In Part 1 of this series on HL7 gap analysis, I covered the need to identify gaps before starting to configure an interface, and explained why gaps happen. Today, I’m going to talk about gap analysis steps and the limitations you need to plan for.
Gap Analysis Steps
1. Obtain vendor conformance profile.
Vendor analysts start out with an HL7 conformance profile for the product they’re deploying. The profile documents the specific trigger events and segments used by the application. It wouldn’t necessarily cover every segment mentioned in the HL7 standard — just the relevant ones. The document also includes fields and related tables. The purpose, constraints, pre-requisites and expectations of each field need to be clearly defined in the vendor profile.
2. Obtain hospital specs and/or message log.
If available, the hospital IT team provides up-to-date documentation for the applications and systems that will need to pull or push data to the new product. Because these specifications are often unavailable, incomplete, or outdated (they potentially change with every product upgrade and interface engine tweak), reliable documentation is sometimes hard to get.
An alternative is to have the hospital share a sample message log with the vendor. The message log can be from a test or production system as long as it represents the “real thing” the vendor has to interface with. The sample message log should be relevant in terms of trigger events used, data exchange workflows, reference data (user tables) and customized data elements. The more use cases you can cover in the sample log, the fewer unidentified and unexpected gaps you can expect down the road.
If the log happens to contain protected patient information, both parties are mindful of encryption needs, usage restrictions, and HIPAA compliance.
3. Document gaps between the product and the hospital’s system.
This is mostly a manual task. The analyst simply opens the vendor conformance profile and the hospital spec (or sample message log), then starts comparing the two documents side-by-side on a computer screen. The analyst lists all the items that will need to be configured or customized. See Part 1 of the Gap Analysis series for details about gap types that analysts look for.
Gap Analysis Limitations
1. Complete, up-to-date documentation is hard to find.
That’s just a fact. When documentation exists, it needs to be validated. While it helps to have the documentation on hand, unfortunately, most of the time it’s just not there.
2. Log querying is still manual.
With a manual gap analysis process, the limiting factor boils down to getting a big enough sample to catch rare occurrences of values that would impact the interface configuration. Yet logs need to be small enough to be manageable on a human scale. Even at 5,000 to 10,000 messages, chances are an analyst will have enough time to sample just 50 messages at a time and read through 500 messages per gap issue. In the real world, with tight project timelines, no one would have enough time to parse every single message. Or catch every single gap.
3. Maintenance is repetitive.
Every time an interface (or the data semantics going through an interface) changes, the gap analysis process should be repeated for every single interface. Again, in practice this is very difficult to achieve. It wouldn’t be just one gap analysis but many more. Organizations sometimes choose to work reactively to solve problems on the fly, rather than proactively decrease the risk level.
Of course, this has an impact downstream during software implementations. Other teams encounter bugs and defects due to constrained gap analysis. And the result is that vendors and hospitals spend more time iterating through corrections and fixes both pre and post Go-Live.
These limitations are why we’re seeing a need to automate some of this work and increase gap identification earlier in the process.
Do you see risk reduction in gap analysis as a need in the industry? Do you see any other issues related to the gap analysis phase in HL7 interfacing? Share your thoughts in the comments.