Michelle McNickle, New Media Producer
WHITE PAPER Biamp Systems
6 reasons today's health IT systems don't integrate well
May 29, 2012
Although the healthcare community has been clamoring for integration of its IT systems for decades, the industry is still in a rather elementary stage when it comes to useful and practical systems integration, according to Shahid Shah, software analyst and author of the blog The Healthcare IT Guy.
"Our problem in the industry is not that engineers don’t know how to create the right technology solutions or that somehow we have a big governance problem," he said. "[Although] those are certainly issues in certain settings, the real cross-industry issue is much bigger – our approach to integration is decades old [and] opaque, and [it] rewards closed systems."
Shah outlines six reasons today's health IT systems don't integrate well.
1. They don’t support shared identities. These shared identities include single sign-on (SSO) and industry-neutral authentication and authorization, said Shah. "Most health IT systems create their own custom logins and identities for its users, including roles, permissions, access controls, etc., stored in an opaque part of their own proprietary database," he said, adding that ONC should mandate all future EHRs use "industry-neutral" and well-supported identity management technologies, so each system has, at least, the ability to share identities. "Without identity sharing and exchange, there can be no easy and secure application capabilities, no matter how good the formats are," he said.
2. They're too focused on "structured data integration." Instead, said Shah, systems should be focused on practical app integration in the early phases of a project. "In the early days of data collection and dissemination, it's not important to share structured data at detailed, machine-computable levels first, [but it's more] important that different applications have immediate access to portions of data they don't already manage." Once app integration is in good shape, he continued, then it's time to focus on structured data integration, and all the governance and analytics associated with it. "When we do structured data integration too early, we often waste time because we don't understand the use cases well enough, so we can't iterate to best-case solutions," he said. "We're driven to worst-case implementations."
[See also: 5 technologies every hospital should be using.]
Showing 4 Comments
Jillian Schwantz say: #2 and Quality Assurance
May 30, 2012 | 17:35 PM GMT
Hello Shahid:
This is a great post regarding the future of proper planning for IT systems integration, and I believe your gripes pointed out in #2 points to the fact that Quality Assurance is something that should be implemented in all projects from the beginning, in order to avoid future downfalls. At Seamgen, we believe leveraging QA throughout the entire length of a project can make or break the outcome of the final product and meeting crucial deadlines. Check out more on what our VP of Product Quality has to say here: http://seamgen.com/blog/
whitney701 say: Another point about SSO
May 30, 2012 | 17:04 PM GMT
Great article.
I just wanted to add to the points given on #1 "They don’t support shared identities." I'm wondering if having to log in without single sign-on affects the way people use a system and the frequency of using that system. For example, when I know I have to log in to a site/service, I avoid it like the plague. If I can access multiple sites by just signing into my email, however (like Google products) then I tend to jump back and forth between them frequently. Sometimes I just go without the information I need because I don't want to mess with signing in or don't remember my login. I'm sure people don't "go without" logging information in EHRs, but they may choose to wait longer to log more information at once. It could affect the quality of data. Just a theory though.
mneece say: What Does Integration Mean? + Privacy vs. Security
May 30, 2012 | 12:47 PM GMT
Dear Shahid,
Thanks for a succinct and clear description of the data integration challenges facing our industry. Well done.
Another obstacle is more political, meaning the lack of shared incentives for EMR and HIE vendors to cooperate in a easy manner. As you highlighted, the focus in hard-coded structured data integration is a significant challenge.
WHAT DOES DATA INTEGRATION MEAN?
Data integration and sharing is achievable today like on many other industries.
But, what does integration mean when clinical data includes coding in ICD-9, ICD-10, SNOMED, etc, structured and unstructured data, and the data may be in different languages like, English, French, Greek, etc.
SECURITY & PRIVACY
Health data must also be handled in a manner that protects patient privacy compliant with the latest HIPAA/ARRA requirements. Privacy is not Security. The distinction between Privacy and Security might make for another compelling article. I can elaborate if you're interested.
Cheers, Michael Neece, COO, FlowLogic.com
Troy Kimberling say: Strategy trumps technology
I couldn't agree more with much of what you've outlined here. There are plenty of technologies that can address what needs to be done and there will always be a way to build a better mouse trap. The bigger question facing healthcare organizations and at the root of the current predicament is why this is a problem today. Culturally, many health organizations have focused on satisfying the needs of their care providers and this has resulted in many departmental solutions. Two mid-size health systems I spoke with recently confided they each had over 800 systems to contend with! Each -ology wants the system that is best for them and often there is no enterprise strategy to ensure that the best solution for an enterprise is selected vs. each department at each hospital. Health systems are recognizing that this trend must change, but it's costly to change out a legacy system that serves it's constituency well.
On the Health IT vendor side, providing brand integration should be easier to manage and actually lends itself to the "land to expand" sales approach... On the other side, until a few years ago, there wasn't a compelling argument to make integration super-easy between HIT vendors. Integration itself isn't easy, for many HIT vendors providing the level of integration demanded today causes massive rework to legacy systems and is like steering the Titanic. Case in point, look at the recent fallout at Allscripts, caused in large part to the difficulty in integrating their own systems...
Due to the time and expenses associated with integration, it is imperative that each health system take stock of their individual business imperatives, current technical capabilities from both a technology and resource perspective and chart a course for the future that aligns their capabilities to serve the needs of their organization. Given the demands on lowering costs, improving outcomes and extending services beyond the acute care environment all organizations must do this quickly if they haven't already. An approach I've seen work very well is setting an information agenda or information strategy. It is imperative to get alignment across stakeholders to define what it is you're trying to accomplish and then chart a course that yields both near term and long term dividends.