9 questions to ask before choosing an interoperability

9 questions to ask before choosing an interoperability strategyHealth technology teams who are focused on growth need a flexible, trusted, interoperability solution that supports secure, scalable, and repeatable data exchange.

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Executive summary

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Integrating data with other systems in the health IT infrastructure is a critical component for any health IT application. While vendor development teams often try to code these interfaces themselves, use open-source or black box prebuilt API solutions, many find that these approaches lack the scalability and sophistication required for success in real-world environments.

Health data integration is complex for a lot of reasons. For starters, there are dozens of healthcare data standards, and they’re constantly evolving. While we’ve seen vast improvements on the standards front over time, this means there are more systems with variations in deployment.

There are also hundreds of EHRs and practice management systems. Even a single health system may have more than one EHR. The amount of data flowing through these systems is also skyrocketing. In fact, between 2016 and 2020, there was an 878% increase in healthcare data, according to one estimate. This data explosion leaves the healthcare terrain ripe for security threats, further complicating data flow.

2 | 9 questions to ask before choosing an interoperability strategy

When you code your own interfaces, use open-source tools, or black box prebuilt API solutions, you risk challenges in scaling, onboarding customers, and maintaining these integrations over time. It also means that teams focus on integration instead of product and service development.

If you are a developer or product leader wondering how to approach your interoperability strategy, there are 9 key questions you should ask.

Regulatory requirements add additional complexity. The 21st Century Cures Act, for example, requires developers of certified health IT to publish application programming interfaces (APIs) for data exchange.

According to a recent Gartner® 1 report: “By 2023, 35% of healthcare delivery organizations will have shifted workflows outside the EHR to deliver better efficiency, experiences, and outcomes.”

https://lyniate.com/blog/spinning-your-wheels-with-data-integrations-lyniate-envoy-can-get-you-moving/

3 | 9 questions to ask before choosing an interoperability strategy lyniate.com

What does your product do, big picture?

Does your product require data exchange with an EHR or other system of record? Does it offer analytics?

Which data inputs will be required now and in the future? Which functions do you want to perform, and how will you share data with other systems?

The EHR may be a key data source for you, but EHRs have thousands of data fields. Which data elements do you need, how is the data presented, and which systems should you interface with?

As you grapple with these challenges, you may overlook tasks that need to occur further down the road. Your interoperability strategy should be flexible enough to accommodate changing conditions in the months and years ahead.

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The EHR will likely be a key data source for you, but EHRs have thousands of data fields. You need to know which data elements you need and which systems to interface with.


What are your workflows? What would you like to be able to do?

Consider your application as it exists now and how you might want it to evolve in the future to, say, meet new customer demands. You have use cases in mind and customers tend to be creative and will likely use your software in novel and unexpected ways. Flexibility is key.

Keep in mind, too, that workflows are moving outside the EHR. According to a recent Gartner1 report: “By 2023, 35% of healthcare delivery organizations will have shifted workflows outside the EHR to deliver better efficiency, experiences, and outcomes.”

1 Gartner, “Predicts 2021: Healthcare Providers Must Accelerate Digital Transformation to Address Disruption”, Sharon Hakkennes, Barry Runyon, Mike Jones, Mark Gilbert, 25 November 2020

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Users are notoriously creative and will want to use your software in novel ways. Flexibility is key.


How quickly can you test and deploy interfaces?

Getting interfaces off the drawing board and into active use is one of the biggest challenges in the application development process. Interfaces must be tested to ensure compatibility with other digital health vendor applications. Operating systems, transmission protocols, and hardware platforms must be checked and verified.

The good news is that working with an interoperability partner allows you to outsource the bulk of testing and verification. In a managed environment, interfaces can be tested and pre-emptively vetted against changing market conditions and put you in a strong position to avoid or mitigate problems.

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Get to market faster

If your product development team is tied up figuring out interfaces, you could miss product release milestones. Ensuring that the testing process is as automated and foolproof as possible will free up resources for high-value tasks and position your team to exceed customer expectations.


How will you monitor your interfaces?

Creating an interface is not a one-and-done activity. In addition to the version compatibility issues referenced above, other events can cause an interface to malfunction or fail completely. User configuration errors, malware, changes to security protocols, firmware updates, and unexpected events can cause an interface to fail. Being able to monitor for roadblocks is critical for vendors and their customers.

Interfaces also need buffer and back-up capability, to log when failures occur and capture messages that are not processed, so that critical data can be restored. An experienced interoperability partner will continuously monitor interfaces and inform administrators of problems, discrepancies, and messages that fail to process. Manual interface monitoring is challenging—no matter how simple or low-volume an interface is expected to be—and a DIY approach can add undue and unexpected burdens to you and your customers.

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What is your plan for scaling?

Will you move from pilot programs to enterprise-scale implementations with your early customers? Most products begin in a beta test or a limited pilot-mode in a target organization and then scale up to broader use.

