EHR Integration Challenges

Did you know that there are more than 1000 EHR systems, and more than 500 EHR software development companies offering some kind of EHR products in the United States alone?

The healthcare industry is reliant and often relies on other healthcare professionals for their expertise to deliver holistic care. Now, looking at this statistic, you see that almost 37% of patients have reported delays in their care due to rising costs.

While care delays have been costing the healthcare industry billions annually, the problem is just the tip of the iceberg. You see, the hospitals that have adopted digital means to deliver have indeed increased their efficiency and started to diagnose patients quickly. However, the problem to which they have been introduced is quite similar but of a different nature. 

This statistic would give you a better idea, as over 60% of healthcare IT professionals have reported system downtime when using IoT or telehealth devices. Furthermore, 58% of healthcare IT professionals further cited that EHR integration challenges have become a major reason for delays in care from the providers’ side.

Custom EHR integration for healthcare data migration or sharing has become a crucial backbone of this new-age healthcare practice. However, to harness the lucrative benefits of EHR integration, you first have to identify, address, and overcome the EHR integration challenges.

On that note, let this blog be your guide to understanding EHR integration better and identifying the EHR integration challenges and how you can overcome them. So, without further ado, let’s get started!

Technical Interoperability Barriers

Since this appears to be a very technical problem, let’s first explore the technical EHR integration barriers in interoperability that impact smooth data-sharing practices:

• Legacy Systems with Limited Connectivity Options

The healthcare digital transformation started a little more than a decade ago. During those times, the healthcare practices that adopted custom healthcare interfaces used outdated technologies and protocols. In simple terms, they have used legacy systems.

Now, these legacy systems with custom healthcare interfaces have made it difficult for healthcare systems to connect with each other. They also lacked API capabilities, which made it even more difficult for the systems that used advanced technologies.

Moreover, these limited connectivity options combined with the data formats without published specifications further make it difficult to track the data repository to get the right data that is actually requested.

• Standards Implementation Variations

The major problem that has been at the heart of EHR integration is the use of different standards and formats for sharing data. For instance, while connecting your healthcare system with EHR integration, HL7 or Health Level Seven format standards were used. While this enabled data sharing as newer technologies made their way into the healthcare industry, the standards changed to meet the evolving needs and requirements of healthcare practices. 

Along with that, since there is a wide range of healthcare software systems in use, every system has different FHIR implementation maturity ratings. Which further makes it difficult to share data accurately.

If you are going ahead with custom EHR integration methods, then the vendor-specific interpretation of standards also causes certain issues that can cause EHR implementation problems.

The best way to overcome these is to use HL7 FHIR standards and prioritize their implementation in the systems.

• Infrastructure & Connectivity Limitations

While standards and systems pose primary technical EHR integration challenges, and in the quest to overcome those, the network infrastructure also needs to be stable. This is important because it creates a base that enables a smooth flow of data between systems.

When analyzing the infrastructure for integrating EHR with your system, check the network reliability and other bandwidth constraints. You see, when the network is reliable and the systems share similar bandwidth, establishing a connection with the systems becomes easier, allowing for easy information sharing.

Along with that, the firewall and security restrictions must also be considered. Also, the integration challenges vary depending on the data storage platform, such as cloud and on-premises. The best way to overcome these challenges is to understand the system infrastructure and align your system with that to establish a connection and enable smooth data sharing across systems.

Some of the top challenges that you’d most likely face in EHR integration are quite common and recurring in nature. So, here are the Top 5 Challenges in EHR Integration and How You Can Overcome them.

Data Mapping & Semantic Interoperability

Now, moving ahead with data-related challenges that arrive in EHR integration, here are some challenges that you’re most likely to face in data mapping and semantic interoperability.

• Field-Level Mapping Complexities

The challenge that often arises at the very start of data mapping is inconsistent data structures across different systems. For instance, some healthcare organizations use a standard EHR system, and some use a custom EHR system. In such systems, the inconsistent data structures make it difficult for the system to understand and interpret the data accurately.

Moreover, the variations in the required and optional fields further add to the complexity, making it much more difficult for your system to understand the data. On top of that, different data validation rules and constraints not only disrupt data mapping processes but also impact the ability of your system to make sense of the data that is to be shared.

