Although the healthcare community has been clamoring forintegration of its IT systems for decades, the industry is still ina rather elementary stage when it comes to useful and practicalsystems integration, according to Shahid Shah, software analyst andauthor of the blog The Healthcare IT Guy . "Our problem in the industry is not that engineers don"tknow how to create the right technology solutions or that somehowwe have a big governance problem," he said. "[Although]those are certainly issues in certain settings, the realcross-industry issue is much bigger – our approach tointegration is decades old [and] opaque, and [it] rewards closedsystems." Shah outlines six reasons today's health IT systems don't integratewell. 1.
They don"t support shared identities. These shared identities include single sign-on (SSO) andindustry-neutral authentication and authorization, said Shah."Most health IT systems create their own custom logins andidentities for its users, including roles, permissions, accesscontrols, etc., stored in an opaque part of their own proprietarydatabase," he said, adding that ONC should mandate all future EHRs use "industry-neutral" and well-supported identitymanagement technologies, so each system has, at least, the abilityto share identities. "Without identity sharing and exchange,there can be no easy and secure application capabilities, no matterhow good the formats are," he said. 2.
They're too focused on "structured data integration." Instead, said Shah, systems should be focused on practical appintegration in the early phases of a project. "In the earlydays of data collection and dissemination, it's not important toshare structured data at detailed, machine-computable levels first,[but it's more] important that different applications haveimmediate access to portions of data they don't alreadymanage." Once app integration is in good shape, he continued,then it's time to focus on structured data integration, and all thegovernance and analytics associated with it. "When we dostructured data integration too early, we often waste time becausewe don't understand the use cases well enough, so we can't iterateto best-case solutions," he said. "We're driven toworst-case implementations." [See also: 5 technologies every hospital should be using .] 3. They're more "push" data-focused versus"pull" data-focused.
"A common question we ask at the beginning of everyintegration project is, 'What data can you send me?'" saidShah. "This is called the 'push' model, where the system thatcontains the data is responsible for sending to all those that areinterested." Future EHRs need to implement syndicatedATOM-like feeds, which could contain HL7 or other formats, for all their data, so they can share and allowanyone who wants it to "subscribe" to the data, continuedShah. In turn, this is known as the "pull" model, orwhen data holders simply allow secure, authenticated subscriptionsto their data without worrying about direct coupling with otherapps. "If our future EHRs became completely decoupled securepublishers and subscribers of the data, many of our integrationproblems would go away like they did for others using modernInternet approaches," said Shah. 4.
They're more focused on "heavyweight, industry-specificformats" instead of "lightweight, or micro formats." According to Shah, appointment scheduling in the "health ITecosystem" is a major source of "health IT integrationpain," he said. "If EHRs just used industry standardiCal/ICS publishing and subscribing, we could solve 80 percent ofappointment schedule integration instantly." Shah continuedand said to think about how an iPad can sync with an Outlook/Exchange server at work. "It's notmagic – it's a basic, industry-neutral and appropriatelysecurable standard, widely used and widely supported." Anotherexample, he said, is the use of HL7 ADTs for patient profileexchanges, instead of more common and better-support standard likeSAML. "If you've ever used your Google account/profile to loginto another app on another website, you're using SAML," saidShah. "Again, no magic – it works millions of time a daywith 'good enough' security and user-controlled privacy." 5.
Data emitted are not tagged using semantic markup, so they'renot shareable by default . "Even when we do have full data governance, we do ourstructured data integration and then we present information on thescreen," said Shah. "We don't tag data with propersemantic markup, when it's basically free to do." Future EHRs,he continued, should generate Resource Description Framework-in-attributes (RDFa) , using industry neutral schemas for common information, such aspersonal data. "Using RDFa as a start, EHRs can then startpublishing full RDF in the future, so it's easier to discover wherecertain kinds of meta data can be found, without requiring massiveregistries and other old-style opaque techniques," he said."None of this is technically challenging, insecure, ordifficult to implement, if we really care about integration and arenot just giving it lip service." [See also: 5 stages of EHR maturity and patient collaboration .] 6.
They don't produce common output in a security- andintegration-friendly way . Shah said future EHRs should start to use industry-neutral CSSframeworks, such as Twitter's Bootstrap, which is both free andopen source. "When using JavaScript, EHRs should use common,lightweight, and integration-friendly libraries, like jQuery, andnot JavaScript frameworks that take over the app and view port, andprevent easy discovery and integration." When you omitJaveScript Object Notation (JSON) from your APIs, Shah continued,offer both JSON and JSONP, so secure integration can occur moreeasily. "All of these techniques … are commonlyaccepted, secure Web practices and need to make their way into ourEHRs," he said. I am an expert from Other Agriculture Products, usually analyzes all kind of industries situation, such as bulk wholesale candy , lower back tattoo.
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