Most experts would agree that healthcare in the United States is too expensive. Furthermore, there is a fairly strong consensus that the cost problem in the sector is not created by the simple fact that care is expensive, but instead by the amount of waste that is happening in the industry. Bi-directional system integration is emerging as a key tool to improve operational efficiency in healthcare, creating a more sustainable fiscal model moving forward.

Excess testing is one of the most commonly cited problems in the healthcare industry, as the lack of data sharing between clinics, physician offices and hospitals makes it difficult for various medical professionals to fully understand what procedures a patient has undergone and the results of those tests. It is not uncommon for a patient evaluation performed by a local physician to be repeated by a specialist in a hospital because, even if that doctor knows the patient has had the test, he or she likely does not have complete access to the results. This issue also extends into prescription writing and medication orders, as the lack of collaboration makes it difficult for doctors in diverse care settings to work together when working with a single patient throughout the treatment cycle.

Between extra tests, problems with orders and results, pharmacy-related troubles and other challenges that stem from poor data sharing, it is clear that the need to support collaboration is becoming essential in healthcare. The urgency of this move is especially evident in the Stage 2 meaningful use standards, which heavily emphasize going beyond basic EHR deployment and uni-directional integration and are now pushing hospitals, physician offices and clinics toward increased establishment of bi-directional integration solutions.

The financial implications of bi-directional integration go well beyond reducing waste. Each time a healthcare facility establishes a need to exchange data they subsequently have to invest in the HL7 interface, work with the vendor(s) and establish the necessary workflow to be successful.  Bi-directional data exchanges presents even greater challenges around registration and order management and the need to match patients and orders between systems. As a result, healthcare networks are filled with valuable, but technically disparate interfaces that are not inherently designed to communicate with each other. Interface engine technology is vital to getting the most out of these investments, as it allows the organizations the ability to leverage their interface investments and reuse these connections points to route the information.  This technology is a crucial piece to the interoperability puzzle and is imperative that organizations invest as part of their integration strategy.  

Tackling bi-directional physician office integration doesn’t have to be so hard.  How are you handling your data exchange today?

Just a few years ago, HIE systems were akin to the Holy Grail of the EHR landscape, an ideal resolution to the quest for improved data sharing that appeared out of reach but was still the overarching goal of most providers. With the rapid rise of EHR infrastructure, led by government incentives that have enabled innovation, and the recent release of Stage 2 meaningful use standards, HIEs no longer look so unreachable and are emerging as more common data sharing solutions.

Now that HIEs are more accessible, the number of healthcare networks establishing new HIE infrastructure or joining existing systems is rising. This is leading to a fresh wave of innovation in the sector that could rival the initial rise of EHRs when it comes to the overall improvement to patient care. However, leveraging HIE technology to dramatically improve doctor-patient interaction is dependent on intelligent healthcare system integration that overcomes the inherent challenges in HIE setups.

The core problem with HIEs is ensuring that data is kept accurate across diverse EHR systems.  Essentially, a Meditech EHR that handles patient data at a large hospital needs to communicate with another facility's Siemens HCIS, and vice versa. To accomplish this, healthcare organizations need to have flexible integration technology to support the different data transmission and receiving needs.  While HL7 transmission protocols have standards, in order to ensure systems can communicate effectively with each other, data will need to be manipulated to meet the needs of the receiving systems. Flexible and robust interface engine technology will be essential to ensuring hospitals have the control at their fingertips to connect all their systems effectively and streamline sharing of patient data.   

During the past few years, many medical providers have moved from the initial establishment of EHR infrastructure to deploying integration solutions that allow diverse EHRs to communication. This has not only led to more communication between hospitals, clinics and physician offices, but has also established a firm foundation for more HIE deployment. The industry is now witnessing the results of that solid core as more providers have the tools they need to make advances in HIE infrastructure.
 

A recent survey of health IT leaders at the HIMSS 2012 conference found that achieving Meaningful Use for EHR setups is the top priority when it comes to employing new information technology systems in the sector, Healthcare Informatics reported.

While the largest percentage of respondents cited achieving meaningful use as their top priority, the number of organizations striving for this goal declined slightly from last year. Approximately 38 percent of those polled said they consider meaningful use as their primary focus for health IT innovation. Last year, more than half of survey participants named meaningful use their most important focus. However, the news source said this could be indicative that more organizations have made major progress toward meaningful use and are moving on to other areas.

Focusing on clinical systems was revealed as the No. 2 priority among medical providers, with 15 percent of respondents identifying this area as their chief focus. Furthermore, 13 percent of respondents pointed to either data warehousing, clinical decision support and evidence-based medicine as their primary areas of emphasis.

The survey also revealed that financial issues are not holding back the sector. The study found that for the first time in years, money is not considered the main barrier to healthcare IT adoption. This indicates that federal grants may be helping fuel innovation and at least validates that many healthcare providers are dedicating enough resources to support technological growth.

