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Leveraging Middleware as Part of a Healthcare Interoperability Framework

Reaping the benefits of Healthcare Interoperability, today, while the Government mandates, prays and hopes its deadlines are met

Healthcare Interoperability is all the buzz in the media. The National Coordinator for Health Information Technology recently released a Report on how to improve interoperability in electronic health-record (EHR) systems. The target date for “healthcare interoperability” which the ONC defines as the ability for providers to use their systems to send and receive data using a common set of electronic clinical information, is set for the end of 2017.

The requirements are pretty minimal by most standards. The common data set comprises only about 20 basic elements. These include data such as patient demographics, lab test results and some identifiers for a patient’s care team members.

But the meager compliance with Meaningful Use to date and the difficulty of achieving healthcare interoperability sheds doubt on whether the target date is even an achievable goal at all.

While the Government and standards organizations can prognosticate that Healthcare interoperability is within reach, the sad reality is that it is most likely decades away.

Caught in the jungle of variability and incompatibility inherent in data exchange?

One has to question, too, whether healthcare interoperability is truly even possible with standards. Those of us in the trenches doing healthcare integration know that standards for data communication are anything but standard and they are constantly changing. Odds are even if your data exchange partner is using the same standard, or even the same version of the standard, they have extended the standard to meet their specific requirements. They may have also interpreted the standard differently than any other organization or how the standards organizations intended. It’s a jungle out there. The nature of data exchange in practice is immense variability and incompatibility, standards notwithstanding.

Legacy technology must also be dealt with, too. Take the HL7 2.x standard (also known as Pipehat) that was originally created in 1989. Unlike HL7 3.x, a more modern but not widely supported XML standard, HL7 2.x is not very compatible with newer technologies such as XML, SOAP, Web Services, Service Oriented Architectures (SOA), Enterprise Service Buses (ESB), etc. Before an organization can leverage the huge advantages of any XML standards-based communication, it must first create a bridge between the old and the new.

To meet healthcare interoperability goals while dealing with all these challenges, an organization’s framework should be based on loosely coupling business applications. Interfaces should NOT be hard coded or part of the business applications, but rather implemented as part of a common integration “hub” or “middleware.” The middleware/integration engine solution should be responsible for the connectivity to the business applications that are going to share data and the transformation of the data from the format provided by any Source system to the format that is consumable by any Target system. Middleware can provide the interoperability glue to make all these work together and it can do it right now while we all wait for Government goals to be attained.

Four practical ways middleware can move Healthcare Interoperability forward.

  1. Middleware can handle the differences in data formats, varying versions of standards, and incompatibilities of working with extended versions. Examples: a Lenient Parser being one tool for dealing with non standards compliant and extended versions of HL7. Another being a Differencing Engine that easily mediates differences between HL7 2.x messages.
  1. Middleware can bridge the gap between legacy and new technology. Data mappers can read in and convert flat files, EDI, XLS, CSV and other files into a common format that is usable by a target system.
  1. Middleware can handle the many different operating systems, platforms, data bases and connectivity protocols that come into play. When organizations have dozens of trading partners, supporting every combination of connectivity or variation is not just difficult, it’s realistically not feasible. With middleware, rather than having to worry about all of the combinations and permutations of connectivity, you need only worry about one conversion to or from a common XML data transport. That is not to say that there aren’t other challenges or that this is always easy. Platforms also often dictate how connectivity can be established.
  1. Middleware and employing a common model can be a huge time saver. It is one of the main justifications for the development of industry XML standards. When using a common model, proprietary or disparate formats from the Source system are first transformed into an industry standard format. Then, if required, they are transformed from the industry standard into the proprietary format of the Target system. If there’s only one Source and one Target system, the benefits of a common standard aren’t as obvious. When there are more than two Sources and two Targets, the advantages and time savings add up. Further, the integration solution proves itself by reducing the number of transformations that you have to write. You can also isolate any changes to just the affected Source or Target format. That simplifies the management of different versions and interpretations of the standard, as well. If your data exchange partner migrates from a proprietary format to the industry standard, you should be able to support the change in minutes (rather than days, weeks or months).

Let’s move forward faster to Healthcare Interoperability and not wait for the promised land’s arrival.

The Government can mandate, hope and pray for healthcare interoperability, and we may see some real progress in our lifetime. But for now we need to all take a realistic approach to achieving healthcare interoperability. By recognizing that it is unlikely that all systems will talk the same language (use the exact same standard) and use the same connectivity protocols, by leveraging middleware now we can reap the benefits of healthcare interoperability today.

Interested in learning about how middleware can help you meet your interoperability objectives? Call PilotFish today 860.632.9900 x309 for a custom demo to see how our solutions can help you meet your needs today and in the future.

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Monika Vainius

Written by: Monika Vainius

Executive Vice President of Applied PilotFish Healthcare Integration. Monika has extensive experience with systems interoperability. She combines this experience with her professional passion for healthcare and healthcare technology to comment on current healthcare and IT news. Website

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