One of the best ways to overcome this is to follow data mapping best practices and try to find a balance between standard data formats and standards so that data mapping becomes easier, and also the system is able to make sense of the data that is being shared.

• Terminology & Coding System Differences

Healthcare practices using different systems use different terminology and coding systems for the same clinical concepts. To explain this better, let’s say one healthcare system uses Roman numerals as serial numbers, and the other healthcare system uses English numerals for the same. Now, this might confuse the system in terms of data interpretations, causing further EHR implementation problems.

Also, the local codes and custom codes without standard mappings can also pose EMR integration problems that can interoperability of the systems. So, what can be done to overcome these issues?

Versioning issues with standard terminologies to help the system understand the data better can be a great way to overcome data mapping and coding system differences for healthcare systems.

• Data Transformation Requirements

Format conversions and data type discrepancies play a crucial role in data transformation and lay the base for semantic interoperability. Carefully implementing these is necessary because it allows your system to transform the data from one format to another to make it easier to share and improve accuracy.

However, the complex business rules for data translation pose a major challenge, and overcoming them with the right strategy is necessary. One of the best ways to overcome data transformation challenges is to maintain the context of the data and build relationships between different data during the mapping process.

Complexities in data mapping can be a big reason to worry in multi-system EHR integrations. If you’re looking to integrate multi-system EHR into your system then you must read this blog.

Security, Privacy & Compliance Concerns

When exchanging data from one system to another, there are high chances of data thefts, which can compromise not only the security of your system but also the privacy of patient data. This gives rise to compliance concerns, which again pose a significant challenge to EHR integration and interoperability.

• PHI Protection Across Integration Points

You see that the data that you’re sharing contains sensitive patient information, and ensuring that the data is safe at the integration points is necessary so that it cannot be stolen. Addressing these security vulnerabilities at interface boundaries, such as broken object-level authorization, IDOR, session hijacking, injection attacks, server-side request forgery, etc., becomes necessary so that the attackers are not able to exploit the trust gaps, manipulate data flows, and bypass security controls.

Follow the best practices for data safety, such as end-to-end encryptions, so that the data remains safe at all times, both in transit and at rest. Also, conduct regular audit trails across systems so that no stone is left unturned and you are able to identify the loopholes in security easily and address them in time.

• Authentication & Authorization Challenges

There are certain authentication and authorization EMR integration barriers that can compromise the security of your EHR integration. That is why managing user identities across applications becomes necessary.

Implement role-based authentication or role-based access control to synchronize the user identities across systems. Moreover, this also helps in maintaining the privacy of a patient’s medical information, as only authorized personnel can access such data.

Managing authentication and authorization in EHR integration is a challenge in itself and can be a separate blog about it. So, here are a few things that you need to know about managing authentication and authorization in EHR integration.

• Regulatory Compliance Considerations

Some regulatory compliance considerations that you need to adhere to are HIPAA compliance for integrated systems. Establish your EHR integration in such a way that it satisfies information-blocking rule requirements.

Other than HIPAA, adhering to other local and international data protection guidelines is necessary so that your data is always safe, even at the time of sharing. This will not only help you navigate through the rough data regulatory landscape but also keep you away from some legal troubles.

Workflow & Process Integration Barriers

When you integrate with your system and the EHR system, you align it with specific clinical workflows and administrative processes. However, depending on the growth of your practice, the workflows and processes often change and that can be an EHR integration challenge. On that note, let’s see the possible challenges and how to overcome them:

• Clinical Workflow Disruption Risks

Starting with the clinical workflow is one of those things that are disrupted even if there is a slight change in the care delivery procedure. That’s why you need to have change management in place to overcome the workflow inconsistencies between the systems. Meaning that whenever there is a change in the workflow, you need to identify, address, and align your software data flow and workflow with that of the clinical workflow.

While doing so, you need to address the workflow inconsistencies between your system and the integrated system. However, while implementing these changes into your workflows, there are certain user adoption challenges as well, and the best way to overcome that is by effective training of the staff members.

• Process Redesign Necessities

Whenever there is a change in the process of doing a certain task or anything for that matter, there are certain changes that you need to make in the system as well. Especially in EHR integration, as data exchange is majorly dependent on that. Now, while redesigning the process and aligning that with your workflow, you need to analyze the current state of the workflow and how the future workflow would look like.

