The coronavirus pandemic has inflamed the sore spots of the global healthcare industry. Namely, it has revealed issues with data sharing and interoperability. The global health community needs structures enabling health IT systems to gather and share information about how the novel coronavirus is transmitted, its symptoms, and testing results. The spread of COVID-19 has also brought multiple privacy, data protection, security, and compliance challenges, all of which rest on healthcare providers’ shoulders.
But nobody has canceled other serious diseases (like cancer) and the necessity of their treatment. Let’s take cancer and view how things with its treatment are going in the UK, ranked sixth among countries with the most well-developed healthcare systems in the 2020 Best Countries report by U.S. News & World Report.
Healthcare data sharing issues related to cancer treatment in the UK
Cancer patients must go to different facilities for diagnostic tests, imaging, and examinations. Clinicians need to access all patient data from all these facilities in one place to review test results and decide on an approach to treatment: surgery, chemotherapy, radiotherapy, or sometimes all three. The local National Health Service (NHS) trust teams commonly manage this process and organize treatment. But transferring all patient data from the NHS hospital to a private provider turns out to be a challenge.
Patient records, lab and imaging results, and radiotherapy scans are stored on different systems. This incompatibility has led to a mass of ad hoc solutions and the systemless transfer of paper documents between the NHS and private clinicians with the possibility of confusion and delays. Rutherford Health, a UK network of oncology centers, managed to come up with a solution to their internal and external data sharing problems.
Networked multi-center system to tackle interoperability
Understanding the high risk of equipment failure, Rutherford Health implemented an advanced networked multi-center proton beam therapy system that’s capable of seamlessly sharing patient information within and beyond the network’s centers.
When individuals receive radiotherapy in a Rutherford Health center, a team of healthcare specialists can examine the planning scans that show the cancer and the area around it to plan radiotherapy. The scans are stored centrally in a secure private cloud. In case the equipment fails in one center, a patient can be quickly moved to another center with properly functioning equipment. A networked system helps the treatment team immediately access and use patient information to proceed with treatment.
This system also allows Rutherford Health to get treatment plans from the NHS and quickly provide those plans to their centers. Additionally, Rutherford Health has already signed service-level agreements with a number of private UK providers to ensure the seamless transfer of radiotherapy information.
Many clinics as well as life sciences, health insurance, telehealth, and remote patient monitoring organizations can also enjoy the benefits of integrated healthcare systems, especially if starting from scratch when there's no dependency on legacy systems at the heart of an organization.
Although these legacy systems are expensive to maintain and hard to connect with other systems, they are difficult to replace. This is due to the amount of essential data they keep and the multiple systems they support. But with modern technologies, it’s also possible to improve legacy systems.
Further in the article, we’ll tell you how you can ensure all-round integration. But let’s first pay attention to key problems within healthcare organizations that an effective healthcare integration system might tackle.
What healthcare providers’ pains might a healthcare integration system heal?
According to ResearchAndMarkets.com, interoperability issues are a big restraint to providing better customer service. One of these issues is the inability of systems to share data and correctly interpret received data. But there are also other pains healthcare providers need to heal.
Data integration issues. Medical organizations are failing to integrate data platforms into their software infrastructures, and data integration problems cost healthcare providers money. Operating costs are high because of low operational efficiency. Any system you need to integrate with might codify data differently, resulting in difficulties with translating or consolidating information. And the more solutions an organization deploys, the more difficult it is to clean the data mess.
Insufficient customer experience. Consumers are paying more and more for their medical bills. Meanwhile, they’re used to the top-notch web and mobile experiences provided by companies in the financial and e-commerce industries. No wonder they expect the same experience from healthcare providers. Offering this kind of experience requires consumers’ ability to access all needed medical information via a software solution that centrally collects all data. As a result, a consumer uses a context-aware solution that doesn’t ask repeated questions.
Medical staff is burdened by administrative tasks. Healthcare specialists are burdened by time-consuming administrative work and the necessity to use inefficient apps. Physicians and nurses are filling out medical forms instead of taking care of patients.
Issues with data security. Medical institutions deal with Protected Health Information (PHI), and US healthcare providers have to comply with strict regulations like HIPAA. Healthcare providers should also make sure they protect patient data well, as cybercriminals often target healthcare systems to get access to PHI.
Data is flooding infrastructure. All of the data a medical facility deals with has to be securely stored, processed, and analyzed to enhance patient treatments, medical outcomes, and financial results. Otherwise, there's a high possibility of occurring errors and missing details. Medical errors are dangerous, as they’re the main cause of death in the US. Incomplete or missing imaging data and relying on memory are some of the causes.
Insufficient use of analytics. Medical institutions often can’t integrate analytics into their clinical and operational workflows. According to a recent industry survey, eight in ten interviewed healthcare managers stated that their use of advanced analytics for decision-making and strategic planning was negligible.
