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Healthcare companies face many challenges as they seek to transform their organizations and remain competitive while managing patients’ health, complying with evolving regulations, and achieving interoperability with the rest of the healthcare community.
At the heart of the healthcare revolution are IT leaders charged with catalyzing rapid innovation. Technology is an important part of the solution for overcoming these challenges and evolving healthcare for the good of both the patient and the business. An open and interoperable IT infrastructure can help stimulate innovation throughout the organization, while creating greater IT efficiency, stability, scalability, and security.
In this post, we will explore the key integration challenges that healthcare companies are grappling with today and discuss both old and new solutions to these challenges.
Healthcare Integration Challenges
Integration is a major challenge in healthcare. Why? It boils down to three primary factors: the complex standards to exchange and manage healthcare data, structure of the healthcare industry, and healthcare’s strict and evolving regulatory environment. Let’s investigate each in turn.
Challenge #1: Complex HIPAA and HL7 Data Standards
In response to the difficulty and vital importance of sharing information across the healthcare industry, regulatory bodies have mandated that healthcare companies adhere to certain data standards.
Two such standards are HIPAA and HL7. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) aimed to standardize healthcare communication by providing rules regarding data definitions, formats, management, distribution, privacy, and security. Another set of standards, the Health Level Seven standards (HL7), attempt to solve the problems of identifying individuals within such a large healthcare system and securing these individuals’ data. If a patient shows up at a hospital with an emergency, for example, healthcare providers need to be able to refer to a definitive source of patient information. Although no single repository for all healthcare data exists, HL7 makes it possible for data to be moved from point A to point B in a standard fashion using 50 well-defined types of messages.
The challenge with HL7, however, is that it can be interpreted in many different ways. Additionally, while HL7 addresses the problem of sharing data externally, its mandate doesn’t extend to internal systems, which vary widely across healthcare organizations. Every entity has different data formats and databases and procedures for transmitting data internally. Between HIPAA and evolving HL7 standards, compliance requires adhering to a complex set of rules and processes.
Challenge #2: Healthcare Industry Structure
To illustrate the complexity of the healthcare industry, let’s consider the hypothetical Patient X. Patient X has a primary care physician and a pharmacy she visits as needed. But Patient X might change her address permanently or temporarily. She might find herself in an emergency situation in a hospital. She might choose—while on vacation, for instance—to visit a different pharmacy. Her physician might refer her to a lab, which sends test results back to the physician, who refers Patient X to a specialist, and so on. Any interaction between Patient X and healthcare providers ties into insurance companies, the government, and other entities. And Patient X is only one of millions.
With such a multitude of touchpoints, keeping data up-to-date and usable is as challenging as it is critical. One key concept for improving patient outcomes is the collaborative care model, where care is coordinated and managed across different health services and providers. To collaborate effectively with other healthcare professionals, organizations need to be able to share patient data across the care spectrum. Not having the right piece of information at the right time can cause any number of medical mishaps, such as delivering the wrong medication.
Another challenging structural aspect of the healthcare industry is the variation among the healthcare organizations themselves. For example, healthcare providers range from small offices to major entities like the Mayo Clinic. While large entities may be more likely to have have implemented highly automated, digitized systems, other healthcare providers may still photocopy records and manually input patient data. Information can get lost along the chain, and with so many sources of data and variation in styles of data input, errors can be common.
The complexity of the healthcare industry has led to the creation of equally complex application and systems, which makes versioning and managing of critical data difficult. Whenever IT modifies any aspect of the application, the cascading impact can be significant. Some companies have been unable to figure out how to get data from one application to another without writing another application around it. Many organizations have nightly jobs that dig into databases and replicate data in another format into another system. This kind of solution—hardly a "solution" at all—introduces a 24-hour lag, which eliminates the possibility for real-time visibility into the patient.
Challenge #3: Stringent and Evolving Regulations
The healthcare industry is also characterized by strict, ever-changing regulations. To help thrive in such a rapidly shifting regulatory environment, IT departments need to ensure that the solutions they implement to address interoperability challenges are as flexible as possible. Two components of recent regulation—meaningful use and value-based care—warrant particular consideration as they relate to integration challenges.
