The No BS Guide to Developing a Healthcare Enterprise Integration Strategy

Presented at HxRefactored 2015, Boston, MA. Key takeaways:

* Any enterprise app which acts like a consumer app that doesn’t integrate well into hospital or ambulatory systems and workflows is doomed

* There’s nothing unique about health IT data that justifies complex, expensive, or special technology.

* There’s a lot unique about healthcare workflows that require common technologies to be adapted properly.

Transcript

1. The No BS Guide to Developing an Enterprise
   Integration Strategy for your Digital Health Product
   Stop dreaming about interoperability and focus on
   tactical enterprise integration
   By Shahid N. Shah, CEO
   

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2. NETSPECTIVE
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   Who is Shahid?
   • 20+ years of software engineering and multi-
   discipline complex IT implementations (Gov.,
   defense, health, finance, insurance)
   • 12+ years of healthcare IT and medical
   devices experience (blog at
   http://healthcareguy.com)
   • 15+ years of technology management
   experience (government, non-profit,
   commercial)
   • 10+ years as architect, engineer, and
   implementation manager on various EMR
   and EHR initiatives (commercial and non-
   profit)
   Author of Chapter 13, “You’re
   the CIO of your Own Office”
   

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3. NETSPECTIVE
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   What’s this talk about?
   Background
   • Many enterprise apps are being built
   these days, most are designed to
   work as a stand alone system similar
   to consumer apps
   • Healthcare-specific software
   engineering and integration tools
   are going to do more harm than
   good (industry-neutral is better).
   Key takeaways
   • Any enterprise app which acts like
   a consumer app that doesn’t
   integrate well into hospital or
   ambulatory systems and workflows
   is doomed
   • There’s nothing unique about health
   IT data that justifies complex,
   expensive, or special technology.
   • There’s a lot unique about
   healthcare workflows that require
   common technologies to be
   adapted properly.
   

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4. www.netspective.com 5
   There is no interoperability
   crisis in healthcare.
   Even if there was, there’s nothing you can do about it so stop complaining.
   There is, however, a vendor management
   and incentives alignment crisis.
   

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   Source: http://jimenezconsulting.com/industries/healthcare/regulatory/hipaa5010
   

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   Why do health IT systems
   integrate poorly?
   

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   Because customers don’t know how
   to effectively punish vendors that
   don’t integrate well.
   But, that’s changing. Slowly.
   

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   Because app developers don’t have
   a systems engineering culture where
   we think of data integration as a
   discipline our customers will buy.
   But, that’s easy to fix. Be disciplined.
   

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   Because we want to wait for others
   to create a new standard or magical
   API that makes integration
   problems disappear.
   But, that’s easy to fix. Follow what other industries are doing.
   

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10. NETSPECTIVE
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    The tactical issues
    • We don't support shared
    identities, single sign on (SSO),
    and industry-neutral
    authentication and authorization
    • We're too focused on "structured
    data integration" instead of
    "practical app integration" in our
    early project phases
    • We focus more on "pushing"
    versus "pulling" data than is
    warranted early in projects
    • We have “Inside out”
    architecture, not “Outside in”
    • We're too focused on
    heavyweight industry-specific
    formats instead of lightweight or
    micro formats
    • Data emitted is not tagged using
    semantic markup, so it's not
    securable or searchable by
    default
    • When health IT systems produce
    HTML, CSS, JavaScript, JSON,
    and other common outputs, it's
    not done in a security- and
    integration-friendly manner
    

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11. So what do we do?
    And now…
    

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12. NETSPECTIVE
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    Legacy integration
    Application A
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Copy features and enhance (everything is separate)
    Application A
    Data
    Functionality
    Presentation
    Feature Z
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Connect directly to existing data, but copy features and enhance
    

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13. NETSPECTIVE
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    Services
    Modern integration
    Application A
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Create API between applications, integrate data, create new data
    Application A
    Data
    Functionality
    Presentation
    Feature Z
    Feature X
    Application B
    Data
    Functionality
    Presentation
    Feature Y
    Feature X
    Feature Z
    Create common services and have all applications use them
    REST
    SOAP, RMI
    SOA
    ETL
    WOA
    APIs
    

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    Start cataloging and
    formalizing use of
    enterprise integration
    patterns.
    You’re not the first (or second) to see
    these problems. Read. Hire experts.
    

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    Learn about MDM, ESB, ETL, and
    BPM – grab open source or
    commercial implementations and
    build around them.
    Don’t hand code things.
    

