Archive for the tag 'HIE'

#HIPAA: When our worlds collided


Co-written by Matt Hoover and Matt Leyva 

On Wednesday evening, ESPN reporter Adam Schefter tweeted an image of an NFL athlete’s personal medical records that set the twittersphere ablaze and had #HIPAA trending throughout the nation.  This setup an interesting Thursday morning for us here at Galen, where three of our biggest passions, Healthcare IT, patient advocacy, and professional sports, collided (well, four if you count fireworks safety – seriously, ask your favorite Galeneer about that).  The reactions ranged from disbelief to disdain, but predominantly disappointment.  These types of events erode the inherent trust in a patient-provider relationship that we collectively work to cultivate as an industry.  As trust is lost, patients may start intentionally withholding pertinent information from their providers which could be critical to ensuring that proper care is delivered at the appropriate time.

Initially, Schefter was inundated with backlash for this blatant HIPAA violation.  Was his decision to tweet the image morally justifiable?  We all have our opinions, but let’s not get into that right now.  Was Schefter in the wrong?  From a HIPAA standpoint, both he and ESPN are non-covered entities that fall beyond the bounds of HIPAA regulations, and his actions are legally defensible by the First Amendment freedom of speech clause.  The primary offender, assuming this patient did not provide consent to share his medical records, are the parties belonging to the covered entity who initially leaked the information.  As with similar cases, this flagrant disregard for HIPAA laws will almost certainly warrant punishment – up to $50,000 in civil penalties and up to $250,000 with a maximum of 10 years imprisonment for criminal penalties.

Situations like this will make patients think twice before sharing information due to fear it may not remain private.  It is counterproductive to the efforts so many in the HIT community are pushing to accomplish, especially as we strive towards increasingly connected systems and improved interoperability with applications such as Health Information Exchanges (HIE).  Whether the victim is a Grammy-winning superstar, an Oscar-lauded actor, an all-star athlete, or an average Joe, this isn’t the first instance of unauthorized individuals accessing and/or disclosing ePHI.  It’s probably not the last either, but if there is a silver lining takeaway, maybe it’s that this incident raises awareness and precipitates a change in behavior relating to HIPAA, both in the HIT arena and the media.

For any additional questions about HIPAA or the guidelines that Galen and the HIT industry follow, feel free to contact us at




Point-to-Point vs Interface Engine: Does your interface setup suit your needs?


In today’s healthcare landscape, many organizations are faced with the question of how to connect their EHR to disparate systems.  Hospitals and clinics need data from their lab and imaging vendors.  They also need to be able to send information to referral clinics and to Health Information Exchanges.  Today, providers require a dependable and effective means of exchanging information with partners and affiliates.  At the end of the day, the main objective of interfacing is to “streamline workflow and the revenue objectives of efficiently establishing productive relationships with referring physicians” and other systems.  To accomplish this feat, healthcare orgs typically adopt one of two strategies, each with its own advantages and disadvantages: point-to-point interfaces or an interface engine.


In a point-to-point interface, the receiving organization (the recipient of the healthcare data) provides a set of specifications to the sending organization including:

  • What type of data will the system be receiving?
  • What format does it need to be in?

The sending organization then builds an interface to meet those specifications.  The interface is only used for that one line of communication.  For every new application that requires an interface, this process needs to be repeated over and over again.  There are advantages and disadvantages to a point-to-point interface.


  • This method is cost effective for interfaces that do not change or do not change quickly.


  • This method can become expensive if the healthcare organization requires multiple interfaces to be built
  • This method doesn’t provide a way to monitor interfaces to determine connection status
  • This method doesn’t provide the ability to review message logs, to determine whether or not acknowledgements were received, or to go back and look at the history of traffic over a particular interface
  • Interface complexity increases as the number of interfaces grow – managing the communication environment becomes challenging


Instead of vying for a point-to-point (one-to-one) solution to interfacing disparate systems, a growing number of healthcare organizations are turning to interface engines in order to meet their integration needs.  An interface engine transforms or maps data to the receiving organization’s requirements after it leaves the sending organization’s system.  If a value needs changing or if a lookup table needs to be used to switch from one set of values to another, interface engines can easily do this.  They are built with a one-to-many concept in mind, and allow for message traffic to be easily monitored and maintained.  In addition, there are several other advantages to using an interface engine:


  • Reduces the dependency on multiple vendors to make changes in the format of messages to be sent or received
  • Leverages one import or export module from core applications (e.g., HIS, RIS, LIS, etc…) and distributes interfaces to multiple applications productively
  • Improves physician and client support through proactive interfacing monitoring and message log management
  • Enables flexibility to adapt to different HL7 message standards, XML healthcare standards, etc… as well as different application data format specifications
  • Lowers overall interface cost by repurposing an application’s import/export module to multiple applications


  • One potential disadvantage of using an interface engine is it adds another piece of software that needs to be maintained and/or worked by your staff in order to maintain interfaces.  If your organization only has one or two interfaces, it may be easier to use the point-to-point solution.

When one considers the effort involved in maintaining several point-to-point interfaces and the growing emphasis on interconnectivity in healthcare, the disadvantages of managing a new piece of software start to look minor. If your organization is planning on connecting with multiple sources, this will require the development of multiple interfaces.  Chances are an interface engine solution may make sense.

