What is Custom EHR Integration & Interoperability?

Healthcare delivery is a complex process; from consultations to tests to symptoms, everything is simply interdependent on one another. For this, healthcare providers usually have to connect with other healthcare professionals like pharmacists, radiologists, lab technicians, etc., and draw conclusions that help in accurate diagnosis and care planning to get the desired health outcome.

Interestingly, by 2021, around 71% of the hospitals reported they had been using electronic health information at the point of care. The percentage of hospitals trying to attain true interoperability has clearly increased from 55% when last recorded in 2017.

Furthermore, as the healthcare landscape continues to adopt healthcare software solutions to simplify administration and care delivery, the need for their healthcare software system to be EHR-integrated and interoperable is extremely important. But why?

The answer to this is pretty straightforward: since healthcare providers depend on many external factors to deliver appropriate, personalized, and holistic care, to reduce the time for diagnoses, care planning, and delivery, their system needs to be integrated with the EHR system and be interoperable while communicating with disparate systems.

But this is where it gets tricky. You see, the arrival of EHR and healthcare IT systems saw the rise of many off-the-shelf software systems. However, given the very limited customization and flexibility, it failed to qualify as a complete healthcare interoperability solution.

This gave rise to EHR interoperability and custom EHR integration, which not only encouraged accurate medical data exchange but also allowed healthcare practices to make an attempt to be a part of a connected healthcare ecosystem.

On that note, let’s understand custom EHR integration and EHR interoperability and why it is important for your custom healthcare software system.

The Foundation – Understanding EHR Integration & Interoperability

Before getting into the intricacies, let’s start by understanding what EHR integration and EHR interoperability are. 

• EHR Integration & Its Role in Healthcare Technology

In short, EHR integration is the process that allows your healthcare software system to share patient data and communicate with different healthcare systems seamlessly. Isn’t that cool?

Having said that, EHR integration has a huge role in healthcare technology as it sets the pathways for data flow between two disparate systems, and the translation tools help in the accurate transfer of the data. 

Now, depending on your needs, you can choose the type of integration you need for your system. Majorly they are classified into two types as: unidirectional or bidirectional integration.

	Unidirectional Integration	Bidirectional Integration
Data Flow	Data flows from one way to another system only	Data flows between both systems
Communication	One-way communication	Two-way communication
Use Cases	Lab Results, Claims Submission, Reporting	Care Coordination, Referrals, HIEs
Advantages	Simple, secure and easier to implement	Real-time data sync, continuity of care, supports interoperability
Disadvantages	Limited feedback and does not support real-time collaboration and updates	Complex to implement, strong security controls and requires HL7 FHIR standards

EHR integration, in the context of healthcare delivery, helps healthcare providers to get instant access to patient health data in real-time, which allows them to coordinate better and deliver care more profoundly.

• Interoperability in Healthcare

Well, in simple terms, interoperability is the ability of the system to communicate, understand, and exchange information with disparate systems without compromising the quality of data that is being shared.

There are four levels of interoperability as defined by ONC and HIMSS. Here is a brief introduction about the four levels of interoperability in healthcare and things you need to know about them:

	Foundational Interoperability	Structural Interoperability	Semantic Interoperability	Organizational Interoperability
What It Is?	The basic ability of your system to send and receive data from other systems.	This type of interoperability ensures that the data shared has the same format and syntax, which makes it easy to interpret.	The ability of the systems to interpret, understand and use the exchanged data in a meaningful nature.	This interoperability involves governance, policies, and workflows that ensure a secure and seamless exchange of data between different organizations.
Key Points	NA	HL7, CDA, FHIR resources	Standard Vocabularies like SNOMED CT, ICD-10	Covers legal, cultural, and administrative aspects of data sharing
Use Cases	Just delivering data.	Delivering data in the same file format and field order.	Delivering data in an understandable language for the system.	Two health systems agree on consent protocols, data governance, and liability before exchanging patient data.

