It should be a hospital’s goal for data to move freely around the entire hospital ecosystem. This can be achieved with integrated hospital systems. The primary purpose of this free moving data is to bring benefits to both the hospital in terms of efficiencies and streamlining operations, and to the end-users of the hospital systems in terms of providing better patient care and outcomes. When planning a hospital integration project, keep the following stakeholders in mind:

• Clinicians – They are time-poor and do not want to log into multiple systems during each shift. They require a single source of truth of their patients’ data so that they can provide the best possible care
   
• Hospital Management –
  • Mandatory reporting requirements
  • Financial reporting needs
  • Operational & performance monitoring

Healthcare IT Integration expert Colin McGrath, who has worked with hospitals around the world for more than ten years, writes about four things that can make hospital system interoperability easier. Interoperability and integration are broad topics, so in this article, he has concentrated on helping CIOs get some overarching principles right.

What can make hospital system interoperability easier?

• The systems – considerations for choosing a system
  Whether you are a new hospital, or an established hospital that is adding to or replacing a hospital system, choosing an integration system that provides off-the-shelf and industry standard integration endpoints will make it quicker and easier to interoperate systems within the hospital. These integration endpoints will usually be in the form of HL7 messages (HL7 V2 and V3) or a restful webservice making use of the FHIR Standard (HL7 V4). Most systems should allow for bi-directional support which means they can send relevant data out and receive relevant data in. Some systems may claim that they are HL7 capable, but sometimes this can mean they can send HL7 but need to build it first - this can cost you time and money so be aware of this during a system review among vendors as it can often be overlooked.
   
• The implementation
  System interoperability is not something that is achieved overnight. It is something that grows and evolves ideally in line with the needs of the hospital staff and their patients. The hospitals that have had success with interoperability are the ones who have made incremental updates that are planned from the start. Taking this approach provides many benefits and avoids some pitfalls. Taking a staged approach can be at the system network level where you add and interoperate the most important systems, and then the others follow. And at a system level where you plan some basic interoperability initially while building on this with future updates. An advantage to this approach is that it can allow the stakeholders of the systems to provide feedback after each new iteration and better keep stakeholders’ expectations aligned with what is being implemented. One of the pitfalls with taking a “big bang approach” is that you increase the risk of project failure. It may never go live or be plagued with delay after delay. By the time it does go live, it can cause significant disruption to a hospital if there are lots of issues that only become apparent when everyone starts using the system en masse.
   
• The integration engine
  Do I need an integration engine? Having an integration engine is a must to facilitate interoperability in a hospital. With many systems and many more different pathways, it is the job of an integration engine to manage this. The integration engine, in its simplest form, will be used to collect data traffic between hospital systems, but most often the reason we need one is that different systems from different vendors don’t know how to talk to each other and the integration engine will act as the translator between them.
   
• The stakeholders
  There are many different specialities in a hospital environment, and therefore, there can equally be as many systems. Where one system may work well for one speciality it may not work at all in another, because each speciality, and their stakeholders have different needs and requirements. But at the same time, all these different specialities need to share information between their systems, and this requires interoperability. Suppose this interoperability does not exist or is limited. In that case, clinicians have to spend more time communicating with the other teams and performing more administrative work and less time providing direct care to patients.

Most of our clients and prospective clients have excellent teams of IT experts, yet understandably always have questions around integration. This is because Healthcare Integration is a very specialised area of Healthcare IT.

Over the coming weeks we will be addressing some frequently asked questions – If you have anything that you would like Colin and our team to look at please email jsampson@vitrosoftware.com

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Colin McGrath
Team Lead and Integration Specialist

Colin graduated from Dublin City University with a Bachelor of Science in Computer Science. He has spent most of his career working with healthcare software. He specialises in designing and developing interfaces for hospitals and other clinical settings around the world. He has considerable knowledge of HL7 and continues to help hospitals improve their health interoperability.