The limitations of integration

EHR Integrating in an efficient and scalable way is possible, but it’s not how many health systems approach the problem of connecting disparate systems.

From the white paper:

Technology in healthcare can be a sticky subject. For many, it represents an intrusion on an age-old profession that was better off without it; for others, it promises advancements in diagnosis and care delivery that would otherwise be impossible.

As with most things, the truth probably lies somewhere in the middle.

Regardless of one’s stance, the reality is that healthcare is experiencing very real pains when it comes to the adoption of technology. The dissatisfaction with EHRs has been heard loud and clear across the country since their rapid implementation following the 2009 HITECH Act, which introduced financial incentives to promote the ‘meaningful use’ of health information technology generally and EHRs specifically. Providers feel as if they have been transformed into data entry clerks, and patients have become accustomed to watching their caregivers interact more with a computer screen than with them.

With 20% of GDP estimated to be spent on healthcare by 2025, this high level of user dissatisfaction represents one thing: an immense opportunity. The response of the market has been enormous—everyone from Fortune 500 companies to scrappy entrepreneurs have poured into healthcare to develop and market solutions.

With over 17.8 billion invested in “digital health” companies since 2011, one thing is clear—new ways of bringing technology to healthcare will continue to emerge.

The unintended consequences

While the explosion of new solutions offering improvements on the status quo is exciting, it’s introduced two incredibly difficult problems for healthcare organizations: vendor selection and systems integration.

Vendor Selection How is a healthcare administrator supposed to effectively vet and select a solution when there are so many alternatives promising similar features and a better experience? She doesn’t have the luxury of simply downloading and experimenting with the few surgical scheduling solutions the way a consumer can simultaneously test half a dozen calendar applications on his phone and select the one that works best for him.

For a health system selecting a new solution, quickly switching or rebounding from an unexpectedly bad choice isn’t an option—the non-trivial purchasing decision requires extensive due diligence, multiple layers of approvals, and a lengthy contracting process, after which the chosen solution will be rolled out and used by a significant portion of providers and patients at a system level.

Systems Integration When you do make a selection on a new tool—probably at the behest of your head of oncology who can’t go another day without it—you have to figure out how it will interact with your other systems. Within this same problem is another even more complex problem to solve: how to keep patient data consistent across all systems. This is challenging because very rarely in healthcare do you see a full removal and replacement of a software solution; more often, a new tool is brought into the fold alongside existing systems.

When this happens, these solutions must integrate seamlessly with all other systems to ensure not only efficiency but patient safety as well—consistency in patient data is essential, especially when considering how even basic information like blood type and medication prescriptions can prove deadly when not recorded consistently across systems.

Though solution selection is an important issue facing health systems, we'll focus on the problem of systems integration, which is a problem so complex that it actually threatens the long-term viability of the organizations tasked with providing us care.

Why this is happening

Let’s take a step back and discuss how this problem came to be.

The reality is that EHRs now represent the nervous system and memory bank of clinical care in our country—from registration to discharge, every single event that happens within a clinic or hospital is both routed and recorded within one of these software systems.

While this cataloging is helpful, unfortunately, EHRs have very real limitations.

Most EHRs were initially designed as billing systems, and because of this, they are not well suited for patient-facing applications nor deliver an enjoyable user experience for providers. Beyond patient portals, (which were only prioritized only because of government mandated regulation), there’s little functionality for patients as the user, if any at all.

Another common complaint of EHRs is how they facilitate care coordination between various caregivers both within an institution and across institutions, as referrals through EHRs are inefficient (if not impossible). Reporting and analytics functionalities, too, are weak points of EHRs, and the unique needs of specialists are not easily accommodated by software designed to serve a broader audience.

Long story short, today’s provider organizations recognize that their EHR cannot, in fact, do everything. Instead, they’re actively looking to extend and augment the EHR functionality with third-party solutions.

It’s important to note that EHRs aren’t incompetent pieces of software nor are inherently evil—they perform routine functions, facilitate accurate billing, and store patient information very well and should be commended for it. Building and maintaining an EHR is also a highly resource-intensive business, and vendors are pouring hours upon hours of developer time into keeping pace with changing government regulations and new models of care, leaving limited capacity to address other user needs.

While this is true, the reality is that no single software solution or organization is capable of meeting the needs of all users—at least not in a space as complicated as healthcare.

There’s a reason even Apple offers an app store—as much as they’d love to build every application people use from their mail client to calendar, Apple understands that they couldn’t possibly satisfy their entire market base. Instead, they chose to let users to select solutions that better meet their specific preferences, allowing them to focus on their specialty and let others compete. Realizing the value of this model, dozens of other technology vendors—from Google to Salesforce to Slack—have followed suit.

That healthcare will adopt niche technologies targeting specific users and use cases is inevitable; we’re seeing it today with an explosion in everything from customized survivorship plans for cancer patients to more efficient ways to collect patient reported outcomes following an orthopedic procedure. The unique challenge that healthcare organizations face is how to have these specialty solutions “talk" to their electronic health record systems. For better or worse, these systems are in place to perform the mission-critical functions of documentation and billing, making them the system of record (and source of truth) at any provider organization. Out of necessity, solutions adopted to augment EHR functionality must seamlessly integrate with the software in order to be successful.

Connecting disparate systems can be done, and health systems have been integrating for years. Unfortunately, the way most healthcare organizations integrate is costly, time consuming, and contributes to an ever-growing maze of tech debt that threatens their ability to react to changes in the industry, meet the demands and expectations of consumers, and ultimately, deliver quality care to patients.