Obstacles to Integrations and How We’re Navigating and Overcoming These at WeInfuse

By Paige “PJ” Bigley
Client Success, Integrations at WeInfuse

If you have started to explore the possibility of integrating WeInfuse with your EHR, you might have encountered some potential roadblocks along the way. Oftentimes, setting up an integration can come with capability or cost-related challenges. With integration representing such an important way to exchange patient data more quickly and accurately between your EHR and WeInfuse, we understand the need to make integration accessible to all of our clients. 

In this post, we will explore some obstacles to integration and how WeInfuse is helping clients avoid these common pitfalls. We will also take a high-level look at the 21st Century Cures Act, including how we hope this Act will positively impact the future of integrations and interoperability in the years to come. If you haven’t already, please read our Introduction to Integration with WeInfuse blog post for an overview of key integration terms, our current scopes of integration and the interfaces we support, and a step-by-step outline of the go-live process. 

Obstacles to Integration:

Perhaps the most obvious challenge when it comes to integration is related to the need for two distinct systems, in this case WeInfuse and your EHR, to communicate and send data in a way that can be internalized by the receiving system. EHRs vary in the languages or formats that they send messages in and in the connection types that they leverage. To try to accommodate so many languages and connection types would be difficult both technically and in terms of resources, but our clients don’t have to worry about any of this. Our integration partners at Redox help us conform to the technical specifications of practically any client EHR. Regardless of language or connection type, WeInfuse sends data into the same Redox model and Redox easily translates our messages into the format required by an EHR. 

This means that when our clients come to us to integrate with their EHR, there generally isn’t any custom development work on the WeInfuse side. While EHRs vary in some of the data fields that they can receive and process, we don’t need to amend our integration messages to accommodate what that EHR can receive. Instead, Redox maps the information we send to accommodate what an EHR can receive. The flexibility of the Redox data model eliminates not only complexity, but development time that would otherwise be necessary, making the setup process easier and faster for all parties involved.

Data cleanup is another consideration when setting up an integration. Data cleanup can be an obstacle to integration go-live in the case that you have duplicate payers or patient profiles that need to be handled before the integration can be configured. As mentioned in our previous post, for our clients with existing patient and payer data in their WeInfuse site, there is a payer and patient linking process that has to take place before a go-live. 

The linking process is especially important to prevent the creation of duplicate patient profiles or duplicate payer entries and helps ensure that we recognize existing patient profiles and payers as existing, rather than new data. This also ensures that we don’t overwrite any existing insurance information on individual patient profiles. Because this is such a critical piece of the setup process, making sure that existing data is aligned can seem intimidating. But, if you provide us with exports of your payer and patient data, we are here to help. We can help determine which payers in WeInfuse correspond to which payers in your EHR, which might be duplicate plans, and how to best go about the cleanup process. Looking at patient profiles as well, we can determine which are duplicates and help evaluate which profiles to keep and which to delete. By working with your team, we can help eliminate some of the burden of the time it would take to do this data cleanup on your own.  

The good news is also that once an integration is live, data won’t be misaligned going forward. All patients that are created after go-live will be automatically linked. And, since your EHR or RCM system becomes the system of record for payers, plans created in your EHR or RCM system are automatically sent to and created in WeInfuse. This eliminates scenarios where a payer exists in one system but not the other and ensures that at the patient level, the plan assigned to a patient in one system is the plan assigned to that patient in another. 

Aside from technical considerations and data cleanup, the infusion workflow is very specific. As our clients know, EHRs aren’t built to accommodate the specific infusion workflow, and in some ways, the same goes for integrations. The infusion order in particular is difficult to capture in an EHR in a way that gathers the information that we need in order to create an Order in WeInfuse. For the most part, existing Order models for integrations are built to accommodate the exchange of data for lab tests and imaging results while Medication models are built to accommodate prescriptions. This is something we have considered as we begin to investigate Order integrations. Even though we are not receiving all of the data we need in order to take an infusion order directly from an EHR into WeInfuse, we can always work to leverage what we can receive. By creating the concept of a draft order, we will be able to generate an order from the integration message that includes all information we receive from an EHR. Users will be able to review and approve the Order prior to officially creating it in WeInfuse, adding in any missing data that is required as part of the infusion order in WeInfuse. In this way, we will always try to work around integration model limitations to make the infusion workflow as seamless as possible.

