April 14, 2016

EHR Integration – Challenges and Solutions

The marriage between a hospital and its electronic medical records vendor may not always be loving and open, and may even end in divorce. But while the relationship is flourishing, the pair are by necessity devoted to one another, and the vendor often tries valiantly to meet its hospital’s every need, in every department.

So why would a big, dominant EHR vendor like EPIC or Cerner allow an interloper into the family…  some young thing fresh from Santa Clara or Madison or Austin, offering a new and exciting way to solve some small part of the hospital’s complicated life? Because they have to.

EHR Integration

Digital health innovation has gone mainstream, with the
federal government encouraging small innovators to develop apps that can work with existing systems to make health care more efficient, high-quality and safe.  “These industry-led efforts pave the way for a truly connected healthcare system where consumers and providers can easily and securely access electronic health information and direct it to any desired location,” leaders of the Office of the National Coordinator for Health IT said in a recent blog post. They cited specifically “the current momentum behind the Health Level 7 – Fast Healthcare Interoperability Resources (FHIR) standard and a growing interest across the health IT community in open, standardized application programming interfaces (APIs) using FHIR®.”

Health IT consultants recognize that one of the field’s great challenges is now making a shiny new app that can coexist with a legacy EMR. Among the more prominent is Redox Engine, a startup founded by three EPIC alumni who are collecting cash and attention for an enterprise devoted solely to helping EMRs, apps and the cloud to work together. The firm offers an integration platform that is being used for more than 120 apps addressing a wide array of health system issues including care coordination, telehealth, medication adherence, patient engagement, chronic care and disease management.

To that end, the big companies themselves are offering assistance. Look on EPIC’s website and you’ll find extensive information about all the parts of the software that can be given an outside boost, how to make it happen, and examples of apps that have succeeded in integrating with EPIC. Cerner also offers an open platform that allows third-party innovators to develop “pluggable apps” using HL7’s FHIR standard.

EPIC lists dozens of current integrations with many different aspects of its EMR, including a number of medical devices from mainstream manufacturers such as Philips and Siemens, as well as newer players such as Voalte, a hospital smartphone company.

One of the big challenges for integrating your great new digital solution into existing hospital and provider EMRs is simply screen real estate – there is only so much room on a screen, and a limited number of opportunities to get the attention of the user, whether it’s a doctor, a staff member or a patient. Carolyn Bradner Jasik, MD, vice president of medical outcomes for Mango Health, has some helpful advice along these lines in a detailed blog post about integration. She recommends being conservative about the amount of information you’re trying to put in front of the user, and to keep their needs in mind. She also notes the importance of following best practices for protecting personal health information.

Digital health innovators need to avoid “data dumping,” pleads Aaron Neinstein MD, director of clinical informatics at the UCSF Center for Digital Health Information. In a 2015 blog post detailing four key features of EHR integration, Neinstein notes the overwhelming amount of data that doctors deal with and asks that developers think about smart ways to fit their solutions into a user’s workday. “Physicians are not going to launch and log on to their EHR and three different applications to compare data, no matter how snazzy and how much media buzz your new app has,” he writes. Any tool being appended to the medical record system needs to offer as seamless experience as possible, perhaps by creating new ways of presenting information.

So it’s not enough to have the next great idea that’s going to save health care in America – it has to fit into the relationship with vendors have with their hospitals, and that users have with their information systems. Don’t go at it alone – get help from a partner who can help with the integration. We would love to talk with you about your idea and how to make it work within the existing health care IT infrastructure.

If you are interested in further reading we have also covered the topic of  EHRs being the “Operating Systems” of Healthcare.

Author: Digital Health Team
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