One of the things we realized when we formed Caristix is that the biggest pitfall in HL7 interfacing isn’t coding or setting up the interface. With modern interface engines, that’s relatively easy. The real struggle is knowing how a system is constructed, where the gaps are, and what needs to be coded – this drives the work. In fact, when this scoping is handled effectively, all other aspects of interface creation and management go well. But when this stage is not well-managed, the impact trickles down to affect all other phases.
Avoiding the Pitfalls: Effective HL7 Interface Scoping
The scoping stage largely revolves around coming to terms with data-exchange requirements. On average, for each message transferred between two systems, over a thousand pieces of data are exchanged. To make sure data is entered correctly in the receiving system, developers need to understand the data being received along with its format and meaning.
For example, the gender of a patient can be indicated using up to six different attributes or coded values in HL7 v2.6. That said, very few systems use all six possibilities, instead using three or four. Even then, each hospital can choose different signifiers for the options and remain HL7 compliant. While one may designate male as “M” and female as “F,” another might use a “1” and a “2.”
Then, there are the variations possible for lab requests and result codes. In one system, the code for white blood cell count might be “ABC” while in another it might be “456.” In light of the fact that LOINC contains more than 42,000 codes, it’s easy to see how quickly permutations can occur from one system to the next.
As a result of the many variances and adaptations of the HL7 standard, there’s no truly standard way that systems are implemented and data is handled. In response, analysts and interface engineers are forced to undertake lots of manual, tedious work: read the specification document, ask the customer for feedback, and hope to catch major differences between the two. This assumes the spec is available, which is often not the case. Even when a spec is available, it’s often not up to date.
To validate data, technical consultants and teams spend inordinate amounts of time counting pipes instead of tackling a known list of what needs addressing.
HL7 Trial and Error Has Run Its Course
To make matters worse, this arduous process only addresses the first phase of an interfacing project. By basing this process on manual efforts and trial and error, organizations set themselves up for issues every step of the way.
With the tidal wave of data coming about due to initiatives such as Meaningful Use – which will force data integration among numerous systems – the problem will only be exacerbated.
Interfacing is often on the critical path within a major implementation project. Improving the interfacing process can boost the overall effectiveness of EMR implementations, leading to better use of project resources, and higher levels of hospital user adoption and customer satisfaction.
What are your thoughts? How can analysts and their managers drive some of these pitfalls out of the process? Let us know in the comments.
May 24 Webinar: CIOs on Leaner HL7 Integration
Implementing systems doesn’t mean much these days if they remain data islands unto themselves, but far too many teams rely on the drawn-out iterative processes of trial and error to get their interfaces created and tested. With so many connections at play, your organization must find a way to get leaner and do more with less. We’re sponsoring an educationally focused webinar on this topic. You’ll hear from CIOs who have blasted away key bottlenecks in integration, leaving them able to deliver faster and better interfaces by focusing on the entire lifecycle.
CIO Panelists
The presenters will be Jorge Grillo, CIO, Canton-Potsdam Hospital, and Cathy Crowley, CIO, Columbia Memorial Hospital.
Jorge Grillo wrote a 17-part series for HealthSystemCIO.com on a Meditech 6.0 upgrade. Part 10 included interface development and testing. He made some excellent points: “The lesson learned for us is that when we upgrade the interfaces to 6.x, we need to TEST, TEST, TEST before any go-live. The military has a saying, “The more you bleed in training the less you bleed on combat.” Getting things corrected prior to go-live is critical to ensuring a smooth user experience.”
Cathy Crowley was featured in a 3-part interview on HealthSystemCIO.com. The first interview covered interfacing, and in fact, Columbia Memorial has tripled interfacing over the past 2 years. She talked about the impact of solid planning: “We did have to upgrade all three systems this past spring, so we upgraded Meditech, eClinicalWorks to 9.0, and even Allscripts. So that was a challenge. In some ways I call it the Big Bang theory because we all did all three very close together. The advantage of doing that is we really did the interface testing pretty much at one time, as compared to if we had done one in the fall and then waited four months and did another in the spring. You’re going to be retesting those interfaces all over again.”
Their messages: it’s all about the scoping, planning, and testing.
Register Today
This promises to be a terrific educational webinar, with CIOs who’ve been in trenches with interfacing. Sign up for the live webinar, which will be held on May 24, 2012, at 1 pm Eastern. If you’re unable to attend the live event, you can register and you’ll receive an email as soon as the archive is ready.
Sign up for “The Secrets of Lean Integration Revealed: Interface Lifecycle Management,” May 24 at 1 pm ET.