EHR INTEGRATION: TO BUILD OR TO BUY

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1 White Papers EHR INTEGRATION: TO BUILD OR TO BUY Understanding the Complexities and Requirements of EHR Integration

2 For digital health application developers, creating an amazing health solution is just the beginning of getting it into patients and providers hands. Between creation and delivery, there s decisions to be made regarding how to develop, market, and sell your product. Though there is a great deal of variance in product development and marketing strategy, when thinking about how to integrate with an EHR, all digital health applications are faced with one fundamental question: Do I build out my product and team to handle integration myself, or do I find an outside party to perform this service for me? While seemingly straightforward, there are many issues that can tip the scale either way. For companies large and small, the main things to consider are the knowledge requirements of integration, the technical skill needed, and how the decision will affect your company s resources. Let s take a look at these key areas and how they influence the decision of whether to build or buy integration.

3 Knowledge Requirements Like any specialized service, integrating health applications requires specialized knowledge. Since the need to integrate with electronic health records is a relatively young demand, the skills to doing so are largely learned through hands-on experience working with health systems (as opposed to being directly taught). This poses a problem for companies who do not have specialized experience in EHR integration. While IT staff are deeply knowledgeable in their fields, they often aren t familiar with health-tech, which is has it s own complexities, nuances, and legal requirements. To successfully integrate, and IT team must either have or develop a strong command of the intricacies of healthcare workflows and databases in addition to integration data standards and communication protocols. Gaining this knowledge takes time and focused attention time that a product team could instead devote to improving their app. Beyond understanding how to technically connect with a health system, there are further areas that require advanced knowledge. For one, identifying the data needs of an application and how to obtain that information from an EHR is complicated. Often, data is bundled together and delivered at specific points in a workflow which may or may not align the specific needs of your product, resulting in frustration and wasted effort from your team. 1 Secondly, healthcare data must be treated extremely carefully when being pulled from EHRs. When in transmission, data needs to be encrypted, and while being stored, it must also be secure. Failure to do so can result in security breaches and the incursion of heavy fines and a tarnished reputation few vendors (especially small ones) can recover from. Lastly, when thinking about building or buying your integration from a business standpoint, it s necessary to think about how to allocate and spend your most valuable resource time. We ll dive into a bit more detail on this subject later on, but the age old adage of time is money holds true in the healthcare industry. As health tech rapidly advances, bringing your product to market faster by leveraging the knowledge and expertise of an integration partner will enable you bring your product to market faster and out compete your competitors. Redox knows the ins and outs of the technical and legal work required to integrate from decades of hands-on experience. We know what data applications need, where and how that data exists, and how to get it securely to and from the EHR. Most importantly, our knowledge expedites the process.

4 Technical Considerations 2 The technicality of integration is nothing short of complex. Your development team must be able to handle the following skills. Any product supporting healthcare integration must build and harness tools to handle the data formats for the content you seek. This includes having tools and the skill sets to address the following: HL7, including C-CDA-formatted structures, as well as Web services. Data Formatting Data Translation Message Parsing Message Routing Once you have an engine built to handle the various messages and formats, you must learn and understand how to establish connectivity with each new customer. This included setting up a VPN connection and addressing the site s security policies, which is unique to each health system and can differ widely from one case to another. Effectively working with a health system s IT department and collaborating with an EHR all at the same time to coordinate this connection takes an incredible amount of diligence, patience, and finesse. These functions can be fulfilled by integration engines available on the market. However, engines only get you halfway they provide tools to handle integration, but you still would need knowledge of the framework for initial setup to actually operate (that is, knowledge of HL7). Additionally, with every deployment at a new health system, your engine would need to be customized to correctly configure with the EHR being used. It s important to note that each instance of an EHR behaves differently from one health system to the next, even those using the same vendor. This means you would have to spend time learning about and configuring your engine for every single new deployment, giving rise to the unfortunately applicable phrase, if you ve seen one interface, you ve seen one interface.

5 Once an integration is complete, the work is still not over. Integrations are fragile, and many things may change over time necessitating a change to the interface. A few examples include: EHRs vendors will modify their program Health systems change their interface configuration Health systems replace entire EHR systems Regulatory changes can affect your product. - Meaningful Use is a prime example of how government mandates required ` industry-wide reconfiguration. Connections aren t always reliable. - VPN connections go down and systems have planned (and unplanned) downtimes. As you connect to more and more health systems, part of your team will always need to be dedicated to updating and configuring each connection. One change implemented by one EHR vendor could result in thousands of changes and hours of work on your end. To be agile in expanding to multiple health systems, you should expect to do the following for each installation: Analyze: before you begin any technical work, you ll need to develop a team that can evaluate the tasks to be completed with each new integration. Code: for every integration, you d need to adjust your product to handle the variation in data mapping. Each EHR has different functionality, so plan for additional effort when working with new vendors. Connect: for each new site you deploy your product to, you ll need to negotiate, configure, and maintain fresh VPN connections. Adapt: Changes among vendors, health systems, and even within the healthcare industry at large will require updating your product. Downtime spent updating can be seen as time wasted.