Lack of competitive advantage. Competition between healthcare providers is fierce. To survive, a medical organization can’t avoid building an effective management system. In the US alone, Medicare and insurance companies prefer to rely on electronic data exchange, which is possible only with an automated system in place. A clinic able to send and obtain patient data and medical reports electronically always wins over competitors.
Lack of process automation. Without one unified system that securely integrates data, the ability to automate processes and effectively use healthcare information is extremely limited. Process automation reduces operational costs. Conversely, if you don’t automate your processes, your operational costs increase.
The solution to all these problems might be an automated hospital integration system tailored to business requirements. Such a system should integrate with all healthcare services (providers, payers, vendors, etc.) and devices to incorporate all the data into one user interface.
But there are some pitfalls on the road to building such a system.
Healthcare integration implementation challenges
Let’s see what the obstacles are to creating an efficient healthcare integration system and figure out how to tackle them.
Prevalence of legacy systems. Healthcare organizations keep using legacy systems, as they’re expensive and difficult to replace. However, these systems often prove ineffective when it comes to processing huge volumes of data and can’t cooperate effectively with new systems.
Explosive amount of unstructured data. Medical organizations must manage numerous data formats. In addition, all clinical data systems such as EMR have their specific data schema. As a result, it’s likely that data points won’t map properly across systems. Healthcare historical data also needs to be processed and transformed to lay a foundation for further complex analysis.
Need for top-notch security. Health systems require a safe and secure authorization mechanism to exchange data. EHRs are extremely lucrative for criminals to capture. A social security number may cost 10 cents on the black market. But a medical record may cost up to $1,000, which is 10,000 times the value.
Insufficient software adoption by end users. Medical personnel has to focus on situations that require prompt medical decisions rather than on dealing with confusing and complicated software. If a system is too complicated, users need time-consuming workshops on how to use it. If users are provided with training materials, error probability remains high.
How can you solve these challenges and what do you need to build a scalable, flexible, and expandable system integration platform for healthcare?
Approaches to building an effective healthcare integration system
There are a huge number of healthcare software solutions and tools to enable integrations. The most powerful are healthcare enterprise service bus (ESB) tools and integration Platforms as a Service (iPaaS). Their use might significantly simplify and speed up developers’ work. Both ESB and iPaaS have their strengths and weaknesses. We’ll help you understand their main functions and differences to understand which approach suits you best.
Healthcare enterprise service bus
An ESB is basically a set of rules and principles for integrating multiple apps together via a bus-like infrastructure. ESB products like those from Oracle, WSO2, and IBM enable developers to build a bus-like architecture but vary in how they do it and in their capabilities.
The key logic of the ESB architecture is that a technical team integrates different apps around a communication bus and then allows those apps to talk to the bus. This approach divides systems from each other, letting them communicate with no dependency on or knowledge of other systems.
An ESB architecture manages the way work is transmitted along the bus, ensuring the ability to easily change or add components. As an ESB takes in all traffic being routed between components, it’s also a great place to implement security and compliance measures and even to ensure performance monitoring and load balancing.
Why ESB is great for healthcare:
Support for various data formats. ESBs commonly support multiple data formats and healthcare standards, turning data from one format into another system-specific format by transforming components. Many ESB-based middleware solutions support common healthcare formats such as HL7 V2.x and V3, EDI, XML, and CSV.
Protocol conversion. ESB middleware usually supports protocol conversion to bridge protocols. For example, WSO2 provides support for converting between a large number of protocols including HTTP, JMS, FILE, TCP, and SAP.
Resilience to load and prompt updates. When using ESB middleware, messages are not dependent on the particular addressee, which enables load balancing and fail-safe behavior. Also, there’s no need to rewrite all APIs to update the system. Updates are only required if you change the service adapter.
Reinforced security. An ESB usually protects the system from unauthorized access thanks to built-in authentication and authorization, encryption, and tokenization mechanisms.
Is an ESB your cup of tea?
ESBs are good at tackling integrations with local or legacy systems. This is because they were created before the era of cloud integration. You can count on an ESB when it comes to vertical scaling within an existing architecture, as an ESB can manage the expansion of existing computing resources.
In general, you can use an ESB for local or legacy systems, primarily those managed on-premises. An ESB will ensure the reliability and functionality required to integrate multiple apps and maintain data architecture health. If you’re a large company with established integration standards and a centralized IT function, an ESB might be the solution to your integration needs.
However, for smaller or newer healthcare systems that need ad hoc integrations, it’s better to use an Integration Platform as a Service.