When selecting an interface engine, there should be several areas of focus.  For a summary of helpful tips and tools for finding potential candidates to handle your integration needs, look out for our second installment of this Healthcare Interoperability series.  The second installment will include a summary of various areas an organization should focus on when considering an interface engine and will provide guidance on how to properly assess whether or not an interface engine will be capable of meeting your organization’s needs effectively.  To find more about our suite of solutions, check out our Technical Integration Services page.



Corporation, Intersystems. Nine Questions to Ask Before Replacing an Interface Engine (n.d.): n. pag.

Health, Corepoint. What Is Your Healthcare Interface Approach? (n.d.): n. pag.


An Interview From The ‪#‎HIMSS15‬ Floor With Galen’s CEO Jason Carmichael

Jason Carmichael, CEO of Galen Healthcare Solutions, explains how Galen helps increase interoperability, leverage Big Data, and supports a platform that predicts the cost of an episode of care while helping design coordinated care plans.

InterSystems Global Summit 2015


If you happened to miss the tweets from @GalenHealthcare, InterSystems Global Summit took place March 8th-11th  in Orlando, FL.  As an implementation partner of InterSystems, members of Galen have attended this conference before, but this was a first for a colleague and myself.  For those of you who don’t know, InterSystems is a global technology company that offers products like Caché®, Ensemble®, and HealthShare®.  They are the main technology provider for companies like Epic, HIXNYSM, HIETexas, as well as many non-healthcare companies.

The Global Summit was a chance for InterSystems, along with its technology partners, to strategize for the new year, share methodologies, educate one another, and celebrate the past year’s successes.  One theme that particularly resonated with me was Interoperability, which has been my main focus for the last five years while working at Galen.  Over time I have gained skills and experiences that help streamline an integration project, but because standards are never strictly followed, or consumers and senders observe different versions of the same standard, an integration does not progress without a few bumps in the road.  While at the conference I picked up a great saying that I hadn’t heard before, “Once you’ve developed one HL7 interface, you’ve developed one HL7 interface”.

Interoperability is my third favorite buzz word phrase behind Big Data and Game-Changing Deep Dive.  Everyone talks about it and everyone claims their solutions are viable.  I believe the true key to interoperability is not to follow the latest and greatest standard but to have the flexibility to support a variety of standards within your product.  InterSystems has been able to accomplish this with C-CDA.  InterSystem’s HealthShare® provides an effective methodology to facilitate version agnostic document exchange.  All documents received into HealthShare® are converted to Structured Document Architecture (SDA) which enables the transformation to any of the 20+ recognized Document Standards. SDA is also considered future proof because you have the ability to create new file formats as the standards change.  This was extremely interesting to me after having dealt first hand with limitations of generating specific document standards to comply with a multitude of receiving systems.

If you would like more information about how Galen can help you with the InterSystems suite of products please contact us at

Healtheway – Not a new diet, but the key to Interoperability

Healtheway, Inc. is a fully incorporated organization that provides management and administration support for two Health Information Exchange (HIE) programs, eHealth Exchange and Carequality.  They host monthly informational calls that are open to the public in which updates on both programs, including general and specific points along their existing project timelines, are discussed.

eHealth Exchange is the federal network that focuses on developing the infrastructure to support the secure and trusted exchange of health information between the federal agencies and healthcare organizations.  Participants in this network are onboarded and must demonstrate success through 35 tests to operate as a bi-directional exchange.  There are currently 51 participants in the eHealth Exchange process and the list can be viewed here.


Carequality is a recent addition to the oversight role of Healtheway and their goal is “to facilitate agreement on a common national-level set of requirements that will enable providers to access patient data from other groups” (Carequality Press Release, 2014).  Their model is similar to the banking industry’s framework during the creation of the ATM network.  Both programs are designed to operate independent of their support organization and have their own by-laws and organizational structure to help them accomplish their goals and achieve their mission.

On their June 6th call, it was evident that the eHealth Exchange model is maturing, and that existing discussions involve expansion of the participants and further defining of specifications to improve confidentiality and security of health information.  An example of the expansion involved a discussion to create a new subset of Responder Only Profile members that would represent intermediaries, such as medical release of information organizations and EHR vendor networks. These members would not initiate requests but only respond to requests over the Exchange network. This represents a shift in how the Exchange had previously been designed, and presents an opportunity to expand both the size and scope of the network.  Further discussions will define criteria for inclusion and sending to the Coordinating Committee for approval.

The updates continued with the Carequality timeline and their creation and approval of the organizational structure, including the Governance Charter, Articles of Incorporation, and By-Laws.  This signifies completion of a critical path in their development, and a shift in focus to establishing additional committees, councils, and work groups to begin defining the common national standard for the transmission of health information.  To facilitate this major undertaking, the organization is actively seeking nominees for individuals to serve as members in any of these roles that have been defined by their By-Laws; interested individuals can apply on their website .

It is evident that progress is being made to build a standardized structure akin to the banking industry’s implementation of online banking for customer access, and eventual banking access across multiple accounts and institutions.  While there are differences in the guiding hand of this progress, the interoperability of healthcare information is key to driving one of the goals of health care reform in reducing costs and improving quality of care.

On July 16th at 2:00 pm, Galen will be presenting a webcast that will provide additional explanation of how this exchange will occur and how real-time access to the patient’s record can substantiate these claims.  You can register to this webcast by clicking here.

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