Global funding for digital health companies reached an all-time high of $26.5 billion in 2020. It's likely that 2021 funding will surpass that record. Much of this investment is tied to an expectation: data exchange will be effortless across the healthcare system and routine for individual companies and their customers. Although federal requirements point the way to more streamlined data exchange, health data interoperability is a work in progress.
While health technology companies are at many different stages—from start-up to established—many grapple with challenges related to data exchange, or interoperability. Their difficulties often involve getting data from and sharing data with electronic health records (EHRs).
Companies at every level of maturity share common priorities:
- Making go-lives faster for customers—and for their own teams
- Illustrating health data integration as a capability so that it does not become a roadblock
- Reducing time spent on troubleshooting data integration issues
- Pivoting quickly to new use cases and opportunities
- Forging strategic relationships with partners
Interoperability obstacles frequently stand in the way of these important business goals.
Interoperability challenges disrupt meaningful workflows
As health technology companies dedicate time and resources to interoperability, they find that most roads lead through the EHR—and the journey is full of hurdles.
A recent Gartner report predicts, "By 2023, 35% of healthcare delivery organizations will have shifted workflows outside the EHR to deliver better efficiency, experience and outcomes."1
This shift in workflow depends on the ability of data to travel from the EHR into a third-party system, or from a third-party application to the EHR, and in many cases make the round trip. And, of course, the EHR, as a system of record, must stay up to date.
Whether the application is a consumer-facing solution like a personal health record; enterprise infrastructure such as a master person index; remote patient monitoring application deployed by a healthcare provider; or a health plan with a care-coordination analytics platform, use cases have similar patterns. Integrating data from the EHR and syncing back to it is critical to improving clinical and financial outcomes and is central to healthcare centered around the patient. Patient-centered healthcare requires:
- Connecting public health and clinical care ecosystems for effective care coordination and improved community well-being
- Building connections between virtual health, urgent care visits, and every other patient care interaction
- Seamless data exchange across and within ecosystems that include systems of intelligence, systems of infrastructure, and systems of record2
- Incorporating data from wearables and consumer devices into the patient’s health record for more proactive treatment options
- Identifying gaps in care for at-risk populations
- Sharing patient data with newly implemented customer service tools for improved and targeted patient experiences
- Supporting health analytics with reliable and complete data sets for healthcare
Data integration obstacles make data exchange slower than expected
Companies new to integrating with EMR data soon find that the integration process isn't a "one and done" experience. As is often said in the healthcare interoperability realm, "Once you’ve seen one integration, you’ve seen one integration."
The integration experience can be completely different from customer to customer and EHR to EHR. Healthcare IT veterans know that the implementations of enterprise-wide systems of record, like EHR environments, vary and are highly customized. These customized builds make EHR data integration challenging.
Further, EHRs are designed to communicate in a way that assumes the EHR is always the master source of truth. As such, EHRs were often designed to not easily share data. Because of the dynamic and evolving nature of healthcare, sharing this data is now a requirement. This results in complicated EHR integrations. Even when hospitals merge with other hospitals that use the same vendor's EHR, rapidly integrating the data is complex because of tailored workflows, varied versions, and data specifics.
To help ease this burden, EHRs are required to support FHIR API endpoints by 2023—but that timing doesn't support immediate needs for interoperability, and the FHIR data set isn’t likely to address every use case.
Data shared by the EHR also follows many different standards, including HL7 2 and 3, NCPDP (National Council for Prescription Drug Program), X12 (for claims), and CCD and C-CDA for clinical notes and summaries.
Healthcare application developers will continue to need API and HL7 expertise
Many health technology developers are well versed in JSON, which commonly supports data exchange requirements in other industries and with peers. Meanwhile, IT teams at healthcare delivery organizations are receiving many requests for custom data access.
One large healthcare delivery organization shared that while their custom development team makes good headway with FHIR API data access, they typically must tap into the HL7 team to augment data. This collaboration across teams is effective, but these resources are in great demand.
The more a vendor can reduce resource requirements, the quicker the go-live will be. This is sure to be the case for a long time because HL7 data is deeply embedded in workflows and designed to be fit for purpose. Many data types are not yet available for transmission through JSON, and some healthcare organizations may lack availability of in-house custom development resources with JSON expertise.
While healthcare provider organizations still rely on earlier versions of HL7, health tech companies may not be able to devote time to training their own team on the standard. Meanwhile, their provider customers may look to them for expertise on transforming JSON to HL7 and vice versa—hindering go-lives.
When integration jeopardizes ROI
Integration to a healthcare organization’s EHR requires an expert team, including development and project management resources. Key steps involve building an infrastructure for data exchange, testing it, fixing problems, running a go-live, and maintaining and monitoring the interoperability infrastructure on an ongoing basis. These time-consuming responsibilities reduce the ROI of hard-won customer relationships.
Given the necessity of connecting with EHRs and the numerous obstacles to health data integration, many health technology companies are reconsidering their interoperability strategies and looking for technology partners who can take on this heavy lift.
Why healthcare innovators are turning to interoperability experts
Health technology companies are finding that an interoperability partner can accelerate time to market and time to value. When a partner provides an interoperability solution with transparency and experts with longevity, the healthcare technology company can focus on its core business or service. A few benefits of this approach include:
- Access to expertise. An experienced healthcare interoperability partner will have deep familiarity with EHR builds, healthcare data standards, and the regulatory/security concerns of healthcare provider organizations
- Time savings. Every go-live will be more streamlined, while the partner does the heavy lifting of technical work and project management. The interoperability partner will manage the build, testing, go-live, and ongoing maintenance/monitoring, saving significant time for the digital health company.
- Pivot immediately. Interoperability doesn’t have to be a barrier to pursuing a new use case or market, or even to a merger and acquisition scenario.
- Scale as needed. Rather than investing in a whole team of FTE experts in health data standards, the company can scale up its support for go-lives and down again for maintenance, as needed.
- Respond to any scenario. A versatile interoperability partner will have many tools in their toolbox, from expertise in FHIR and other APIs to deep knowledge of HL7, XML CDA, DICOM, X12, or even non-standard options such as SFTP.
- Go beyond FHIR APIs. A fully managed solution can work flexibly with health data to push and pull, read and write, going beyond current FHIR API capabilities.
- Know that data is safeguarded. With current security concerns, an interoperability partner can handle time-intensive security work, including ensuring that the data exchange includes redundancy and disaster recovery.
Proven integration solutions, with flexible deployment options, are helping digital health companies bring customers live faster and manage resources efficiently and strategically. With the right interoperability partner, health data exchange becomes faster, secure, reliable, an opportunity to build trust and credibility with customers, and, most importantly a differentiator.
Counting on a reliable partner for orchestration, monitoring, and security surveillance of every interoperability requirement lets digital health vendors focus on building their corner of the healthcare ecosystem instead of connecting it.
1. Predicts 2021: Healthcare Providers Must Accelerate Digital Transformation to Address Disruption, Sharon Hakkennes, Barry Runyon, Mike Jones, Mark Gilbert, 25 November 2020