HL7 Survival Guide - Chapter 4 – Your EHR Strategy and Working with Vendors

This guide is for healthcare integration analysts and their managers. In this chapter, learn how to work with third-party vendors when implementing a new system or migrating from one to another. Stay in control and avoid hidden expenses by getting answers to the interface-related questions from your clinical system vendor(s).

1. HL7 SURVIVAL GUIDE CHAPTER 4 A publication of A supplement to the HL7 Survival Guide, available at http://caristix.com/blog/category/hl7-survival-guide/

2. Caristix software brings your whole interfacing process together in a single, powerful platform. 2 ABOUT CARISTIX VENDOR-AGNOSTIC Work with any interface engine. NO MORE TRIAL AND ERROR Scope it right. Manage requirements. CUT TIME-TO-GO-LIVE Up to 50%. CLEAR YOUR INTERFACING BACKLOG Simplify dramatically. Align teams. REQUEST A DEMO http://promo.caristix.com/demo/

3. CHAPTER 4: Your EHR Strategy and Working with Vendors

4. Many organizations use third-party vendors when implementing a new system or when migrating from one system to another. 4 Nine Critical Questions You Need to Ask Your Clinical System and Interface Vendors Get answers to these 9 questions to stay in control of your projects and avoid hidden expenses.

5. 1. “Who provides the hardware, if any?” Validate that your new EHR or clinical system doesn’t need extra hardware If it does, validate any hidden costs Determine who does maintenance Verify the response time How do you determine who is accountable for arising issue? If there is a problem with data exchange, is the vendor going to help troubleshoot? 5 Question 1

6. 2. “What standard does your system use for data exchange? HL7? Which HL7 2.x version are you using? (A no-brainer at first glance – but you need this information!) 6 Question 2

7. 3. “Can you supply a list of customizations to the HL7 v2.x standard you are using?” You will find deviation in several ways: Custom messages, Z segments, customized data types, customized data sets, etc. Understanding these customizations help you grasp the overall interface and the amount of work required to integrate to other systems 7 Question 3

8. 8 Question 4 4.  “Within your HL 7 2.x based interface, can you tell me which elements and values are configurable?” Get the details If not, you face longer testing cycles with trial-and-error interface validation

9. 9 Question 5 5 .   “When you send us the interface spec for sign-off, do we get a fully documented list of gaps and exceptions for specific data values and data elements ?” Get the full list or face lengthy validation Avoid black-box syndrome ( http ://caristix.com/blog/2012/06/interface-black-box-syndrome / ) wherein the vendor maintains control of the interface

10. 6.    “Will you provide a list of the interface customizations you create for us?” What’s been customized for your environment? You need this list for troubleshooting and maintenance If not, you’ll be waiting constantly on vendor trouble tickets 10 Question 6

11. 7.     “How do you document changes and upgrades throughout the lifecycle of the interface? Do you automatically provide us with updated documentation?” What you get at go-live is not usable 2 years later Spell out the responsibility for document updates 11 Question 7

12. 8.   “ Does the interface you built contain any intellectual property?” Crucial point Does a license apply to the code? Will you own the interface or does the vendor? If the vendor is the owner, you will need to engage the vendor for every costly tweak or new project . 12 Question 8

13. 9.    “ How guaranteed is message delivery? Does each message get an “acknowledge” (ACK) or “no acknowledge” (NACK) reply?” Part of the HL7 standard No guarantee of message delivery without it 13 Question 9

14. 1 .   “If an application makes an information request, does the replying system acknowledge that it received the message or does it just reply ?” In the case of information requests (query messages for instances), the system will respond with one or several messages containing the information. In most scenarios, no ACK/NACK is involved as few systems implement Query/Response messages . 2 .    “ What happens if the replying system does not have the requested information?” The response format allows systems to return a message stating no information was available based on the criteria requested, rather than just sending a reply with blank fields. 14 3 Bonus Technical Questions

15. 3.   “ What happens when a message requests data be updated or inserted ?” Let’s say the lab system sends results to the EHR but the patient ID is not recognized at the EHR – what happens? The role of a message is to publish an event once it occurs and provide related information. How the information is handled is system specific and in some cases, the system might do nothing. While the system is responsible for handling the information received, the interface needs to provide information the system can handle. 15 3 Bonus Technical Questions (cont.)

16. Chapter 5 in the HL7 Survival Guide Vendors, Consultants, and interface specialists If you’re building your interfaces in house, you’ll be dealing with clinical system vendors. And if you’re outsourcing interface development, you’ll be working with consultants. Either way, you want to know what issues to avoid. Learn more in Chapter 5. Blog link: http://caristix.com/blog/2012/11/hl7-survival-guide-chapter-5/ Slide deck on Slideshare : coming soon. 16 UP NEXT: CHAPTER 5

17. Is a recommendation unclear? Disagree with something we said? Let us know! We thrive on feedback. Contact Us [email protected] 1-877-872-0027 17 QUESTIONS? FEEDBACK? © Caristix 2013. All rights reserved.