Author: Kevin Roy

Tip 4 in the Interoperability Tip Series

5 Questions for HIT Vendors and Internal Interfacing Teams

Like last week’s healthcare data interoperability tip, this week’s tip is geared to hospital teams asking their vendors the right questions.

Why Should Health System Leadership Care About This?

These are the basic mapping and workflow questions that kick off the planning for an interoperability project. Your teams will work with your vendors to answer these questions for every system they work with, and for most of the interfaces they build. Your managers will be tracking answers, and the quality of the information they get will impact risk, timelines, and costs.

The questions:

1. Map out the message process or workflow. For instance, if your interface transfers data from a remote application via FTP, what is the flow? Do messages start in one application, get routed to an engine, then another engine, and then finally reach the destination system?

2. Map out the business impacts of the interface. If you make changes to a patient charge interface, what is the business impact? What if you choose not to implement the interface? For example, will it result in more manual data entry for a clinician?

3. What information does the destination system need? Where in the message structure is the information found?

4. Is the vocabulary used in the destination system different from that used in the source system? Either the vendor or an internal team member will need to track vocabulary and mapping.

5. Is all of this information documented? If not, how will the vendor keep you updated on changes after your interoperability project planning phase is over ? This is an especially important question to ask vendors, since they simply won’t be as responsive two years down the road as they were during implementation and go-live.

Caristix Software

These are the questions that Caristix Workgroup software asks and helps analysts answer automatically.

Download the HL7 Survival Guide

Tip 3 in the Interoperability Tip Series

Work in a health system or for a provider organization? This tip on healthcare data is especially important for you.

If you work for a vendor, read this tip to understand what’s on the minds of your customers.

Why This Tip Matters to Leadership

Health system CIOs, this is the work your interfacing and interoperability team performs everyday. Their jobs revolve around answering these questions. The questions you need to ask your team lead are:

• In getting the answers to these healthcare data questions, are your processes set up to avoid rework?
• Are your teams using technology and processes to reduce cycle time this year?
• Are you setting expectations for increased productivity?

Interfaces and interoperability are on the critical path to Meaningful Use Stage 2 and ICD-10 project delivery. The ROI and business benefits a C-suite member must deliver is going to be dependent on how productive  your interfacing teams can be in effectively and speedily driving projects to completion.

6 Questions – Healthcare Data

1. Understand the message/interface specification provided by your vendor. “We are HL7 2.4 compliant” is not enough. Ask the vendor to provide details about messages, segments, fields, the need for z-segments, etc. Also find out how they handle data semantics. In other words, what does the data mean? What is it used for? By extension, understand workflow-related information, event timing, vocabulary definitions, and who will use the information and how. This will give you an overview of how the healthcare data should be managed.

2. Understand the type of message that will be generated based on the event (e.g., a patient admission, patient visit, cancelling a transfer, sending a partial lab result). Understand what data is provided with the event, including the various code sets. Ensure you have a full list of code sets. The code sets are the values you need to handle in your healthcare data.

3. How do the code sets and content evolve over time, and who handles the updates and how?

4. Where does the healthcare data go? How is the healthcare routed? Are any of these routed or delivery points insecure? How are you protecting sensitive healthcare data and/or de-identifying PHI?

5. How does the new system manage errors? What happens to messages that aren’t understood by the destination system? What happens to rejected messages? We all agree that in a perfect world no piece of healthcare data and no messages would be dropped, but the reality is it that it can and will happen. How would users and the overall workflow be impacted in such a situation? How can you mitigate the risk?

6. How do you handle workflow changes? If it’s a matter of adapting the interface, how is this handled, how much time does it take, what does it cost, and who pays? You want to avoid Frozen Interface Syndrome, which occurs when you are trying to implement a new interface and need all participants to switch over at the same time but can’t get their cooperation. Worse yet is Interface Black Box Syndrome, when you lack full visibility into all the work that has gone into interface development handled by a third party, making it nearly impossible to upgrade, tweak, and manage the interface without spending lots of money and time.

Answers to these questions will help you understand the healthcare data in source and destination systems. This is important for new product implementations (like EHRs and EMRs). Once you’ve nailed down these details, you need to pinpoint the gaps with the receiving system(s) so you can bridge them with an interface.

Caristix Software

We built our software to help you answer these questions automatically and increase team productivity by at least 50%. Take a look at our online Workgroup demo webinar to learn more.

Download the HL7 Survival Guide

Tip 2 in the Interoperability Tip Series

Data and Information Challenges

Learn how this tip boils down to speed and dollars.

In Tip 1 of our Interoperability Tip Series, we talked about the HL7 interface standards and their 3 challenges.

Dig deeper, and you find that underlying challenge with interoperability in healthcare information systems is at – you guessed it — the information level.

To tackle the challenge of interoperability within healthcare information systems, analysts need to ask: What information is needed by whom, when, and in what format?

