Q&A: Cloud Integration in Health-Care Organizations

We examine the special challenges and best practices of integrating cloud technology in the health-care industry.

Cloud is taking off in a variety of industries, but in the health-care industry, there are special challenges especially in light of recent regulations. To learn more, we spoke with Eliot Muir, CEO of iNTERFACEWARE, a health-care integration company.

Enterprise Strategies: What are some of integration challenges of implementing cloud computing solutions that are unique to the health-care industry?

Eliot Muir: Despite widespread adoption of cloud-based solutions by most industries, the health-care industry has been slow to embrace cloud computing. Although this slow adoption is partially due to concerns about safeguarding confidential patient information and compliance with key regulations such as HIPAA, and many health-care IT departments are simply burdened with outdated legacy systems and feel overwhelmed with the prospect of supporting yet another standard or protocol.

If these obstacles can be overcome, cloud computing solutions can bring tremendous benefits to health-care organizations as well as help them improve patient care and reduce overall health-care costs.

What are some of the factors health-care organizations need to keep in mind when trying to integrate disparate health-care information systems in the cloud?

There are several challenges health-care organizations need to be aware of when integrating with cloud-based solutions. These organizations should:

Use Modern Tools: The easiest way to bridge the gap between existing integrations and the new cloud-based interfaces is to use tools that are specifically designed to do just that. It might sound obvious, but many organizations attempt to reuse technology from the past – or build new tools from the ground up -- rather than embracing technology that was built to integrate using both old and new protocols.

Maintain visibility into highly scalable data centers: Traditional health-care applications need to be installed on individual servers within hospitals. Therefore, the amount of CPU, disk, and resources for each application is huge and reduces the efficiency tremendously. On the other hand, a cloud data center is scalable and typically handles millions of transactions per day and has to stay up 24x7. Monitoring all those interfaces can be a difficult. It is important to use tools that can help organizations scale efficiently and still provide visibility into the many feeds.

Be flexible: The idea of everyone adhering to the same standard is a noble concept, but in health care, it’s a long way off. To benefit from the numerous opportunities and applications available, organizations need to be flexible. That means being able to accept data "as-is,", handle any data format from HL7 to XML, and map information on the fly. The more efficiently you can send and receive data -- from SSL to HTTPS -- the more likely you’ll be able to create a robust, secure method of exchanging, analyzing, and presenting data.

We all know that HIPAA is a major regulation for health-care providers. Does it affect how cloud solutions are integrated? Are there other regulations that apply?

HIPAA is undoubtedly the most important regulation in the health-care industry. Protecting sensitive patient information and regulatory compliance have prevented many organizations from embracing cloud-based solutions. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, is helping promote the adoption and meaningful use of health information technology.

As a result, the health-care industry is working on developing cloud computing solutions that are secure and enable organizations to store data safely in the cloud. As these solutions become ubiquitous, we anticipate many health-care organizations adopting the cloud model for business applications including e-mail, CRM, and file-sharing.

Due to recent health-care reform, there is added pressure on organizations to adopt Electronic Health Records (EHRs) and Electronic Medical Records (EMRs).Can you discuss health-care integration challenges in the light of EHRs and EMRs?

Meaningful use is an as-yet to be determined critical level for the use of electronic health records and related technology within a health-care organization. Currently, most health-care providers still use medical record systems based on paper. New government incentives and programs such as Meaningful Use are helping health-care providers across the country make the switch to electronic health records. Meaningful use will have a significant impact on HL7 integration. As the discussions for Stage 2 and 3 requirements are well underway, it is clear that these next two stages will focus on infrastructure and interoperability.

With organizations scrambling to meet the requirements of meaningful use, HL7 integration is understandably on the minds of many EMR vendors and physician practices. That’s good for the integration engine business because these vendors are going to be looking for interfacing solutions. However, the biggest concern centers around how these new participants will implement interface technology. HL7 leaves a lot of room for personal interpretation. With so many EMR vendors flooding the market and promising to help customers meet the meaningful use requirements, there is always a risk that each vendor will handle HL7 differently. Thereby, more complexities will be introduced into the ecosystem of integrated health-care systems.

From an integration standpoint, it is essential to ensure that these systems are equipped to deal with real-world integration challenges and improve future patient-care.

You mentioned HL7 -- what is it and what role does it play in health-care integration? How does it impact cloud computing solutions?

HL7 standards are the most widely deployed standards across the health-care industry. They have successfully eliminated the headache of custom designing and programming on the part of both the sending and receiving application vendors. HL7 standards have been around long enough to be tried and tested for creating interfaces. They have helped the health-care industry reduce costs by outlining best practices for processes such as collection of patient attributes or a standard set of interesting events.

