Challenges with Healthcare IT Interoperability


Interoperability of EHRs with all of the peripheral devices that make an EHR a one-stop shop that the clinicians cannot live without seems to still be a challenge.  Despite “standards” such as HL7 which define how the systems communicate there still is significant challenge in getting through the projects.  It is by no means “plug and play” and the difficulty is in getting the parties to even have their own version of the standard specification.  The flexibilities of the standards leave some room for interpretation and this is where difficulty sometimes arises.

The desire to freely communicate is not there yet.  When folks start to understand that the end game is quality healthcare and if a system is easy to integrate with the customers will be more happy and everyone wins.  Unfortunately now, it seems that everyone sees integration as a constant revenue generator.  The costs associated are not bogus but without proactive thought to how to make a system be repetitively interoperable there is a significant waste of resources crafting the same wheels over and over.   I have been involved with projects where copious amounts of hours are spent discussing the most basic details of an HL7 interface because the parties involved don’t know anything about the fields or the data.  I have also been involved in the antipodean scenario where both parties show their standard specifications, discuss the minor differences and they agree upon who is going to accommodate the differences and moments later they can send test transactions.

The tendency for integration points to become projects by themselves inherently lengthens the process.  With the lack of knowledge often exhibited on such projects they tend to collect teams of individuals who collectively should have the knowledge to make the integration work, but the points of ignorance of those individuals in other areas exponentially increase the topics of discussion that are in play to educate everyone involved.   This becomes very annoying to the individual that has their stuff together on the the other end of the integration.

The challenge to healthcare organizations is that the complexity of the EHR is not only a complex IT project but one that also demands a clinical understanding to help with all of the integration.  Clinical organizations are required to have resources that are more technical and the technical resources have to have clinical knowledge about what they are doing.  It is extremely difficult to complete a lab interface if you don’t have the knowledge of how to flip the flags and when to flip the flags.

The resources involved in integration need to step up and take the time to learn what they are doing rather than spending one hour a week trying to make something work.   Know your part and then some and don’t waste others time.  If you know what you are talking about and what you want the efficiency of the process is greatly increased.

I argue that a clinical organization that takes the time to acquire or train an individual that knows their business on integration will recover his/her salary multiple times in EHR efficiency, buy-in and ability.  I have seen organizations where they pay both vendors $30,000 to complete 20 integration points, why not pay one individual $60,000 for 10 years or $100,000 for 6 years.  I have seen this work.   Once you have the individual on staff the integrations become easier and easier and even a small interface that only aids a few clinicians is now justifiable.

There are other staffing changes that seem and are significantly different, but when you compare them to what you might spend paying to have the work done elsewhere, they make sense.

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