Lastly, one of the biggest hurdles presented by integration is cost. This is especially the case for HL7 integrations. The most significant cost generally comes from the integration interfaces that need to be purchased from our clients’ underlying EHRs in order to enable the exchange of patient demographic and insurance information, billing details, and other data. Typically, the EHR vendor also needs to assign a contact to the integration project to work on scoping, message formatting, and oftentimes VPN setup. There can also be monthly or annual maintenance costs associated the interfaces and/or VPN. While pricing on the part of EHR vendors can be lofty, this isn’t the case with WeInfuse integration fees. As we continue to integrate with different client EHRs, we continue to establish relationships with them, and we will continue to work with those EHRs and strive to ensure that pricing from EHRs is not an obstacle to integration for our clients. 

Looking Forward: 

Some of the obstacles to integration that we’ve just examined are not only challenges that we are trying to address at WeInfuse, but are issues that are being examined at a larger scale as well. Since the 21st Century Cures Act was enacted in December of 2016, “interoperability” has been a buzzword in the healthcare industry. At WeInfuse, we hope that the industry push for interoperability means a step towards reducing technical barriers to integration, more readily accessible documentation and APIs, and a push for more affordable connections. 

Taking a look at the 21st Century Cures Act and in particular, Sections 4002, 4003, and 4004 of the Act, which lay the framework for interoperability standards over the coming years, gives us some sense of where the industry is headed. All sections in the 21st Century Cures Act is a step in the right direction for our clients. 

Section 4002 outlines that there should be no “information blocking” and that a health information technology developer should ensure that they have “published application programming interfaces and [allow] health information from such technology to be accessed, exchanged, and used without special effort.”

Section 4003 provides a definition of interoperability, and section 4004 establishes what constitutes “information blocking,” outlining that EHR vendors should not engage in practices that are “likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.” 

Under the “Practices Described” portion of Section 4004, the Act says that information blocking may include:

“practices that restrict authorized access, exchange, or use under applicable State or Federal law of such information for treatment and other permitted purposes under such applicable law, including transitions between certified health information technologies; ‘‘(B) implementing health information technology in nonstandard ways that are likely to substantially increase the complexity or burden of accessing, exchanging, or using electronic health information; and ‘‘(C) implementing health information technology in ways that are likely to— ‘‘(i) restrict the access, exchange, or use of electronic health information with respect to exporting complete information sets or in transitioning between health information technology systems; or ‘‘(ii) lead to fraud, waste, or abuse, or impede innovations and advancements in health information access, exchange, and use, including care delivery enabled by health information technology.”

You can review the 21st Century Cures Act here.

We hope that integration projects specifically are considered as Section 4004 of the 21st Century Cures Act is enforced. And, although there is currently no concrete indication of what kinds of costs should be considered prohibited, we hope that exorbitant integration fees come to be seen as information blocking and that there come to be accepted price ceilings on integration interfaces, setup costs, and maintenance fees. 

At WeInfuse, we will continue to do our best to eliminate technological hurdles to integration and hope that other organizations will embrace interoperability in a similar way, paving an affordable path to integration for all of our clients. 

In every post we write about integrations, we have to mention our integration partners at Redox who help us set up and maintain our integration connections. In addition to helping us code up to client EHR specifications, Redox also provides a wealth of information on interoperability across the healthcare industry. For those who want to take a deep dive into this content, their podcast episode “The State of Interoperability in 2020 with Redox’s Brendan Keeler” is a great resource.