For cloud-based solutions to be successful, it is important for them to be interoperable with the key systems that hospitals run today. Many systems that were designed in the 70s and 80s have been able to support HL7 but do not support the latest in Web standards. HL7 standards bridge the difference between legacy and the cloud-based solutions to keep the disparate health-care systems running seamlessly.

What are the benefits of cloud computing solutions in the health-care integration industry?

Cloud computing solutions can bring tremendous benefits to health-care organizations as well as help them improve patient care and reduce overall health-care costs. For instance, cloud computing can help health-care organizations share information stored across disparate information systems in real- time and can free up IT staff to attend to more critical tasks in an efficient and cost-effective manner.

In my opinion, the biggest benefit of embracing the cloud is the ability to take advantage of a new generation of innovative applications. The cloud levels the playing field for health-care start-ups and entrepreneurs who previously could not enter the market due to high barriers to entry -- primarily adhering to industry-specific protocols.

Today, small teams of software developers have created entirely new industries and revolutionized the way we shop, share, and interact with the outside world. One of the key forces behind these innovations has been the ability to exchange data seamlessly between disparate systems powering these applications. Interoperable standards such as HTML, XML, and JSON enable search engines to index virtually all the content on the Internet and display results in a fraction of a second. They enable Web sites to notify users when content changes and enable organizations to create add-on applications to existing social networking and communications platforms.

This ability to extend the functionality of existing data is what often leads to new innovation and new optimizations; something health-care IT desperately needs.

What are the biggest mistakes IT makes in trying to integrate health-care information?

Sometimes IT gets fixated on developing health-care integration solutions from scratch. Although this works in most industries, developing solutions from the ground up spell doom for the health-care industry.

The traditional economics of the software industry can be very profitable. Once a company sells enough copies of its software to cover development costs, every additional unit sold generates pure profit. With this economic model, companies do not have to emphasize efficiency or innovation.

However, the economics of developing software change dramatically when the final product has to be integrated with customers’ existing systems. Development costs become variable and unpredictable with each sale, requiring custom integration work that effectively raises expenses and lowers overall profits.

The significance of integrating disparate systems in the health-care industry cannot be overlooked. Virtually all software sold to hospitals, clinics, labs, or other health-care organizations requires integration with existing networks and applications in order to become a valuable addition to the organization’s existing IT infrastructure.

What best practices can you recommend to prevent such problems?

In this economic environment, many software vendors and health-care organizations will (or should) investigate the merits of both sides of the well-known “buy-vs.-build” debate. Although the majority of development teams are capable of constructing interfaces, very few are able to do so cost-effectively.

There are several key considerations to review before you decide whether to custom build an interface or purchase one. They are:

The Opportunity Cost: Spending significant resources on the development of custom interfaces when there is software available is less valuable than devoting the same resources to projects that provide a competitive advantage to your business. It is typically less expensive to buy interface solutions than to create them.

The True Investment: The initial cost estimates of building integration software typically do not include long-term maintenance costs. However, health-care integration is an on-going process rather than a one-time project. Most projections about the cost of maintaining and updating code are often unpredictable and/or result in the true investment amount being overlooked or underestimated.

Integration is not Simple: Integration usually consists of connectivity, transport, routing, and data manipulation. That’s just the part of the picture -- the challenges your customers want to resolve with integration are complex. Each implementation will present unique issues with each site requiring its own custom code, unique connections, and destination types.

The Pitfalls of Proprietary: Health-care integration is specialized but that doesn't mean it needs to be proprietary. In addition to the expenses associated with writing and maintain site-specific custom code, proprietary systems can be vulnerable to outside attacks or corruption.

Features Matter: Successful integration projects rely on integration platforms that provide flexibility. Monitoring and logging features are essential to the support, maintenance, and reduction of downtime in any integration project. Features such as configurable notifications are vital to troubleshooting and minimizing support costs.

Think of the Future: It is often all too easy to think in terms of single projects. If you look at a single integration project and determine that your development team can build the required interface, what happens when the next one comes along that is more complex, more sophisticated, needs more features, and requires the flexibility to change? You will likely end up with unmanageable code and a poorly designed system that is ultimately more expensive and less feature-rich than a third-party system.

What does iNTERFACEWARE do?

iNTERFACEWARE simplifies the exchange of electronic health-care data among disparate systems with its HL7 integration engine, Iguana. Hospitals and health-care organizations are able to seamlessly transfer electronic information without the need to replace existing systems or write additional code, thereby improving patient care and reducing costs.

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