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The Good, The Bad, and The Ugly: Interoperability, Negotiation, and Culture

By sovita.chander@caristix.com | Published: April 17th, 2014

Tip 6 in the Interoperability Tip Series

interoperability-due-diligenceThis tip is for hospital or provider analysts and team leads.

You’ve got a firm grasp of the technical ins and outs of system and application interfacing. Because you’ve got the background, you know that contractual and cultural issues can affect your team’s ability to deliver on time and on budget. 

Make sure these issues are on the table with your leadership, ideally during negotiation before a deal is signed. Your leadership will thank you for thinking ahead — focusing on the good and avoiding the bad and the ugly. Use your operational expertise to avoid expensive problems down the road.

6 Points for Due Diligence

Is your leadership aware of these points?

1. Negotiating an Interface
When a hospital buys a clinical system, interoperability and HL7 are usually not addressed during the negotiation. The vendor’s sales rep often glosses over the requirements and simply mentions the “thousands of interfaces they’ve got in a library.” The problem is that analysts like you get pulled into the project after the contract has been executed only to discover it’s challenging to interface with the new system – but you’re stuck with making it work. Approach your manager before the negotiation phase and ask to be involved. By highlighting the issues that can arise when interoperability and HL7 are not addressed during the vendor negotiation, you can help avoid lots of project complications and will set you and your manager up for a smoother, more successful project.

2. Black-box Syndrome
In this scenario, the vendor keeps control of the project and interface, leaving you to pay for any tweaks or additional needs going forward, including documentation. Just as painful is the fact that the knowledge walks out the door when the vendor implementation team or consultants leave. How do you ensure this doesn’t happen? Ask for documentation specific to your site, including the interface specification, as part of the contract. This should detail which systems are linked/interfaced, which messages are exchanged, and which message formats are used, at a minimum.

3. Vendor Lock-in
Some interface vendors or consultants introduce their own intellectual property into the interface. In such cases, your organization has license to use the interface, but not full ownership of the interface, which means you need to pay the vendor on an ongoing basis for any required changes or updates you’d like to see. We’ve come across situations where providers are stuck paying five figure fees for gaining access to their own interfaces and data.

4. Who Drives the Interface Specification?
In the past, the clinical technology vendor would drive the spec and customers had to conform to the requirements. Nowadays, the opposite approach is increasingly common: the hospital drives the spec and vendors must conform. While this approach is more expensive initially, down the road it makes the process smoother for the hospital, especially as hospitals are increasingly part of HIEs and merge to form large hospital groups or IDNs. This is good for hospitals and providers but you need the right infrastructure (i.e., the right HL7 software and integration engine, configured to meet your organization’s needs) and culture to support this approach, whether you handle interface implementation in house or outsource it.

5. Supporting Technology
A good integration engine is a great building block, as we mentioned in Chapter 2 of the HL7 Survival Guide. But you also need supporting technology and a culture that help you – and anyone else who gets involved at any time – manage and update the engine and interfaces over time. Look for software and technology that simplify the process of generating, updating, and managing specifications, requirements, test scenarios and other documentation associated with your engine and data exchange work. You’ll also want a repository that provides a central location for anyone with permission to access the documentation. A detail that may seem nit-picky at the beginning of a project just might be the essential connectivity information you need a year later, when an interface goes down at 5 pm and you are the Tier 3 support on call.

6. Culture
Your organization’s culture and approach can make or break a consulting engagement or in-house project. Ideally you want to drive the show with consultants. Set clear expectations. Control deliverables by coming to clear agreement as to their definition and due dates. Use your project documentation from Point 5 above to ensure clarity and accountability throughout the interface lifecycle. Ensure a structured methodology is used to test and validate the interface. And clearly define your acceptance criteria for the project.

How to Use Caristix Software to Get Answers

Laying the foundation for interoperability, these are the questions that Caristix Workgroup software organizes for analysts and developers. By creating specs automatically from messages, the software helps analysts provide answers with little to no manual work, while enabling developers to get interfaces into production faster. We think it’s a win-win for both vendors and providers.

Download the HL7 Survival Guide

Download the HL7 Survival Guide