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EHR Integrations

Like it or not, healthcare’s transition from a volume-based incentive model to one of value is here. The current industry design is unsustainable given trends towards increasing risk exposure and care provider liability. In response, new value-based models have been enacted, including readmission prevention, accountable care organizations, and bundled payment initiatives. To remain viable through this shift, healthcare organizations need to alter their priority of care from the provider to what truly matters — the patient. A reshaping foundation of incentives coincides with billions of investment dollars from organizations to implement electronic health record (EHR) systems, mainly due to the ramifications of the HITECH Act and other legislative mandates. These EHR systems are the hub of clinical data and clinical workflows today.

Unfortunately, they are hubs siloed across thousands of organizations, meaning that the critical health data is siloed away as well, leaving it inactionable. The solution? Integration.

What is EHR Integration?

EHR integration is the partnership between providers, payers, vendors, and other players that brings the data or function from one application or program to that of another. Because of the sheer quantity and diversity of data, healthcare providers face major obstacles in integrating and effectively analyzing healthcare information. Traditional health IT systems, such as electronic health records and personal health record (PHR) systems, utilize completely different technical and semantic standards to depict and house data, and are based on exclusive technical architectures. With all considered, it can be extremely difficult to properly and easily integrate data from multiple, conflicting systems.

Data integration methods vary primarily in the level on which they focus.

EHR Integration at the Application Level

At the application level, integration involves integrating data from individual applications by reimplementing them in one domain-wide application.

EHR Integration at the API Level

In integration at the API level, applications expose their APIs so that other applications can access their data.

EHR Integration at the Data Level

Finally, at the data level, integration establishes a common domain archetype or global schema so that independently developed applications can exchange information. Data-level integration has more development flexibility than the others because it largely focuses on common exchange.

Why does EHR Integration Matter?

EHR integration matters because it is how healthcare moves forward. It is the key to creating and improving advanced digital health applications. Integrating healthcare data from a variety of providers and payers will explicitly improve the current healthcare delivery model and extensive research efforts. Data integration allows the unification of healthcare data that exists in various forms (structured or unstructured) on different data storage systems such as relational database management systems, file servers, and EHR standards, such as HL7 messages.

True interoperability and successful Integrations will have a cornucopia of benefits, such as a decrease in clinical errors, enhanced care coordination efforts, and increased patient care endeavors. Long term, true integration allows for the furthering of public health research opportunities and population surveillance to identify real-time issues.

What is HL7?

Health Level Seven (HL7) is a not-for-profit organization that created a set of standards to ensure information unity and validity when sharing data across health information exchanges or between healthcare systems, such as, in messaging applications.

These standards, simply referred to as HL7, define how messages are sent from one party to another, setting the language, structure, and data types required for seamless integration between systems.

To foster adoption of common data exchange to meet the mandates of federally enacted programs, the HL7 Organization offers completely free access to their standards. HL7’s C-CDA is a library of templates that help enable data exchange needed for EHR Integrations. Various types fall under the C-CDA but they all provide a common format to assist in health data exchange. This library contains nine templates, each of which has defined sections to harmonize the data across systems.

What is FHIR?

Fast Healthcare Interoperability Resources (FHIR) is the emerging interoperability standard evolved from HL7 by Grahame Grieve and the HL7 organization. It describes data formats and elements (known as resources) and a RESTful API for data exchange.

Why use FHIR for EHR Integrations?

FHIR is Open Sourced

FHIR is open sourced, making it open to everyone in the industry to participate. It also takes many of the learnings from earlier versions of HL7 and incorporates some of those models into it.

RESTful APIs are Easier

RESTful APIs and accompanying documentation will make it much easier for developers and applications to quickly connect and get the data needed.

FHIR Helps Make EHR Integrations Less Expensive

FHIR solutions are built from a set of modular components called “Resources.” These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives.

FHIR is Flexible

FHIR is suitable for use in a wide variety of contexts – mobile phone apps, cloud communications, EHR-based data sharing, server communication in large institutional healthcare providers, and much more.

The key to enabling healthcare organizational transformation is unlocking EHR data to make it easier to integrate with. The industry has been focused on interoperability for the reason that being able to access the aggregated data is the only way to move from documentation tools to innovative care delivery models. An open data standard, such as FHIR, and a single implementation of the standard in a centralized data hub is the most efficient way to move the needle on data accessibility and represents the future of EHR Integrations.

Datica Academy articles on EHR Integrations

Recommended FHIR API Implementation Principles

The FHIR standard is based on API routes but what should the API route look like? Learn general design principles and guidelines to build RESTful APIs.

The FHIR Resource Object: The Core Building Block

To understand FHIR, you must understand the FHIR Resource Object. This entry will help explain its origins and intent with links to help.

Introduction to FHIR

The FHIR acronym stands for Fast Healthcare Interoperability Resources. FHIR is a new open sourced interoperability standard of the HL7 organization.

HL7 101 - A primer

HL7 is a healthcare industry standard for messaging between applications, for example from EHR to PMS. Learn HL7 basics, including HL7 v2 and v3.

HL7 102 - Anatomy of an HL7 message

This deep dive explains HL7 message types, message structure, message segments, codes, fields and the complete anatomy of an HL7 message.

HL7 201 - The Admission, Discharge, Transfer (ADT) Message

HL7 ADT message types are the most common HL7 messages. We explain ADT message structure, segments, and event types, including HL7 ADT message examples.

HL7 202 - The HL7 ACK (Acknowledgement message)

The HL7 acknowledgement message, HL7 ACK, is critical for smooth, ongoing HL7 communication. Learn the nuances of HL7 ACK messages, segments, and codes.

HL7 203 - The HL7 ORM (Order Entry) message

The Order Entry (ORM) message is a common HL7 message type. ORM messages contain information about an order, most commonly radiology or lab orders.

HL7 204 - The HL7 Scheduling messages, SIU and SRM

The HL7 SIU and HL7 SRM message types are HL7 appointment scheduling messages with date and time, resources, services, location, and more appoint info.

HL7 205 - The HL7 MDM (Medical Document Management) Message

The Medical Document Management (MDM) message is a commonly used HL7 message type that provides information about new or updated notes or documents.

How to integrate with Epic (or any EHR)

Lets walk through the names, players and timelines for delivering your first HL7 Epic integration or any other EHR integration like Cerner or Allscripts.

Blog posts on EHR Integrations

Datica Guides on EHR Integrations

Datica Guides

Healthcare Innovators Podcast on EHR Integrations

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