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    Create a formal Enterprise
    Integration Group (EIG).
    Even get a cool logo and team mascot.
    

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17. NETSPECTIVE
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    Popular cloud data exchange approach
    DHP Protected Environment
    CDO’s Protected Environment *
    Practice’s
    Systems
    Filter for
    DHP Patients
    Encrypt
    and
    Transmit
    DHPSB
    DHPSB
    DHP
    Data Repository
    (DHPDR)
    Encrypt
    and
    Transmit
    * EHR could be a standalone or hosted by a service provider
    DHP = Digital Health Product
    DHPSB = Digital Health Product Service Bus
    

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18. NETSPECTIVE
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    In cloud, data filter strategy is crucial
    Encrypt and Transmit
    Filter using
    CDO’s rules
    Customize to send only
    filtered data
    Send data for all CDO’s
    patients
    Preferred Option
    Send all data and let
    the DHP Gateway
    perform the filter
    Alternate Option
    Pre-filter data from
    each practice system
    before it reaches DHP
    Gateway
    Alternate option requires more work
    on the CDO’s part; the preferred
    option requires more work on the
    DHP’s part
    Encrypt and Transmit
    DHP
    Protected
    Environment
    

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19. NETSPECTIVE
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    Data architecture questions to pose
    1. Kinds of data to collect (e.g. demographics, medications, labs, physician
    notes, etc.) - we need this in excruciating, painful detail. Lots of arguments will
    emerge here and that's really good. This means we give specific field names,
    field types, data lengths, etc. as part of the requirements.
    2. Frequency of data to collect (e.g. real-time, hourly, daily, etc.)
    3. Data code types (e.g. LOINC, CPT, ICD9, ICD10, etc.)
    4. Discrete and structured data standards (e.g. CCR, CCD, BB+, etc.)
    5. Directionality (unidirectional from EHR to DHP
    , bidirectional between both
    EHR and DHP)
    6. File types and transport types (HL7, CSV, etc.)
    7. Broad source types (BlueButton, BlueButton+, Ambulatory EHR, Health
    System EHR, Private HIE, Public HIE, etc.)
    8. Specific sources (e.g. named customers, named EHRs, named HIE, etc.)
    

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20. NETSPECTIVE
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    Healthcare integration RACI
    • Name the EHR or HIE (or any other source named in #7/#8
    above)
    • Coordinate with the legal and executive team to ensure that you
    have legal rights to the data
    • Coordinate with the IT team at the system owner at the client
    (usually a covered entity but could be a systems integration firm
    or consulting outfit)
    • Coordinate with the EHR or HIE vendor see how cooperative they
    are
    • Send the EHR or HIE vendor the Enterprise Integration document
    and have them fill that out in collaboration with your team
    • Get physical access to the vendor’s database or system
    

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    Create a
    technical profile
    questionnaire
    and checklist.
    Be disciplined, use tools like
    Caristix to document
    requirements and visualize
    interfaces.
    

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    Lets see what all
    of this looks like in
    practice.
    You can do this in less than 40 man-
    hours of work.
    

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23. NETSPECTIVE
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    Ambulatory MU2 Market Share (2014)
    http://www.policymed.com/2014/05/2014-electronic-health-records-market-share.html
    

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24. NETSPECTIVE
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    Inpatient MU2 Market Share (2014)
    http://www.policymed.com/2014/05/2014-electronic-health-records-market-share.html
    

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25. NETSPECTIVE
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    Healthcare fears open source
    • Only the government spends more per
    user on antiquated software than we do
    in healthcare.
    • There is a general fear that open source
    means unsupported software or lower
    quality solutions or unwanted security
    breaches.
    Open source can save health IT
    • Other industries save billions by using
    open source.
    • Commercial vendors give better pricing,
    service, and support when they know
    they are competing with open source.
    • Open source is sometimes more secure,
    higher quality, and better supported
    than commercial equivalents.
    • Don’t dismiss open source, consider it
    the default choice and select commercial
    alternatives when they are known to be
    better.
    Rely first on open source, then proprietary
    “Free” is not as important as open source, you should pay for software but require openness
    

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26. Thank You
    Visit
    http://www.netspective.com
    http://www.healthcareguy.com
    E-mail shahid.shah@netspective.com
    Follow @ShahidNShah
    Call 202-713-5409
    Need to develop an enterprise integration
    strategy for your digital health product?
    Call or write to us.
    

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