Instead of financial limitation, the study found that staffing resources are now the greatest barrier to innovation in the sector. Approximately 22 percent of respondents explained that finding staff with the right training to implement IT systems is the greatest challenge they face. Financial barriers came in second, with 14 percent of respondents saying a lack of resources is limiting technological growth.

As more healthcare providers advance their EHR systems and other IT investments, it is essential that they find ways to integrate their healthcare systems to enable data sharing and similar advanced capabilities. As physicians depend more heavily on EHRs, automatically updating data between systems is essential to limiting errors and ensuring doctors can always get access to the information they need.

Healthcare solutions that streamline operations and make life substantially easier for physicians are rapidly becoming more prevalent in the sector. However, these advances will all come to nothing if the patients are unable to recognize how EHRs improve their care. The medical industry is recognizing this and patients are responding. According to a recent study from the National Partnership for Women and Families, consumers are becoming increasingly aware of EHRs and are beginning to trust the new health IT tools.

Most of the respondents to the survey said they are beginning to accept that EHRs and other similar solutions will improve how doctors manage their care, even though they are still somewhat concerned about data privacy. While this worry is valid, respondents clearly see the potential gains of EHRs as greater than the risks.

The key difference is that the respondents are seeing their physicians use EHR systems. The study found that respondents whose doctors actually use EHR solutions are more positive about the technology's potential. Furthermore, even those whose physicians are still using paper records tend to see the advantages of EHRs. This has become so prevalent that approximately 75 percent of patients whose doctors depend on paper say their care would likely be improved if their physician turned to an EHR.

Christine Bechtel, vice president at the National Partnership, explained that the growing consumer support of EHRs is critical, as patients will likely drive the technology forward and ensure continued political efforts to drive innovation. "For health IT to deliver on its promise, consumers must support it. If they don't, we will see political pressure for repeal and the promise will be squandered. What we found is encouraging, but there are still potential landmines ahead," said Bechtel.

Farzad Mostashari, national coordinator for health IT at the U.S. Department of Health and Human Services, echoed this sentiment, pointing out that patients are often put on the back burner when technology becomes the focus, even though the innovation is designed to improve the patient experience.  For medical providers working to optimize EHRs for patient needs, healthcare system integration is emerging as a key technology. Integration allows organizations to connect their EHR platforms and automate data updates and other similar processes. This keeps all physicians within the care spectrum up to date and ready to meet the needs of patients.

In this installment of Summit Connection I thought it would be worthwhile to discuss the importance of selecting the right interface engine for your Healthcare Information System (HCIS). The interface engine is the central location that ensures clinical and business data is passed smoothly and securely amongst multiple HIT systems. Government regulations such as the American Recovery and Reinvestment Act (ARRA) of 2009, have mandated hospitals to foster open channels of communication with local physician offices and clinics electronically. This particular act has provided incentives for hospitals to strengthen their HCIS to improve communication flow among multiple entities, with the ultimate goal of improving the safety and quality of patient care.
Why purchase an interface engine vs. using individual point-to-point interfaces?

Implementing an interface engine will provide a healthcare organization the flexibility to develop and manage an array of interfaces from one central application. Here are four examples of how a well-equipped interface engine will provide efficiency and cost-containment to your organization:

1.)    Consolidates status and alerting views: Monitors all interface activities from one central location
2.)    Enhances flexibility:  Maps and filters interfaces to your liking and easily incorporates future interfaces
3.)    Automates documentation: Enables seamless reporting and task distribution
4.)    Cuts costs: Ensures rapid ROI by reusing interfaces and reducing maintenance fees from multiple interfaces and vendors

What makes a good interface engine?

The best interface engines offer very high levels of flexibility, enabling the user to initiate and control its core functions according to their specific needs and environment. An interface that facilitates exploration and a trial and error process for its users works best; users will become better at incorporating the proper settings for their unique interests.  Most importantly, the interface should assist in preventing user errors, highlighting the most important information upfront. Consistency is also key. A humble layout is simpler to master and also provides a consistent appearance. The design should foster a good balance between maximizing functionality and maintaining simplicity.
 
If you are in the beginning stages of upgrading your interface there are several items to keep in mind:

•    Size of organization
•    Number of facilities
•    Type of messaging format (HL7 or non-HL7)
•    Current pain points that are being experienced
•    Budget constraints
•    Time needed for training / implementation

Rushing or not undertaking a thorough evaluation when choosing an interface engine could bring about dire consequences for your organization. Remember, choosing a vendor that will properly train your IT staff is of most importance to ensure staff can accurately implement the interface and respond appropriately to a problem.  It is also advantageous to maintain a strong partnership with the vendor to receive swift and thorough answers to questions.

Not seen by the end user, but recognized as the “heart” of the entire HIT infrastructure, the interface engine typically goes unnoticed until it fails. If a malfunction to the interface engine does occur, a stoppage to the entire HIT system ensues -- resulting in crucial data exchange being halted and patient care being disrupted. That’s why spending the time to choose the proper interface is important!

I look forward to your thoughts.

-Ellen

Next blog post: Best practices to ensure a successful MEDITECH 6.0 migration