• The Critical Relationship Between Integration & Interoperability

Even if you’re barely familiar with the healthcare IT landscape, you must have heard about integration and interoperability together. Now, though they have different meanings and purposes, they have a very peculiar relationship that complements each other and helps you in delivering the best possible care.

You see, electronic health record integration helps you get patient health information from disparate healthcare systems. And for your system to get that information, interoperability is required so that your system is able to communicate with the disparate systems so that the right information is being shared.

Despite being intertwined with each other, integration and interoperability are different, while they might appear the same on the surface. To know the difference between them, read our blog – The Fundamental Difference Between EHR Integration and Interoperability.

Why Do You Need Custom EHR Integration? – The Business Case for Custom EHR Integration

If you’ve made it here, then one question must be lingering in your mind: ‘Why do you need custom EHR integration?’

To understand this, we need to switch the perspective a little. You see, every healthcare practice is unique and functions in a specific way that is unique and works best for them. In such cases, custom EHR integration is required for your software systems and devices to interact with each other and seamlessly share data. This process involves connecting your healthcare system with the EHR system in a way that aligns and meets the unique needs and workflows of your healthcare practice.

• Limitation of Standard or Out-of-the-Box EHR Solutions

To understand why you need custom EHR integration, you first need to understand the limitations that come with EHR solutions. These EHR solutions are built on the basis of one-size-fits-all and offer standard integrations. It is because of this eccentric nature of standard EHR solutions that it is difficult to exchange information with disparate healthcare systems.

Moreover, these standard solutions come with a vendor lock-in period, which makes it difficult for you to change the software, and this is where you get stuck with outdated or incompatible software. If your providers are unable to access patient health information, it will disrupt not only the clinical processes but also the administrative processes.

• Financial Benefits of Custom Integration

Now that you know why a standard EHR solution fails to offer integration, let’s explore the financial benefits of custom integration:

With custom integration, you reduce, if not eliminate, the manual data entry process. This not only helps you cut down on administrative costs but also improves accuracy in data exchange. Furthermore, with seamless and real-time data exchange between systems, the chances of test duplication are decreased to a minimum.

Custom integration eliminates the repetitive work and streamlines dataflow-related roadblocks, which usually result in additional costs, giving you a financial advantage of saving on administrative costs.

• Operational Advantages

Well, for the financial benefits of custom EHR integration, there can be a separate blog. However, with financial advantage, custom EHR integration also offers an operational advantage to your practice. 

For instance, with data flow being tailored to the specific needs of your organization, the workflow is optimized, how? Well, let me simplify.

You see, your healthcare practice works in a particular process where data acts as a point of reference. Here, with custom EHR integration, the data flow is aligned with your practice’s specific workflow. This way, the staff finds it much easier to work, and so do patients.

Furthermore, by making this a standard for your practice, you also set the base for the scalability of your organization, and the dataflows align with the growth aspects of your practice.

• Competitive Differentiation in Healthcare Delivery

While many healthcare practices don’t see it, with custom EHR integration, you somewhat get a competitive advantage in many ways. The first one comes in the form of enhanced patient experience, as the custom approach takes them away from regular gigs and brings a sense of convenience in using the software.

By elevating the patient experience while accessing their healthcare information, you not only encourage them to take an active part in their care journey but also increase the chances of patient retention.

Last but not least, with instant access to patient health data, you can deliver holistic and value-based care, which enhances the quality of care without disrupting the workflows.

Note – Read the exclusive benefits of EHR integration for healthcare practices in detail here – Benefits of Custom EHR Integration for Healthcare Organizations.

Key Components of Successful Custom EHR Integration Solutions

Custom EHR integration has become one of the factors that determine the success of modern-day healthcare practices. However, the process of custom EHR integration with healthcare interoperability solutions is quite complex, and the success factor depends on many things. 

In our many ventures of broadly serving the healthcare industry, we have identified some of the key components that determine the success of custom EHR integration solutions. On that note, let’s get started:

Integration Architecture Options

• Point-to-Point Integration Vs. Hub-and-Spoke Integration

As your meetings with vendors progress forward, you’ll most likely encounter two integration architecture options: point-to-point and hub-and-spoke EHR integration architectures. Each of these architectures has its distinct benefits and can be crucial for your success depending on your practice.

