Interoperability is necessary for the attainment of a more efficient healthcare system and the use of HIEs. It puts important patient data at physicians’ fingertips, allowing for more informed decision-making and better continuity of care. Interoperability is on the rise, spurred by government efforts to increase health information exchange; however, barriers by EHR vendors often make it difficult for organizations to effectively share patient data.
If EHR companies advertising interoperability at HIMSS in recent years is any indication of vendor commitment to the cause, one would think that connecting EHR software to third-party solutions is easy. The reality, however, is altogether different. Despite government efforts (ie. MACRA) to drive changes in the ability of disparate IT systems to connect to one another, exchange data and use the information that has been exchanged, interoperability remains a big challenge for many healthcare organizations. The creation of integration standards such as CCD and FHIR are great concepts, but CCD has been mainstream for many years and still EHR vendors struggle to support a quality CCD file.
Part of the blame for the lack of progress on interoperability can be placed on some of the larger EHR vendors that make it difficult for organizations to integrate third-party software solutions with their EHRs. In most cases, large medical practices can expect to spend anywhere between $5,000 and $20,000 for uni-directional data feed access. These prices increase dramatically as complexity increases and for larger hospitals and health systems. This is not cheap, and it’s not the only obstacle that EHR vendors can legally put in the way.
In addition to charging exorbitant fees for interface development, vendors also create barriers to interoperability in the following ways:
- They prohibit access to the EHR database outright.
- They allow read-only access to the data feed.
- They allow data to be sent, but not received in any way.
- They delay the process to the point where interest by the physician is lost.
“One reason big EHR companies have this policy where they try to limit data feed access is that they’re afraid of customers getting away from them,” says Kemp Stephens, VP of Sales at PrognoCIS. “The customer might notice deficiencies in the EHR system, or they might find things they like better about the other product and consider using that company for other things as well.” PrognoCIS welcomes third-party integrations with its EHR, working with companies like Bridge Patient Portal whom specialize in hospital, clinic, IDN and HIE patient portals to deliver solutions that truly meet customers’ needs.
Though it is becoming more and more difficult for vendors to place obstacles in the way of interoperability without losing customers to more forward-thinking companies, for now the problem remains; and physicians must find alternative ways to surpass vendor regulations.
“It takes an educated consumer to know how to approach that conversation with their EHR vendor,” says Leana Gorsline, Director of Business Development for X-Link. Similar to other medical software interfacing companies, X-Link educates physicians on the options available to them in terms of finding workarounds for affordable interface development.
So, what exactly are the options for practices that want to integrate a third-party patient portal EHR or practice management system with their EHR?
Choose a vendor that is truly committed to interoperability.
Though connecting to the EHR database may not be a necessity now for all healthcare organizations, it will be at some point in order to achieve a truly interoperable health IT infrastructure. For this reason, it is important for physicians to have a discussion about interoperability with their EHR vendor early on, this way expectations are clear if and when data feed access is needed. The earlier this discussion is carried out the better, as the negotiation process could get drawn out, delaying potentially critical software integrations.
Two things to consider when searching for an EHR vendor that really cares about interoperability and that won’t make it difficult to support an integration:
- Look for a vendor that has a functioning API with timelines for access to the API and clearly documented pricing schedules.
- Look for a vendor that has a relationship with a third-party company or interface engine that can facilitate the integration.
Work with a third-party company that can go right to the database.
When an EHR vendor isn’t able bundle their practice management software or patient portal with their EHR, they may look for ways to offset the cost of the solutions that they weren’t able to sell. Charging expensive interface fees is one way to recover lost revenue. Third-party interfacing companies can oftentimes provide the same services, but for a fraction of the cost.
The demand for companies that service the needs of underserved EHR customers is growing faster than ever, and it is being driven by the need for interoperability and the shortcomings of larger EHR vendors. X-Link and MTS Healthcare are two examples of companies that partner with vendors such as Bridge in order to provide valuable third-party interfacing services. Both have developed unique methodologies for navigating vendor policies and keeping costs down for physicians. This is all done with permission from the healthcare organization after verifying that such access is permitted in the end-user license agreement.
Many third-party companies also offer custom integrations as an alternative to the out-of-the-box interface solutions offered by EHR vendors. Interface technology that allows for the selection of data types (e.g. appointments or demographics) to be sent to unconventional places is becoming necessary and at an inexpensive cost. Most vendor-led solutions are either too costly or do not fit the functionality needs of customers. Solutions like X-Link cater to these specific needs and even surpass them by providing a means to customize off-the-shelf interface solutions that can be implemented to each customer’s needs.
For more information on Bridge’s current interface capabilities please see the following link.