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 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.
Bridge offers an integrated patient portal through interfaces developed into many of the leading EHR vendors, namely NextGen, GE Centricity and Allscripts.
For more information on Bridge’s current interface capabilities please see the following link.
Many of the today’s leading health information technology organizations that offer a full suite of solutions, such as McKesson, are on a general trend of developing less and less software. As these organizations dedicate fewer resources to maintaining their previous developed software it makes it hard to trust in these organizations as long term partners, especially as their cost effective solutions continue to diminish in lieu of higher priced offerings. When it comes to the EHR space, McKesson is unique, as unlike many EHR vendors that offer only a single product, McKesson offers multiple. These include McKesson Practice Plus, Paragon and InteGreat EHR. (more…)
Many of the today’s leading Electronic Health Records (EHR) organizations, such as Greenway Health™, are challenged to provide a patient-centric, user friendly experience for their patient portal users. This is especially true when the EHR is being used as part of an Integrated Delivery Network (IDN) which uses multiple EHRs. The primary issues we have identified in this scenario include: (more…)
Many of the today’s leading Electronic Health Records (EHR) organizations, such as GE Centricity™, are challenged to provide a patient-centric, user friendly experience for their patient portal users. Often times the patient portal is an afterthought to the core product offered by EHR software companies and the portal is left without core functionality. Some of the biggest issues we have discovered in organizations using EHR-bundled patient portals include: (more…)
Many of the today’s leading Electronic Health Records (EHR) organizations, such as Athenahealth®, are challenged with interoperability issues when they are operating in Integrated Delivery Networks (IDNs) that include inpatient and outpatient facilities. Frequently the EHR bundled portals from the larger hospitals or facilities become the primary portal, and the other patient portals, such as Athenahealth’s, are used less frequently used. The main issues we have discovered in organizations using EHR bundled patient portals in IDNs with multiple EHRs are the following: (more…)
As a result of acquiring 3rd party software vendors, many of the today’s leading Electronic Health Records (EHR) organizations, such as Allscripts®, offer multiple software platforms, including EHR, patient portals and Revenue Cycle Management (RCM) solutions. Their patient portals, often lack customizability and have trouble adapting the software to organizations’ unique workflows and preferences. Some of the other underlying issues we have discovered in organizations using EHR-bundled patient portals include:
Many of the today’s leading Electronic Health Records (EHR) organizations, such as NextGen®, offer an EHR bundled patient portal that offers convenience and cost savings to their customers. However, EHR bundled patient portals are often an afterthought to the core product offered by EHR software companies and the portals are left without core functionality. Some of the biggest issues we have discovered in organizations using EHR-bundled patient portals include:
Bridge Patient Portal and MD EMR Systems, an electronic medical record solutions developer and certified development partner for GE, have established a partnership to build an interface between the Bridge Patient Portal product and the GE Centricity™ products, including Centricity Practice Solution (CPS), Centricity Business and Centricity EMR.
These new integrations will allow healthcare delivery networks using GE Centricity to bring a patient-centric and engaging portal to their patients, with seamless integration of data and functionalities between the portal and their EHR. (more…)
Helathcare interoperability has become a hot topic in the world of health IT – yet due to its inherent complexity, it remains the biggest hurdle to efficient and effective use of communication across a broad spectrum of systems and solutions. Whether healthcare organizations are using EMRs, telemedicine, patient portals, mHealth or EMPIs, it is necessary for there to be a “common denominator” between those systems in order to achieve interconnectivity. The common denominator is an open architecture platform by which all communication can occur.
Google and Apple are two high-profile examples of open architecture platforms – Google with Android and Apple with iOS. Both companies encourage the introduction of new, highly useful functionality through plug-n-play applications, despite having been developed by different companies. Not all companies, however, are as open and welcoming as Apple and Google.
At the opposite end of the spectrum are the closed architecture platforms such as Epic and Greenway that don’t easily allow for third-party vendors to interface with their EMRs. Meaningful Use has forced these companies to allow interoperability, albeit not without varying degrees of resistance.
If the healthcare industry wants to go down the path that leads to interoperability, open sources, open standards and open platforms are the vehicles that are going to lead us there – and the keys with which to start these vehicles are application programming interfaces (APIs). APIs will specify how software components will interact with one another when all the systems involved are tied together. APIs, for example, can tie-in multiple EMRs so that data is shared easily between different systems.
What to look for when tying together multiple systems?
In order to facilitate a successful interface, the first thing to look for is that the system being used is on an open source architecture. Here are some other key areas to focus on when engaging with and selecting an API interface engine vendor:
- The prospective vendor should use an open architecture. Mirth Connect is one choice. It is one of the largest open source architecture platforms within the healthcare space. Mirth Connect provides the necessary tools for API interface vendors to develop, test, deploy and monitor an interface; and it has a large and active community of users. Whatever architecture is used, adaptability and flexibility are key to a successful interface.
- Choose a developed API that can handle multiple EMRs. Even if you currently operate with a single EMR, at some point in the future you may want to add another software system, such as practice management or billing. This will require building an EMR interface. If the vendor you choose already handles multiple EMRs through its API, you know they will be ready should those changes occur. It’s important to keep in mind that each organization is unique in its structure, areas of specialty, personnel and workflow processes. Even if a vendor has not currently developed a specific API with your EMR, don’t eliminate them from your list. What matters is that they have experience successfully interfacing previous client spec requirements.
- Select a combined EMR and patient portal that meets or preferably exceeds Meaningful Use attestation. For some organizations it’s all about meeting the minimal requirements in order to receive Meaningful Use funding. However, it is important to note that the Meaningful Use program is currently in its early stages, and attestation requirements could still be added or removed. For example, due to uncertainties regarding the likelihood of patient engagement, revisions could still be made to future requirements for Meaningful Use. Being on board with a vendor who is “ahead of the curve” will go a long way in saving future changes (and headaches) from being made to your system.
There is no question that open platforms within the health IT world are inevitable. When that becomes the common knowledge, the possibilities for improvement within the healthcare industry will be endless.
This article was originally published on the Medical Web Experts blog.