	Point-to-Point Integration Model	Hub-and-Spoke Integration Model
What Is It?	In this integration model your healthcare system connected directly with the disparate system i.e., EHR system with which it wants to exchange data.	This integration model is more centralized in nature where each system is connected to a hub rather than directly with each other. The hub acts as a bridge that connects all the systems with each other.
Benefits	Tailored for specific use cases and gives more control over integration.	Centralized way of data exchange with the required flexibility of scaling. Moreover, it is easier to enforce data standards and governance.
Disadvantages	It comes with a complex scalability process and the integration is harder to maintain with a risk of inconsistency of data format and standards across systems.	The hub acts as a single point of contact for every system. The failure of a hub can result in integration failure.
Suitability	Best suited for your practice if there are fewer systems and low volume of dataflow between the systems.	This model of EHR integration is perfectly suitable for your practice if it has to be connected with many systems and has a high data flow.

• API-First Integration

There is also an API-first approach that many healthcare practices are adopting for modern integrations. The healthcare software systems are designed and built with an API as the foundational element before developing other components. By developing standardized APIs, seamless, secure, and scalable data exchange ability can be achieved by your healthcare software system.

• Middleware & Interface Engines

Middleware and interface engineers have emerged as a sound option for building the foundational architectures for modern EHR systems. While they can be incapable of working separately, together, they offer benefits like improved data consistency, scalable flexibility, and low-cost maintenance of EHR integration architecture. While middleware provides a flexible intermediary layer that handles data transformation and routing, the interface engines act as a specialized middleware platform that facilitates standardized, secure, and efficient communication between the systems.

Essential Technical Elements

The essential technical elements that play a part in determining the success of your custom EHR integration are the data mapping and transformation capabilities of your system. Since data mapping is necessary for connecting the data fields from one source to another, the transformation capabilities ensure that the data is understandable and accurate for the system.

Despite all the precautionary measures, there are chances of data errors, which is where the error handling and exception management features of your system come into the picture. These elements ensure that the integration is to the point and accurate and ensure the credibility of the system.

Apart from this, you also need a monitoring and alerting system, just in case of integration. This is crucial as the care delivery processes majorly depend on the data exchange. Also, do not compromise on the security and compliance features.

Implementation Methodologies

The success factor of custom EHR integration as a healthcare interoperability solution also depends on the implementation methodologies that you adopt. In this section, we’ll see the options you have and try to give you clarity on which one you should choose:

• Phase Vs. Big-Bang Approaches

As the name suggests, the phased implementation approach relates the system in stages. These stages can be specific to a department, functions, location, or workflow, depending on the priority. The major benefit of this approach is that it lowers the risk of system failure, and the staff members are easier to train on this method. However, it comes with some disadvantages, such as longer implementation time, requiring hybrid systems, and the risk of data fragmentation.

On the other hand, the big-band approach is where the entire system is released for everyone, everywhere at once. Moreover, it requires a shorter implementation time and offers an immediate transition to a newer system. Having said that, it also comes with high risk and requires massive upfront training and system readiness. All these factors make it a perfect option for smaller organizations.

• Testing Strategies for Healthcare Integration

Depending on the specialty you’re serving, here are some comprehensive testing strategies that you can adopt, such as integration testing focused on critical scenarios such as high-volume discharge diagnosis and revenue generation procedures. Along with that, functional testing must also be conducted to test the specific functionality of the software. Last but not least, conduct interoperability testing so that the system targets the correct data and ensures completeness of data exchange.

Other testing that you can conduct are performance and scalability testing, security and compliance testing, usability and user experience testing, cross-platform and mobile testing, etc.

• Change Management Considerations

When conducting a wide range of tests, there is a chance that you might be required to change certain aspects of your custom EHR integration. In such cases, you need to have a change management system in place so that the changes brought into the system are seamless and do not disrupt the clinical and administrative processes of the practice.

