EHR Integration

So, what is EHR integration? EHR integration is the process of onboarding or implementing an electronic health record solution within a healthcare organisation’s existing system of software. 

Alternatively, if we talk about an integrated EHR definition, we are referring to a software solution that is capable of connecting to existing healthcare software to share data back and forth. 

These two definitions are what’s being searched for on the internet by curious minds, but both ultimately lead to the same point: integration may refer to the connection between the new solution and the existing ones, but the avenues to communicate are APIs – application programming interfaces. These are what makes it an integrated EHR solution.

An integrated EHR solution will connect the patient record software to other solutions, such as a Customer Relationship Manager (CRM) or a medication management software. To do this, there needs to be EHR API integration.  

APIs are the translator that allows a software to communicate with one or more additional solutions. Sometimes these are developed by an internal IT team, but often there are industry-standard APIs utilised to enact such communications. 

The NHS for example commonly utilises the HL7 V3 API, which stands for Health Level 7. HL7 would most likely be the EHR integration API used by a healthcare provider when onboarding electronic patient record software. This API is approved and accredited by NHS Digital as meeting the international FHIR (Fast Healthcare Interoperability Resources) standards, so it’s safe and preferable to be used by NHS organisations and their partners to enable integration with approved software solutions. 

Electronic health records are important, which is why their integration is important. Getting accurate patient data and medical records into a healthcare software ecosystem improves the quality of care through better assessment and better decision making. It is with that in mind that EHR data integration should be done methodically.

There are four steps to the integration process: 

1. Know your APIs. HL7 is probably the optimal choice but there are more APIs out there.
   
   
2. Assess workflows. Improving or optimising operational practices might mean a change to the style and routines of work. Theorise before you take action and disrupt important care.
   
   
3. User experience. Similar to the above, but if staff can’t use the EHR software effectively then it either has no impact or even a negative impact on care provision. This isn’t about software design or how easy a solution is to learn, but rather about additional steps that might be needed because the integration couldn’t do enough; steps that would hinder care.
   
   
4. Testing. Prove it works before deployment.

As with any implementation of a software solution, EHR integration has its challenges to overcome. Nexhealth, in their article on EHR integration, cites six potential hurdles: 

1. Compatibility (with the current system)
2. Issues with staff adopting the new solution
3. Costs
4. Staff Training
5. Data Privacy
6. Data Migration 

We would add a seventh to that list – deployment time – and would contest the data privacy part, but lets work through the list. 

Not all electronic health record solutions are capable of integration. Many software companies dislike interoperability because it means they can only sell you a single solution, rather than needing to partner with them and purchase a suite of products. 

Staff resistance is also a common occurrence. People in all walks of life tend to be resistant to change. We like routine and familiarity. Humans are nostalgic and embrace tradition. The challenge here for a healthcare provider is how to demonstrate the benefits – which are quite significant in the case of EPRs. In most cases, people are hesitant because they’re scared. Nobody wants to have to suffer the ignominy of struggling to learn, so it’s important to engage with a good software provider to get rigorous training and reliable support should there be issues. 

Buying anything costs. Healthcare software is no different, and yes, there might be an upfront lump sum, but then this is why managers and financial officers are hired – to do research and demonstrate costings, return on investment, and long-term benefits. There are even solutions that are subscription based; to be less of a lump sum impact on a business that may not have that capital. It’s important to shop around and see who the trusted providers are and what they can offer you. 

Data privacy follows on nicely. While you’re researching suitable deals, also check out their credentials. Have they ever been a provider that was hacked? Are they accredited by organisations like the NHS for their software? Who else do they provide solutions to – could you reach out to them (presuming they’re not a rival) and gauge their opinion? The law requires software developers to put in place appropriate protective safeguards to shield data from unapproved access, internal or external, but there’s no simple answer of “Company A uses SuperSafe Anti-Hack” as its data protection measure. It all boils down to diligent coding within the solution. 

Data migration and deployment time are sort of hand-in-hand really. You know how long it takes to load documents onto a flash drive or photos off a camera/smartphone. Now imagine you’re doing that for thousands and thousands of records. It’s a slow process, and has to be done right, so you will need to be patient. It’s more than just data though – the system itself has to be considered. How many solutions is the EHR having to connect to? Are you running the software from your own on-site servers and systems, or do you want cloud-based?

The good news is, there are benefits to EHR integration – primarily increased efficiency of the clinical workflow and as a result improved care outcomes by virtue of more time spent on diagnosis, engagement, and treatment.  

It’s a very simple knock-on effect when you boil it down. When you give doctor and nurses the time and space to be carers and clinical experts, they will do it, and patients will benefit. As an example, the EHR talking to other software means it can stay updated with the latest medication prescribed to the patient, so if they return in five days time with an unusual symptom you can connect the dots and realise there’s a side effect or it’s an ineffective remedy, and quickly alter the treatment approach. But, what if the patient doesn’t return to your hospital but goes to an urgent care clinic? Software being able to communicate will mean their records can be shared not only within a hospital, but in many cases within the wider NHS trust in that area as part of a joined-up network of intelligence. 