Integration Platform as a Service
An Integration Platform as a Service, or iPaaS, is better crafted for horizontal scaling. Almost by definition, this means adding new apps or components to the existing environment. Some iPaaS solutions are based on robust core healthcare integration engines and are highly available, reliable, and secure. iPaaS also boast these two capabilities:
Advanced cloud integration. iPaaS is perfect for healthcare systems relying on cloud integration. An iPaaS system is more agile and adaptable than an ESB, which allows for easier integration of new apps within an existing framework. And as iPaaS solutions are born for the cloud, they can help you decrease or avoid the necessity of local servers or hardware.
Real-time data access. iPaaS is agile and efficient when it comes to aggregating data taken from smart devices or third-party apps. It ensures real-time access to data stored in multiple apps and locations. That’s why iPaaS might be a great solution for those who want to conduct real-time analytics or collect data from all types of apps or devices and access it in a single, unified system.
iPaaS supports different architectural approaches, including microservices architecture, layered architecture, and event-driven architecture. For instance, such platforms as Dell Boomi and MuleSoft provide:
API management. These platforms support the entire lifecycle of APIs in a hybrid environment. They can be used to configure APIs, enable real-time integrations, test APIs, and deploy them. Specific dashboards help you monitor how APIs are functioning.
In-box connectors. Dell Boomi, for example, provides connectors to more than 200 apps and more than 1,000 endpoints to promptly connect to virtually any healthcare app to meet your particular integration needs (on-premises, in the cloud, or any combination). The platform also provides integrations with the top EMR/EHR systems and helps to enable the flow of data among your critical applications.
Data mapping. Thanks to data mapping, iPaaS platforms allow for quick data transformations from one format to another. With an iPaaS platform, developers can build the needed data structure by means of profiles.
All these tools enable developers to create an integrated healthcare system in a short time.
What iPaaS platform to choose
Each of the top iPaaS platforms has its advantages and drawbacks. For example, Informatica is considered the most stable and was among the very first on the market. On the other hand, many developers like Dell Boomi and MuleSoft for their flexibility, approach to mobile and web development, and interface usability.
MuleSoft provides a more familiar environment for Java developers. This platform also offers a so-called API-led connectivity approach to deployment. API-led connectivity is an approach to transmitting data to apps via reused and specialized APIs. Each API plays a particular role, like aggregating data from different systems or combining data into specific processes.
API-led approach by MuleSoft
MuleSoft refers to its API-led connectivity as the application network approach. Let’s see how it can be applied in healthcare by looking at three separate projects:
Patient 360 portal. Let’s say you have a contact center that needs to be modernized. You can create eHealth APIs and integrations using MuleSoft’s HL7 V2 connector, FHIR templates, and pre-built integration templates. The Design Center, MuleSoft’s development environment, provides API Designer and Flow Designer. These two tools will help you fetch key EHR, IVR, and ERP data into one patient portal, enabling your call center agents to process inbound requests in real time.
Appointment scheduling. Next, you can help patients manage doctor appointment scheduling by reusing the patient API from the first project. You can find this API in the Anypoint Exchange, create a new API for doctor calendar data, and run a new scheduling app.
Telehealth. Next, you might need to provide patients with telehealth services and homecare support. Again, you can reuse the APIs created in the first and second projects. You can also monitor each of your company’s APIs and integrations in a dashboard in the Anypoint Management Center.
As you can see, MuleSoft’s API-led connectivity is an excellent approach to enabling integrations for highly complex projects. But these capabilities might be excessive for small projects or organizations.
Furthermore, there are some indications that MuleSoft is a relatively expensive solution in the field of iPaaS software. According to reviews on G2, the MuleSoft Anypoint Platform is 30 to 45 percent more expensive than the average iPaaS product for companies of any size. So you’ll likely want to use another more efficient option if your project isn’t very complicated.
Build from scratch or use an existing solution?
In general, horizontal scalability is a big advantage of iPaaS platforms. This is because they mostly rely on cloud environment deployment and containerization. Moreover, it will be much easier and faster to build your infrastructure with iPaaS than to build it from scratch.
But to predict the overall cost of a project created by means of iPaaS, you should take a balanced view of existing solutions. Each platform charges specific fees and sets specific limitations. MuleSoft, for example, allows you to integrate only ten apps for one vCore (a unit of computing capacity for processing on CloudHub, which is equal to one virtual core). Dell Boomi, in turn, charges for connectors. Sometimes, it’s easier and cheaper to apply on-premises deployments or use hybrid solutions.
That’s why we suggest you contact a mature outsourcing software integration provider who will help you choose the most suitable solution. Such technology vendors have health system integration engineers experienced in creating customized solutions. They can build the healthcare integration ecosystem you need in the most efficient way.
Moreover, such a dedicated team will make sure the software system is user-friendly and help your staff or partners adapt to it. This includes providing continuous support, gathering end user feedback, making improvements to the system, training employees on how to work in the new environment, and showing the process of using the system to avoid manual issues.