Meaningful use offers financial incentives to medical practices for demonstrating improvements to care quality, efficiency, and patient safety as a result of converting paper records to electronic records. Unless medical practices complete this conversion and can demonstrate interoperability with other healthcare organizations using mandated data standards, they will not be able to claim these incentives. This opportunity is driving many healthcare companies to upgrade their IT systems.
Value-based care is another regulation that is forcing the healthcare industry to improve interoperability. Under the old model, healthcare providers received a certain amount of compensation for a given procedure. The more procedures they completed, the more compensation they received. Under the new model, healthcare providers are compensated based on procedure outcomes. If a surgeon performs 10 ACL procedures, for example, and keeps patients out of extensive physical therapy, they receive better compensation. Value-based care can lead to an increased emphasis on integration because the only way to track outcomes—and therefore receive compensation—is to know what’s happening with patients at every touchpoint.
Healthcare Integration Solutions: From Older, Monolith to Newer Style ESBs
To overcome these interoperability challenges, organizations should invest in tools that help bring this information together. What are these tools, and what are their advantages and shortcomings?
One way to address these interoperability challenges is to use ESB technologies that provide capabilities like connectivity, transformation, mediation, routing, and service orchestration. Today, many of the prevalent ESB technologies provide these capabilities, but can be heavyweight, monolithic, difficult-to-change, difficult-to-adapt to different use cases, and may not support the relevant healthcare standards or be compatible with the cloud. Others are scheduled to go out of support, which introduces risks from a regulatory compliance perspective. What is needed is a newer style ESB, a modern integration platform that is lightweight, modular, adaptable, and faster to develop, and can support multiple use cases as well as changing healthcare standards and regulations.
Red Hat Fuse: A New Style of ESB
Red Hat Fuse, and its underlying Apache Camel technology, offers traditional ESB capabilities like transformation, connection, scalability, clustering, high availability, and failover, as well as an open, modular, lightweight, patterns-based integration platform that can help organizations develop quicker, adaptive, microservices-based solutions. These lightweight capabilities can make it easier for healthcare companies to address their integration challenges, . Red Hat Fuse supports HL7 standards and enables healthcare companies to create HIPAA compliant solutions.
Consider the following example involving a Red Hat customer. This leading healthcare provider specializing in kidney dialysis needed to update its technology to better communicate with its customers and partners. With an unsupported legacy ESB in place, the company was struggling to integrate the disparate capabilities required to exchange pieces of information between its own applications and other companies. With a hard deadline to build out a new solution, the company turned to Red Hat not just to assemble the right technology, but also ensure it could adopt modern best practices. Leveraging a combination of Red Hat Fuse, JBoss A-MQ, and additional open source products, Red Hat delivered a unique solution utilizing enterprise integration patterns and a queue-centric, event-driven architecture. The new system not only allows the company to interoperate with other healthcare agencies but offers them previously unavailable flexibility and scalability with a shorter delivery timeline.
Few industries today offer a more challenging environment for IT leaders than healthcare. From stringent regulations to business system upheavals, obstacles are seemingly at every turn. Yet savvy healthcare executives are turning these challenges into opportunities to make their IT organizations into centers of innovation. Doing so requires end-to-end technology solutions that are scalable, well-integrated, more secure, backed by a robust ecosystem, and flexible enough to support a dynamic IT environment. With these technologies, organizations can better position themselves to compete in the rapidly changing healthcare industry.
To learn more, attend this webinar: Creating HIPAA-compliant applications without JCAPS/JavaMQ architecture on Dec 2, 2015
About the author
Sameer Parulkar is a Product Marketing Director for Red Hat Integration products. He coordinates marketing, evangelism and product strategy for those products across all regions. Sameer has around 20 years of experience in the IT industry with various roles like developer, technical architect and product marketing primarily supporting integration middleware technologies. Sameer holds a Bachelors in Electronics Engineering (BE) from India and a MBA from Babson College.