sees, as long as that doctor uses the same EMR software, the patient’s health information is accessible here to both the patient and the physician.
This has some clear benefits, particularly for the patient. I can access my primary doctor’s patient portal as a patient and view all the information they have gathered on me as well as any information that other doctors who use the same EMR software as my primary doctor have uploaded.
The outcomes of my trips to other doctors or hospitals are also visible to my doctor, including conditions, listings of my current and previous medications, notes from the doctors, and summaries of my discharge.
Integrating with the small number of EMR providers offers some clear benefits for organizations that make health software. You enable the majority of patients to use your software by integrating it with some of the key vendors.
The issue with this strategy is that the main suppliers may not be amenable to software companies integrating directly with their products. Although they provide integration APIs and (slightly) publicize their documentation, their integration material is mostly directed at their clients, not other parties.
For many software vendors, there are two options:
- Create your applications with HL7 and FHIR in mind.
- Use an engine for EMR integration.
Writing integration APIs that use HL7 for the data format and FHIR around the data format and APIs is the first step for any organization wishing to combine their health data with the patient’s data in the EMR. Although it may seem intuitive, many businesses fail to consider interoperability and external integration when designing their apps. But this ought to be apart of the architecture from the start.
The use of an integration/interface engine is the next stage. They are widely available now and all offer some sort of connection with the top EMR vendors.
HIES AND HIE NETWORKS, APPROACH 2
As was already indicated, the initial HIEs were focused on geography; that is, teams of providers from a certain area or geography would come together and decide how to exchange their data. They were frequently supported by state governments or the providers themselves. Everything in these HIEs has to be created from scratch, including decisions about what data to disclose, how to share it, and how to link patients with physicians.
This kind of integration still (to a certain extent) excludes patients. Despite the fact that patient data is shared around the various healthcare providers, they themselves must sign in to numerous EMRs in order to access it.
This strategy still necessitates that third-party software providers interact with each EMR provider in order for them to connect to patient data (see Approach 1).
Connecting to an interoperability framework like Carequality, which offers software “implementers” a common language for communication, is the solution for many software vendors. While utilizing HL7, it goes above and beyond by giving software manufacturers a way to exchange data directly without using point-to-point connections.
Health software manufacturers can have their products interoperate and exchange data with each other when Carequality is joined with the CommonWell Health Alliance, which offers a link between software vendors rather than just the concept of such a relationship.
POINT-TO-POINT INTEGRATION IS APPROACH 3
This method, like the previous, calls for health software vendors to contact each organization they wish to integrate with and negotiate access to their data using HL7 and/or FHIR. But with this strategy, access to each healthcare provider’s EMR must be negotiated with them directly rather than with the EMR vendors.
The strategy of the largest personal health record (PHR) vendors serves as an illustration of this. PHRs can extract information from the EMR and deliver it to the patient using the HL7 CCD (Continuity of Care Document).
For patients, this is a practical and easy option because it gives them a single location to access all of their pertinent medical information. The drawback for the software implementation business is that they must contact individual health systems in order to obtain access to their data, in addition to knowing where to obtain data from each vendor’s software. Despite the standardization of the methods for achieving this, agreements with each provider still need to be established.
Despite the fact that data exchange is now commonplace, the healthcare industry still finds it difficult to exchange data. Health software firms must consider the greatest and most pleasant option for their end users, including patients, doctors, and medical professionals, in addition to the best technical solutions to convey health information.
KPi-Tech takes pride in developing HL7-compliant HIE software solutions and HL7 Integration that enable full interoperability within all medical data management systems.
Our Healthcare IT services achieved milestones to support the storage and transmission of medical data interfaced with the various medical data management systems.