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IT Integration: Navigating challenges and finding the path forward

February 03, 2016
From the January/February issue of HealthCare Business News magazine

he Argonaut project has over a dozen health care vendors focused on “[developing] a first-generation FHIR-based API and Core Data Services specification to enable expanded information sharing for electronic health records and other health information technology, based on Internet standards and architectural patterns and styles,” according to the Argonaut wiki.

DirectTrust, a nonprofit trade alliance, focuses on establishing and maintaining “a national, transparent Security and Trust Framework upon which trust relationships for exchange technology can be scaled and federated nationally,” according to the DirectTrust “About." Thirty-six HISPs comprise this group.

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The industry is moving in a positive direction, according to the ONC’s April 2015 Report to Congress on Health Information Blocking. However, lingering issues are a direct result of the lack of past collaboration. For example, the availability of a standards-based network for interoperable exchange of health information is not sufficient, itself, to motivate actual exchange. Some EHRs and their customers have business models opposed to the exchange of patient data with competitors, even those caring for the same patients. In addition, huge variation exists in the usability of EHRs’ Direct user interfaces. Some vendors have made Direct easy to use, but others have hidden Direct exchange capabilities deep within the software or left out key components, such as an “in box” or attachment generator.

The path forward
Integration is the first step toward local and global system interoperability. “Integration” and “interoperability” are often used interchangeably, partly because they have inherently similar challenges. Whether connecting a lab instrument to an information system or an entire EHR to a Health Information Exchange, the information or data must be standardized, so communication and data can be sent and received accurately and securely. HL7 did that effectively for a couple of decades.

Transport protocols (VPN, HTTPS, SFT) and middleware provided an extra security layer, which was more effective in certain environments. However, the complexity of instruments to systems and of systems to systems grows exponentially, along with resources and cost. Early-adopted or interpreted security and data standards have shown severe weaknesses as breaches of security and privacy appear in headlines across the country.

Collaborative involvement on projects such as the Argonaut, DirectTrust and governmental regulations (i.e., MU and Cybersecurity Act) are helping to close gaps and provide the motivation and possibly the monetary incentives required to fix and navigate through integration obstacles. Integrating and securing complex, electronic patient care and workflow information is a herculean undertaking, but so were the moon landing and completion of the Panama Canal.

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