Then, by identifying the gaps and filling up the changes, you can easily address them and standardize the process change requirements so that the data flow is accurate and aligns with your workflow.

On top of that, the change in healthcare data migration and the process can also impact the roles and responsibilities of individuals who access the data on a regular basis. Adjustments to that also become necessary, as it can compromise the security and privacy of data.

• Testing & Validation Complexities

Testing and data validation complexities also pose a significant EMR integration barrier. The most common problem that you will most likely encounter is end-to-end workflow testing challenges. Some of the major challenges include data interoperability and standardization, workflow disruptions, healthcare data migration, integrity, testing environment complexity, dependency management, etc.

Once you conduct end-to-end workflow testing, you also include scenario-based validation requirements so that the data flow is always smooth and seamless in certain scenarios.

Data Quality & Integration Issues

If you ask about EHR implementation problems, then data quality and other integration issues are something that almost every developer will point out. So, let’s discuss some of the data quality issues that can pose a threat to your custom EHR integration.

• Data Inconsistency Problems

Inconsistencies in data are one of the major factors that deplete the quality of data, especially in electronic health records (EHRs). For instance, duplicate patient records and reconciliation often create conflicting clinical information across systems. This can not only conflict with historical data quality variations but also impact data sharing, which can lead to incorrect data sharing.

• Master Data Management Challenges

Also, it is a common practice to have a master database to store all the important data for your practice. Since this database would contain almost all the varied information, patient identifiers can provide complexities that can create problems in locating the right patient and sharing the right data.

This can also create certain issues when synchronizing the data from the master database to the provider directory. The best way to overcome this is by following location and facility data standardization practices.

• Data Governance Requirements

Depending on the ownership of the data, establishing EHR integration can again be a challenge. That is why, if you are developing custom healthcare interfaces, then define the ownership and stewardship of data. This will not only help you understand who has control over the data but also can further you in its flow, permissions, etc.

Having said that, data correction and maintenance processes are also important for data governance. Data correction and maintenance help in maintaining the accuracy, consistency, and credibility of data. Some of the processes involved include correcting errors, updating master data, managing changes, and performing data cleansing to ensure the quality of data.

Last but not least, you need to implement quality monitoring across integration points so that the data that is being transmitted is accurate and right. However, it is said than done, and consulting healthcare IT professionals for adhering to data governance requirements to overcome this EHR integration challenge is recommended.

Tip: We realised that most of the projects we take often come with a request of connecting their old legacy system with new healthcare systems. If you wanna know how we do it, then click here to read legacy system integration.

Organizational & Resource Constraints

Now that we’ve covered some of the major technical EHR integration challenges that you’re most likely to face, here are some of the organizational and resource constraints that you need to keep in mind:

• Budget Limitation & ROI Challenges

EHR integration can be a costly affair if certain things are not streamlined. Moreover, depending on factors like data mapping, data quality, etc., not only impact the cost estimation but also the timeline for custom EHR integration.

Furthermore, long-term maintenance budget requirements are less but clearly would appear like a significant investment. That is why it is suggested that you discuss the budget and ROI of EHR integration beforehand with your EHR integration vendor.

• Skill Gap & Expertise Shortages

EHR integration is necessary when integrating your system with an EHR system is easier said than done. Discuss the technical expertise of the healthcare IT professionals working on EHR implementation problems so that EMR integrations can be easily overcome.

Moreover, project management for complex integration is also challenging, which is why hiring those who have sound clinical informatics knowledge is necessary to establish seamless integration between you and the EHR system.

• Vendor Management Complexities

Vendor management is one of the major EHR integration challenges that you’re most likely faced with custom EHR integration and interoperability. You see, multi-vendor coordination can be challenging as there are multiple systems and servers involved, and connecting all that to share information with your system can be challenging.

Also, the different data formats and standards used by the vendors can further make the integration process challenging. Last but not least, carefully consider the service level agreement and specifically ask them to include the services that you want, along with release cycle synchronization issues.

These issues usually occur when the two systems are not synchronized, which can lead to delays, conflicts, and errors.

EHR integration can optimize the performance of your practice, even for high-volume EHR data exchange. Click here to read how you can do it.