Healthcare Standards Powering Modern Interoperability

Interoperability is nothing but the ability of your system to communicate with disparate systems. In such cases, certain healthcare standards allow the healthcare systems the required means to identify and address the data pointers in another system.

You see, just like humans, computers also communicate with other systems but in coding languages. These standards provide the structure for the system to understand the data in the code accurately. In this section, let’s explore the healthcare standards that power modern interoperability.

• Evolution of Healthcare Data Standards

Ever since the introduction of IT in the healthcare landscape, professionals have immediately identified this data-sharing problem. Ever since then, there have been many standards that have provided healthcare providers with guidelines to determine data-sharing standards. HL7, also known as Health Level Seven V2, has been one of the widely used healthcare interoperability standards.

Over the years, many of these have been replaced by HL FHIR standards to improve efficiency and accuracy in integration and data exchange. Fast Healthcare Interoperability Resources (FHIR) set the stepping stone for modern and web-based approaches to exchange electronic health information. 

The reason for FHIR’s popularity has been in curation as it standardized data exchange with a common language and resource-based architecture. This helped the system to communicate with the system conveniently, and the web-based approach helped ease the accessibility of data. 

Now, these standards act as standard guidelines for healthcare IT professionals when developing a healthcare software system and achieving interoperability with custom solutions.

• Key Protocols in Healthcare Interoperability

Key protocols in healthcare interoperability are the technical standards and frameworks that enable your healthcare software to exchange, make sense of the data, and use it. With the help of these protocols, patient information flows securely across various platforms and helps healthcare practice improve coordination, bring efficiency to the process, and ultimately contribute to improving patient outcomes.

As you dig deeper into this, you will encounter many protocols that vary from the use of HL7 standards, DICOM, X12, IHE profiles, etc. However, the protocol of Open API standards is something that you should emphasize in particular. Why is this?

Well, this is because it enables your application to securely access and exchange healthcare data. One of the most prominent examples of this is SMART on FHIR, which makes it easy for your system to exchange data with third-party applications.

Another thing that you must consider bringing in your custom EHR integration for interoperability is IHE profiles. You see, Integrating the Healthcare Enterprise or IHE promotes the coordinated use of established standards like HL7, DICOM, and X12 by specific integration profiles for various clinical and operational uses. For example, IHE can be a great guiding tool for achieving interoperability for specific scenarios like sharing radiology reports and cross-enterprise document sharing between two different healthcare systems.

• Certification & Compliance Considerations

Coming to the last bit of the key protocols, ensuring security during data sharing is essential. Some of the certifications that you are required to have or at least adhere to are ONC. Other than that, you can also follow the United States Core Data Interoperability (USCDI) as a standard for health information exchange. Last but not least, comply with information-blocking components so that your data is always safe and protected.

The journey of healthcare standards for interoperability and integration have evolved overtime. To learn more about them in detail, here’s your read – Evolution of EHR Integration Standards and Protocols

Real-World Applications of Custom EHR Integration

I know that up until this point, the blog has become too technical. Though I have tried my best to help you understand the complex technical terms in simple words, they often stay unclear until we see them in action. Don’t you agree?

On that note, let’s see some of the real-world applications of custom EHR integration and how it has the potential to completely transform your healthcare practice on almost all fronts.

• Primary Care & Multi-Specialty Clinic Scenarios

In a typical healthcare practice that has adopted a digital healthcare software system, EHR integration comes in handy at almost every step of the way. But let’s be more specific and generic at the same time.

So, in a typical primary care or multi-specialty care setting, custom EHR integration can streamline the patient registration process as administrators have instant access to the patient’s entire medical history. Along with that, by demographic synchronization, your staff members don’t have to spend time on manual processes, and the entire process is sped up.

This can also be used while patient transfer and clinical document exchange can facilitate real-time information exchange so that your providers get a complete picture of patient health. Some of the aspects of this can also be seen in care continuity and preventive care practices.