6 Business Considerations Beyond thinking about the knowledge needed to execute the technical work required, you need to approach integration from a business perspective. 3 Your business leaders will likely be evaluating this decision from a few specific angles. Here are the five most common considerations business leaders will weigh: Up-front Cost The up-front cost is the immediate effort required to develop the functionality to integrate versus partnering with an integration expert who already has the knowledge and skill set to execute projects. By slowing down your timeline and dedicating staff to prepping for integration, the money you spend will not see a return until much farther down the line. The money you spend on this phase could be spent on developing other core aspects of your business. Speed Many business leaders are focused on getting their product to market quickly and seek to adopt additional integration features to maintain their competitive edge. Choosing an integration strategy that is quick to implement initially and quick to update as you expand to new sites is critical to moving fast and staying competitive. Expertise If your team does not currently have a command of integrating, you will need to hire analysts and programmers to get your product off the ground and maintain it as you expand and adjust to changes in the industry. HL7 analysts and integration developers are expensive hires, and your team will only need more of them as you scale.

7 Credibility Given the risks associated with leaked health data, health systems are understandably judicious about how they share it externally. Most health systems require some type of security audit, and attending those meetings with a known and respected integration partner will help establish trust with the health system and get your projects prioritized and kicked off faster. Scalability Most application developers want to integrate at not just one health system, but expand to multiple health systems across the globe. Each EHR behaves differently from others, and without a tool to standardize the content coming from or going to each health system, you will need to scale your integration team as you deploy your product to more health systems. The main take away is that integration requires an intricately specialized skill set that takes years of experience to gain and is difficult to hire. If you choose to tackle EHR integration in-house, we encourage you to consider not only the immediate tasks, money, and time required to stand up individual interface connections, but also the long-term maintenance and support that s required to keep your connection healthy for as long as it s active. A Note on Total Cost of Ownership As mentioned above, hiring or training the right people to execute your integration projects is a resource-intensive endeavor. Based on an average HL7 analyst's salary, Redox estimates that within the first year of partnership, an average company will save 75% using Redox (as compared to integrating in-house). If you d like to see more on this, get in touch with us. We d be happy to explain how integration through our Platform will not only save you money immediately, but is an economically sound decision for the life of your connections.

8 How Redox Helps Redox enables companies to bypass the hurdles they often face when bringing their product to market. Often, some of the best and most innovative digital health solutions struggle to be used to their highest potential because integration proves to be too technical and time consuming for their team to tackle. Many of our customers have small development teams operating at full capacity who struggle to make time to learn the complexities of integration on top of developing their existing product. We let product teams remain focused on their application by providing both the API engine and a knowledgeable team of integration experts to install, support, and maintain every connection. With the ability to code once and connect to Redox, there are no up-front costs to sink into building out your team and no need to shift attention from high-priority projects. Our typical project is completed in weeks, not months, and our expertise in EHR integration comes from decades of hands-on experience. With staff members dedicated to monitoring connections and providing on-call support, we are able to quickly update connections while maintaining data security and HIPAA compliance. In addition, we power an ecosystem of applications that are live at sites running Cerner, eclinicalworks, Epic, McKesson, and others, giving you the advantage of coming to health systems with a well-known and respected integration team as your partner. Lastly, one of the main advantages of choosing an integration partner is the benefits in terms of scalability. Integration needs scale linearly with an application s number of customers. As your product takes off, so does the time, manpower, and resources you d need to dedicate to each new integration. With Redox, our network enables applications to deploy to multiple health systems without ever having to increase their IT team or infrastructure. Redox Gallery When you partner with Redox, you are eligible to list your product on our Public Gallery. We use it to promote the groups that are using us as their EHR integration partner and show health system administrators around the world the wide variety of digital health solutions available to their organization through one integration project. The goal of the Gallery is not only to showcase the amazing ecosystem of innovative applications we re building, but to also drive valuable leads to our partners. With an average of 10,000 unique visits per month, our Gallery is another advantageous marketing tool at your disposal. Click here to view the Gallery and all the organizations connected in our network.

9 Additional Resources If you d like to learn more about what integration with Redox looks like, click on the icon to download The Road to Going Live white paper which details phases of a project, key tasks, and who s involved from your team, our team, and the organization with whom you re integrating. For more resources on integration, visit us at and be sure to check out our Library page for industry insights, our FAQ page for answers to common integration questions, and our Downloads page for more content like this white paper. For direct support, drop us any questions or comments at hello@redoxengine.com and someone from our Solutions Team will be in touch with you shortly. Give us a call at any time if you have any questions you d like to discuss with an actual human being at (608)