Initial development to support small-scale pilots is fine, but you need to be ready for enterprise-scale use. Dare to dream big! If a large organization wanted to deploy your digital health solution across dozens or hundreds of locations, would your interfaces and workflows be up to the challenge?

Additionally, many products today have a cloud-based component consisting of a single hosted instance of the software, with data aggregated across various organizations. While your application may only be used by select individuals or smaller organizations, you should be able to scale quickly to handle increased demand.

If you hope to operate at scale in a particular client site, or across multiple sites, make sure you have an interface strategy that allows you to grow seamlessly and quickly.

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Dare to dream big. If a large healthcare organization wanted to deploy your digital health solution across dozens or hundreds of locations, would your interfaces and workflows be able to handle that level of volume?


How well will your product fare in the ‘real world’ of healthcare?

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There are important differences between how EHRs and other systems—such as scheduling or billing programs—function on paper vs. in the real world.

Health systems may rely heavily on major EHR vendors such as Epic and Cerner, but they also tend to have “ecosystems” of more obscure applications—old versions of no-longer-supported software and custom-coded applications. As we like to say, “When you’ve seen one health system’s IT infrastructure, you’ve seen one health system’s IT infrastructure.”

The idiosyncrasy of health system IT stacks isn’t going away. Organizations constantly adopt new technologies in order to innovate and launch new capabilities, and the pandemic has only accelerated this trend—with increased use of virtual care, alternative care sites, pop-up clinics, and other novel systems.

The fact that your healthcare solution can connect to major EHRs is important, but your solution must also be agile enough to adapt to unique IT infrastructures and a constant parade of emerging tech.


FHIR® is hot, but how will you solve issues it can’t address?

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FHIR is ideal for certain things, for example, making data available directly to patients and integrating with mobile and web-based applications. However, there are still many applications in use where FHIR is not the best fit.

ADT feeds are one example—where data is typically presented in good old HL7 V2. This messaging standard continues to work well for many types of data and will likely be employed for the foreseeable future. (See consideration number 6 above about legacy systems and custom-coded applications). The fact is many systems may never catch up to the FHIR movement.


How does your product protect against security vulnerabilities?

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The rollout of new capabilities, processes, and workflows associated with COVID-19—and the adoption of new interoperability rules—means that the risk for cybersecurity breaches is high. When hackers see new systems or processes being implemented, they look for weaknesses associated with the software, as well as opportunities to develop their own zero-day attacks. Complicating matters, new interoperability rules require sharing data publicly via APIs, which could open new avenues of attack for hackers.

Maintaining up-to-date security and privacy protection is critical. Routing data through a central integration engine hub can help you minimize the attack surface of an application and enhance your ability to monitor all data exchange. At the same time, keeping up with the latest threats and quickly responding to them is a job best left to the experts. Working with an experienced, proven interoperability partner will allow your organization to minimize vulnerability to cybersecurity attacks and ensure customer security.

Keeping up with the threats and quickly responding to them is a job best left to experts.


Do you have a partner you can count on for support?

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Health IT systems are dynamic environments—with frequent updates, new configurations, and sophisticated, ever-evolving security protocols. Each of these areas requires dedicated, experienced, professional support to keep up with changes and respond to problems.

DIY is rarely the right choice for HIT application developers, for these reasons. Lyniate Envoy provides digital health developers with a system that does it all—from scaling, monitoring, and alerting, to enhanced security and ongoing maintenance and support. Most importantly: with Lyniate you have access to teams of seasoned pros who live these challenges every day.

Case study BioIntelliSense uses Lyniate to quickly pivot to support market needs

Market Medical-grade wearable devices

Business goals Quickly onboard new data sources to support a safe return to work, school, and travel; accelerate delivery of tools for clinical trials

Solution Lyniate Envoy integrated the customer’s JSON device data into Epic. Through connections we established, BioIntelliSense was able to pursue new use cases and integrate with 20 applications, including remote patient monitoring devices, telehealth solutions, medical grade care at home, and hospital-to-home programs.

Read the case study

https://lyniate.com/resources/biointellisense/


Why Lyniate?

Lyniate connects applications based on years of trusted partnership. Interoperability is part of our DNA. Built by interoperability experts who helped steer HL7 and advance FHIR, Lyniate was here at the beginning and continues to invest in staying current over time.

Lyniate Envoy changes the game for health tech teams. Envoy makes the most difficult integrations happen fast. Built on a backbone of expertise and proven technology, Envoy delivers data where you need it, freeing you to focus on your products and customers. As a trusted partner, we help you move fast and avoid roadblocks.

By enabling secure data exchange from any source to any destination in any format through fully managed interoperability—including installation, monitoring, maintenance, and turnkey API connectors—patient data access becomes effortless. Choose Lyniate Envoy to connect once, exchange FHIR, and more.

Remove roadblocks to interoperability and exchange data securely and robustly, with Lyniate.

Contact us today

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9 questions to ask before choosing an interoperability