Last but not least, the most used application of custom EHR integration that has been seen in primary or multi-specialty clinics is referral management workflows, which ease the pain of managing the continuous flow of patient population.

• Hospital & Health System Use Cases

We’ve seen the applications of custom EHR integration for small-scale practice. Now, by moving the scope of practice a little, let’s see what the benefits of custom EHR integration are in hospitals and healthcare systems. So, without further ado, let’s get started.

Hospitals and health systems manage very high in-patient and out-patient populations. Amidst this huge patient flow, keeping track of the care setting for every patient is quite difficult. However, with custom EHR integration, every member of the healthcare team can be brought on the same page. And with ADT (Admission, Discharge, Transfer) notification to the entire team, whenever a patient undergoes a change in their care setting.

For example, when a patient is admitted, the assigned care team will get a notification about admission, if the patient is discharged about their discharge, and if transferred, then about the transfer. In such a large setting, these notifications play a crucial role in managing and coordinating care for the patients. This way, they can not only prevent readmissions but also improve patient outcomes towards the desired goal.

Other than that, lab and diagnostic result integration is also a high priority in many practices. This custom EHR integration helps reduce the time to care and ensures that the patient receives timely and accurate care.

Another interesting application of this is also medication reconciliation across facilities. Meaning that it helps the practice manage medications better while giving the patients the freedom to track patients’ medication adherence.

• Healthcare Network & HIE Integration

Moving away from the typical hospital setting, the benefits of custom EHR integration in healthcare networks are quite different. For example, these healthcare networks can use custom EHR integration for population health data aggregation. This makes it easier for them to analyze and find health patterns in the population.

Furthermore, they can use this data to control quality. This means that the data can give them crucial insights about their hospitals and identify the areas that require improvement. These areas can be related to finances, care quality, clinical or administrative processes, etc.

The use cases of EHR integration can vary by a margin and can be a separate blog altogether. If you want know the exact use cases, then read these 6 Common EHR Integration Use Cases in Modern Healthcare.

The Future of Custom EHR Integration & Interoperability

The technological landscape is evolving, and it is changing the healthcare IT landscape as well. That is the reason that when you are looking for custom EHR integration and interoperability options, you need to consider the futuristic aspects as well. But what exactly are the things that you need to consider? Well, let’s get into this:

• Emerging Technologies Shaping the Integration Landscape

Emerging technologies like AI and machine learning are slowly making their way into mainstream healthcare. However, you can leverage these technologies in your custom EHR integration for intelligent data routing. It will not only speed up the process but also ensure that the data that is being shared is accurate and correct.

Other than that, you can also use blockchain technology to secure the exchange of health information and bring a sense of transparency to the data exchange process. And last but not least, the advanced analytics capabilities of your healthcare software solution can be unlocked with the integrated data.

• Regulatory Trends Impacting Interoperability

The major concern in custom EHR integration and interoperability is regulatory compliance. You see, these regulatory compliances are constantly changing or evolving due to evolving technologies. This is the reason why you need to be always all over the rules, regulations, and timelines of upcoming interoperability rules, changes, and best practices.

Furthermore, you need to ensure that your data format and standards are in perfect alignment with international standards so that your system finds it easier to connect and communicate with disparate healthcare software systems.

These changes in the regulatory landscape can impact not only your system’s alignment with the international data exchange standards but also patient data access initiatives.

• Preparing for Future Integration Needs

The future is unpredictable, and it constantly changes; however, you don’t build your software every other day, right? That is why you need to prepare with a vision of keeping the evolving nature of technology and healthcare in mind when it comes to custom EHR integration. And the secret to that lies in building a flexible and adaptable interaction architecture. You see if the structure is flexible, changes become easier, and the process becomes simpler.

Along with this, you always need to keep a tab on the latest developments in the technological and healthcare landscape so that you can easily adapt to the change. Last but not least, find a skillful and resourceful vendor for custom EHR integration to amplify your success rate.

The impact of EHR integration of clinical workflows and patient care is huge. Read about that in detail in our blog – How EHR Integration Enhances Clinical Workflows and Patient Care.