Integration Major Challenge at All Points for Health Care

Loraine Lawson
Slide Show

2011 Health Care IT Survey

The race is on for hospitals nationwide to deploy EMRs.

Integration is hard and, honestly, nobody gets it perfect. Just ask the oncologists.


KLAS, a research firm specializing in covering health care vendors, recently asked oncology IT specialists about integration of oncologists' systems, an area that's recently been targeted by enterprise vendors, as well as niche vendors. Oncology is a particularly tricky area for health care records since it involves radiation records, patients moving between infusion suites and radiation oncology facilities, doctors moving between locations, and ambulatory care issues.


The survey found the oncology IT crowd was not impressed, thanks largely to integration problems.


"Full integration is critical in the new world of accountable care," Monique Rasband, author of the report, says in the press release. "At this point in time no one is quite hitting all the targets; enterprise vendors are offering products without radiation oncology applications, and best-of-breed vendors are pushing to interface suites to enterprise and other systems."


The oncologists aren't the only ones annoyed by integration across health care systems. Health care IT is struggling with three integration problems, according to a recent blog post on Galen Healthcare Solutions. Let's see if any of these look familiar to those of you who don't work in health care but do deal with integration:


  1. Customized interfaces that require point-to-point integration instead of a hub-and-spoke architecture.
  2. A lack of standards-or, at least, standards that vendors actually follow-on medical devices. This makes it hard to share with medical systems, the post points out. For instance, most vendors have their own specifications for the HL7 message definitions standard.
  3. Integration is just so dagburn expensive, largely because of the aforementioned integration challenges. The costs right now are too prohibitive for smaller groups, which keeps them from being able to electronically share records and data.


When I first started writing about integration, I just couldn't quite wrap my head around why it was still such an issue. Of course, I've since learned that the problem is very complex and involves, to some extent, both money and politics - two factors that often undermine progress. Vendors create their own proprietary solutions and then have a vested interest in not providing integration. The system we once thought could handle everything couldn't, and now needs to be integrated with new tools to bridge the gap (looking at you, ERP!). Handcoded, point-to-point integration complicates it all. And standards, well, standards don't often live up to their name.


Of course, in enterprise IT, there's a growing intolerance for integration, and that's put more vendors on the hot spot for cooperating, at least when it comes to data. That same intolerance for integration is starting to influence health care IT - one report revealed that around 80 percent of consumers and doctors are demanding hospitals and doctors' offices be required to share information.


Susan White, who covers surgical technician schools, says integration issues are undermining technology investments in the medical field.

In such cases, it becomes a white elephant that costs more than it is worth, and it's better to do without the technology than spend hundreds of thousands of dollars on something that's not more than a showpiece. This is exactly what's happening with EMR systems-they're supposed to make medical history access, updates and management as easy as pie for hospitals and other health care facilities; instead, they're becoming a headache because of integration problems.

Usually, it's not hard to find a business case for integration-if you know how to look. But given that the medical community is so far behind in how it handles data, this may not be the case. White certainly wonders whether or not it is.


But if middleware expert Hollis Tibbett's math is right, the health care industry loses a hefty $314 billion to fraud and inaccurate billing each year. If I were looking for a business case, I'd start sniffing in that direction first. Then I'd take a look at cloud computing to see what it has to offer health care. Surely, with all the great minds working in integration and health care, you can come up with something that doesn't involve invading my home and putting me under surveillance.

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