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Damian Esteban for BetterHealthcare

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How to Integrate with an EMR as a Digital Healthcare Startup


The biggest technical challenge facing the American Healthcare System is the lack of interoperability between EMRs,largely due to the lack of a strong standard protocol. While HL7v2 is the most widely used messaging standard among Healthcare systems, it has loose and optional definitions which lead to discrepancies, and many application vendors do not support the latest and best-defined versions of HL7.

FHIR is a modern and robust standard that could solve this problem, but adoption is slow. Unless you are working with the major players like Epic, Cerner, AllScripts, or a handful of others it is unlikely that FHIR is an option.

At BetterHealthcare we create solutions for healthcare interoperability. Being integrated with BetterHealthcare means that patients can request accurate appointments that are updated in near real-time, and patient information can be sent back to the EMR. This increases efficiency for our customers, allowing them to effortlessly manage their schedules and intake new patients using our robust set of online tools.

What is necessary to integrate with an EMR?

  1. Patience. As a startup, your team is able to move fast and efficiently. Once your project is specced and you have decided on your architecture your team is ready to roll. However, the path to integration with most EMRs is a long one that often involves dealing with many layers of bureaucracy. You’re on their time.
  2. Flexibility. This applies to both the technology and the project timeline. The majority of EMRs do not have RESTful APIs, nor do they send data over HTTP. In my experience, the most common solution is the transmission of CSV files over SFTP. HL7v2 transmitted via MLLP is often an option, but if you don't have a Healthcare Integration Engineer on your team this can be challenging. In order to get an integration project started there is usually a security assessment which takes time, and larger companies may want penetration test results performed within the last year.
  3. A willingness to learn. Even if you do not deal directly with HL7 you must become familiar with the different message types and their content. An excellent resource is Datica Academy's HL7 Primer.

How do I send and receive data from an EMR?

Stay tuned, more detailed blog posts will follow about different approaches. At BetterHealthcare we built a custom integration engine that leverages AWS Lambda, Dynamo, and Kinesis as a proxy layer that transforms incoming data into the desired format. There are many potential solutions. Here are a few services I recommend exploring:

  1. The Google Cloud Healthcare API is a powerful service that allows you to consume and convert HL7v2, FHIR, and DICOM.
  2. Azure FHIR Service is a fully managed FHIR server that you can get running in a few minutes.
  3. FHIR Works on AWS is an official AWS Solutions Implementation that leverages AWS Lambda.
  4. Redox Engine offers EMR integrations with a well-designed standard API. Their services are costly but can be worth the investment. This is your quickest option.
  5. Mirth Connect is a powerful integration engine that allows you to send and receive any type of healthcare data.

The End

As you may have realized, this article barely scratches the surface of healthcare integration strategies. Expect more content on this topic soon and feel free to reach out to me if you have any questions.

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