Author: Kevin Roy

Caristix was selected to present at Interconnected Health 2012 recently, and we focused on a new concept, HL7 Interface Lifecycle Management.

Up till now, there’s been a sort of unspoken assumption in the industry: interfacing is a linear event based on simple drag-and-drop configuration within an interface engine. However, if you look at all of the tasks that are involved in interfacing, it is far more helpful to model interfacing as a lifecycle.

Here’s why.

HL7 provides a framework to support the process of mapping and exchanging disparate data. However, while the standard provides needed guidance, every provider organization and vendor takes advantage of HL7’s flexibility to adapt data syntax to different clinical workflows. As a basic example, even when two hospitals are using the same version of an ADT system from the same vendor, they will most likely configure systems and interfaces differently. 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 manual, tedious work as part of implementation process — even if they’re using state-of-the-art interface engines.

When interfacing is modeled as a lifecycle process, you have an opportunity to reduce that manual, tedious work, and make better use of your interface engine investment.

Browse the presentation to learn more about Interface Lifecycle Management. You’ll see the 7 key stages that every healthcare organization goes through when implementing interfaces: scoping, configuration, validation, go-live, monitoring, maintenance and support, and finally, an upgrade decision when sending systems change. There are examples drawn from providers and HIT vendors, and we’ve covered best practices and automation strategies that leadership can implement during each step regardless of interface engine or integration technology in use. From a project management and delivery point of view, these strategies can help to standardize implementation processes and support vendor-provider collaboration.

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.

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.

Typically, when you start an interfacing project, there’s a getting-your-feet-wet stage. “Where’s the MRN in that feed? Does it have leading zeros? Who’s got the lab codes? What do the z-segments contain?” There are a whole lot of questions at this stage. One question cascades into another. You check the interface documentation. Then send an email. And pretty soon, you’re in the deep end, with scope creep, a runaway timeline, and very little real data (read: specifications and test messages) to go on.

Is there a better way? We think so.

Here’s a slide deck that captures a new way of doing things — starting with a new concept, Interface Lifecycle Management. Just about every interfacing project goes through this lifecycle. But we think there’s a way to bring a little order to the process, and simplify development and go-lives. It starts with scoping, where an analyst captures a conformance profile that reflects the real environment: local code sets, segment structures (including z-segments), and real-world messages. This drives the rest of the lifecycle, reducing trial and error.

Let us know what you think in the comments.

Healthcare IT blog HIStalk featured Caristix in a series on innovative companies developing technology products for hospitals, providers, and others in healthcare.

Here’s what one of our users at a major HIT vendor had to say about Caristix technology when he was interviewed for the article:

What problems have you solved using Caristix products and what impact has that had on your organization?

We are seeking ways to continuously improve our customer enablement process for our product. An activity in that process is understanding the customer environment. The Caristix Conformance product assist the SME knowledge of their environment and not to rely on outdated documentation and assumptions. Conformance gives us (and the customers) a great visual of their environment.

With this improved visibility, we reduced the rationalization logistic interactions – a lengthy Q/A process (i.e. what systems are involved in the project? what data comes from that system? <<…implementation period…>> Are you sure? Well, we’re seeing this type of data and it does not agree with the initial statements. Are there any more surprises? etc.). This form of interaction occurs over weeks or months and creates much re-work as information becomes known. Knowing upfront the true reality not only mitigates loss time (and financial expenditures), but also improves customer satisfaction and overall product experience.

Read the rest of the article on HIStalk.