Once analysts have these answers, they need to validate that information being transferred through the interface has the same meaning in both healthcare information systems. In technical terms, the information would have the same semantics in both systems.

4 Data and Information Issues

Here are the 4 data and information issues that analysts tackle when they work on interfacing and interoperability for healthcare information systems:

	Issue	Example
Data structure	The HL7 standard specifies a data structure based on trigger events, segments, fields, and data types. The recommended structure must account for complex clinical workflows and data representations.	There might be a gap based on the maximum length of data elements. A field in one hospital system specifies a maximum length of 50 characters. The same field in the system under implementation is set at maximum length of 20.
Data tables	HL7 provides a recommended set of data values. These can be modified.	HL7 v2.6 “suggests” six different values for patient gender.
Data semantics	Good data semantics implies that the meaning or intent of the data is exchanged accurately – not simply the data value itself. It’s essential for HL7 interfaces to convey their interpretation of the HL7 standard in use.	Patient identification is the classic example. It is important to determine which fields are in use. Possibilities include: PID-2 Patient ID, PID-3 Patient Identification List, PID-18 Patient Account Number, PV1-19 Visit Number, or a combination thereof.
Z-segments	Z-segments are custom message segments. They are used when an application must convey information outside the scope of the HL7 standard. Development teams also resort to Z-segments to work around technical limitations.	By definition, all Z-segments result in gaps. If Z-segments aren’t mapped accurately, critical information can be lost.

Why This Matters to Healthcare Leaders

If you’re speaking with a leader with profit and loss responsibility, let them know that these data and information issues boil down to speed and dollars.

We talked about best-practice requirements-gathering in Tip 1 of our series. In interoperability projects that complete on time and at/under budget, analysts get all their requirements upfront. They don’t hand off partial or “good-enough” requirements.

Best-practice requirements cover the data and information issues listed above – data structure, tables, semantics, Z-segments. Typically, they are covered in a gap analysis between two or more healthcare information systems: the sending and receiving systems.

The more completely an analyst identifies the gaps, the faster a developer will get to a production-ready interface.

If that gap analysis is less than complete, the developer will spend time testing that interface looking for bugs and defects before it goes live. And if that happens, your entire go-live slips.

That’s why we say it boils down to speed and dollars.

Download the HL7 Survival Guide

Introducing the Interoperability Tips Series from Caristix

If you’ve seen our HL7 Survival Guide, you know it’s chockablock full of valuable information for interoperability and HL7 projects. (If you haven’t seen the HL7 Survival Guide, get a copy here). We’re starting a series of brief snippets and actionable tips based on learnings from the Guide.

Use these tips to get your interoperability projects up and running, educate leadership on interoperability, and sell your vision.

Here’s the first tip.

Reading time: about 2 minutes

Tip 1: HL7 Interface Standards and 3 Challenges

When you’re starting with HL7, you need a clear idea of what you’re up against. Here are the three main challenges we routinely see with HL7 data. They’re all about format, content, and what the data really means.

1. Customizable HL7 Format

Version 2 among the HL7 interface standards specifies a data structure based on trigger events, segments, fields, and data types. The recommended structure must account for complex clinical workflows and data representations. This means that the standard allows for extensive customization even when product specifications exist. As a result of the many variances and adaptations of the HL7 interface standards, there’s no truly standard way that systems are implemented and data is handled. In other words, plug and play is not part of the vocabulary.

2. Configurable and Customizable HL7 Data Tables and Code Sets

HL7 interface standards provide a recommended set of data values for transactions. But the values can be customized. In fact, they should be customized or configured under certain circumstances. Again, this means that data can be handled differently in each system. Some translation and data mapping need to occur during data exchange so each system sends/receives data it can understand.

3. HL7 Data Semantics

Good data semantics implies that the meaning or intent of the data – not simply the data value itself – is exchanged accurately. It’s essential for HL7 interfaces to convey their interpretation of the HL7 interface standard in use – or confusion will ensue. It’s the difference between NA standing for “Not Applicable” or “No Allergies”.

Business Translation

What does this mean to a business leader?

First, keep in mind that just about every interoperability project relies on HL7 data. And with HL7 interface standards today, there is no such thing as plug and play. Why? Because of those 3 challenges around format, content, and what the data actually means.

You might be wondering: won’t Meaningful Use Stage 2 fix these problems? No. Meaningful Use prescribes a broad, basic format and broad, basic content. But each and every provider still has customizations – choices – to make. These choices depend on the meaning (or semantics) of their data. The way to speed up interoperability and interfacing delivery is to fully capture  business and technical requirements up front, and convey them accurately and completely to developers.

Address the challenges that come with HL7 interface standards. Get the right resources – people, technology and processes – to capture those requirements and overcome these hurdles.

Download the HL7 Survival Guide