If clinical efficiency wasn’t enough, there’s also a benefit towards patient engagement and patient portals, which can showcase a patient’s medical record to them – meaning no need to contact a receptionist. People can be more self sufficient, like using mobile banking. It’s a similar principle of wanting to know their business at their convenience, and it’s an easy win for improving a patient’s perception of your service to facilitate it.

Improving CQC Ratings

One area that is really experiencing the benefits of electronic health records is the care sector, and those care providers utilising EHRs to support their care delivery.

The Care Quality Commission has an inspection framework it works to when assessing care providers and the service quality they are delivering. The CQC has evolved beyond annual inspection though - now there is a continual process of monitoring, assessment, reviews, and feedback. You can read more about how to pass a CQC inspection here.

The five key lines of enquiry (KLOEs) want care provision to be safe, effective, caring, responsive, and well-led. The beauty of using an EHR solution is that electronic health records help manage all five of these lines of enquiry. Accurate client records mean appropriate care, fewer errors, and greater safety. This in turn means more effective care, but the record software also allows for notes and greater information beyond stats; carers can pass on the minor details about personality, about client preferences, that will allow the care experience to be maximised. 

All of this can be managed accordingly too, with permissions and privileges assigned per user within that care business, meaning that ranks or hierarchy of responsibility can be established and management and supervision can be enacted. Actions can be tracked within EHR software to see who is using it correctly or who might need more training, and interventions can be made rapidly to minimise detrimental actions.

One solution can do all this legwork, meaning people can be empathetic and engaging and deliver the personalised care that clients seek.

There are several EHR software solutions that are interoperable and therefore able to integrate to an existing healthcare system, but there aren’t that many specific software solutions to handle integration specifically. 

At Access, we do have one of these solutions – Rio Integration Hub. We touch on this in our previous article about Trust Integration Engines, as well as APIs and their function, but the short version is that this hub knows the coding language that our software speaks in, and quickly learns the coding language that another company’s software speaks in. It then, with the help of IT developers, builds a translation database so that communications are automatically converted from one ‘language’ to another to enable the seamless and quick transfer of information between systems and thus between staff – optimising communication, collaboration, and healthcare itself. 

Of course, there are more EHR integration solutions than just our own. Below we have selected a few competitors from the market.

Nextgen EHR Integration 

Nextgen’s Healthcare Integration Engine (HIE) is called Mirth Connect. Their core product is free and open source, but there are limitations in terms of capacity – which is where paid services come in at the Silver, Gold and Platinum levels. 

You will need to purchase one of these packages – if not towards the higher end – to get features such as Multifactor Authorisation, Role Based Access Control, and the Interop Connector Suite.

Redox EHR integration 

The Redox Engine homepage opens with a quote about why a customer switched to them from Mirth, so we’re off to a great start, but it’s worth remembering that Redox are a heavily America-centred provider and so some functionality will be international, some will be domestic. 

Redox offer three products: 

1. Redox Nexus – Normal integration using JSON or the HL7 FHIR protocols. Standard stuff.
2. Redox Nova – Automated data transfer between cloud servers, again via HL7.
3. Redox Access – Specifically for connections to CareQuality and DirectTrust

Salesforce EHR integration 

Perhaps the biggest player on the board, Salesforce is unusual in that there’s no specific Salesforce EHR integration solution. As the Salesforce development team explains, Salesforce Health Cloud is their solution, and others are expected to integrate with it – by whatever means. 

Our research actually saw some healthcare software providers offering to marry up their solutions with Health Cloud by using tools like Redox and Nextgen, which is a bit cheeky given it’s these solutions doing the API work, not the partner.

Rhapsody Integration Engine 

The Rhapsody Integration Engine is a tricky product to study. Unless you sign up for a demo, intel is limited, but they do have a section on their website discussing the Rhapsody Interoperability Suite. 

Like Redox, there is an element of being domestically-focused for a US audience, but the principles of their integration functionality are the same: they want to connect patient records, via APIs, to other solutions. It doesn’t matter if these records come via CRMs or EHRs.

For more information and market research you can check out G2.com’s Healthcare Integration Engines comparison table, with links, reviews, ratings and product details to see which solution may suit you best. By the nature of the private healthcare market it is North America heavy, but there’s a good breadth of solutions available, and many providers do adhere to international FHIR standards that are suitable in the UK and Europe. 

At Access we have our own Rio EPR software solution, and you can read testimony about its performance in our Lancashire and South Cumbria NHS Trust case study. 

This concludes our rundown on EHR integration. We hope our article has helped you understand the mechanisms behind integration, the importance of interoperability, and the options available to healthcare organisations – or software providers – to bridge these gaps and forge the connections necessary to facilitate joined-up care.