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I’m proud to be part of a company that works with leading hospitals including UCSF, Mount Sinai, and many others who are on the forefront of innovation in healthcare. But at its core, while some hospitals have embraced transformation, most remain stuck in the past, and here’s why.

Hospitals can be an extremely chaotic place. With overworked doctors and nursing staff as well as patients non-stop streaming in and out, something crazy is happening every minute of the hour. It is astonishing to see the amount paperwork and data entry that is required from the staff in the middle of this life-saving chaos.

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I have worked in enterprise IT for over a decade and helped businesses become efficient with automation and connectivity. Americans pay $3.4 trillion a year for medical care. I wonder how much of it is getting lost in hours of paperwork and data entry.

Hospitals have been trying to computerize themselves for decades. There are various reasons why this hasn’t kept pace with rest of the world. To summarize, healthcare is a difficult domain, but it doesn’t have to be that way.

At the center of this computerization effort sits an electronic health record (EHR) system. A system that promises to improve the delivery of clinical care and has been around for decades under different names and countless abbreviations. Over the years EHR systems have become a monolithic piece of software serving as a system of record for patient care.

There is a rapid adoption of EHR by hospitals of all sizes. The meaningful use incentives as well as the penalties for not using an EHR, have been the main reasons for the high adoption of EHRs. The EHR vendor space is highly fragmented with over 1000 EHR providers in the vendor space. There is still not a single system that is complete with true interoperability, which brings me to my next point: What is the state of interoperability in healthcare?

Interoperability in healthcare

Interoperability in healthcare has its own set of challenges:

1) Hospitals are reluctant to invest capital towards interoperability because patient mobility was viewed as a loss in revenue.

2) EHR vendors are reluctant to build true interoperability into their systems, in order to maintain vendor lock-in.

This lack of interoperability is one of the biggest reasons why healthcare IT at the majority of hospitals is stuck in the middle ages and cannot support the needs of quality care.

The interoperability gap in healthcare has existed for several years. Patients, caregivers, and physicians have been frustrated with the lack of innovation. More recently, however, we have witnessed more and more hospitals join the great wave of innovation in the healthcare field.

More specifically, the shift from fee-for-service reimbursement to value-based payments that put providers and insurers at some risk for the cost and quality of care, has fueled the motivation to innovate, and provided healthcare institutions with a unique opportunity to move forward.

According to Accenture Strategy research, 60 hospital-sponsored or corporate venture capital funds are now actively investing in healthcare startups. From 2009 through 2015, they invested a combined $10 billion in healthcare technology companies, with that investment more than doubling in the past four years.

This is certainly very exciting, but all of this external innovation will eventually need to tie into the existing EHR systems. How can hospitals address some of the interoperability issues we discussed earlier to foster innovation?

According to several Harvard medical school professors, EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share, as well as block new entrants.

In reality, diverse functionality doesn’t have to reside within single EHR systems.There’s a clear path toward better, safer, cheaper, and nimbler tools for managing health care’s complex tasks: digital platforms.

The role of platforms in healthcare

With lack of support from traditional EHR vendors to build true interoperability, providers are turning to platforms that can sit in between the EHR product and external applications and partnerships.

Such a platform needs to provide the following:

1) Out of the box connectivity to EHR Modules. This can be via HL7 interfaces, traditional SOAP services or FHIR based interfaces.

2) Easy data transformation, translation and routing capabilities.

3) Built-in API management to govern and secure the access points. This will enable outside applications to securely access only the most relevant data from the EHR system.

Equipped with the above platform features, hospitals will have the tools necessary to foster innovation and ensure better, faster, and more reliable interoperability across applications and systems.

MuleSoft: A partner for hospitals and other healthcare institutions

At MuleSoft we work with leading hospitals and health systems like UCSF, Sutter Health, and Mount Sinai Medical Center to enable this platform-based approach. By leveraging out of the box HL7 connectors and FHIR templates we have helped hospitals implement projects like IVR modernization, mobile appointment scheduling applications, and remote patient monitoring solutions––among many others.

With an API-led approach, hospitals have not only realized success on the individual project level, but have leveraged reusable connectivity assets to deliver incremental projects requiring EHR data much faster than before. To help organizations adopt such an approach, MuleSoft provides Catalyst Accelerator for Healthcare, a publicly available offering that includes pre-built APIs and a prescriptive architecture to help health IT teams jumpstart the development of common healthcare applications.

These types of IT projects have played a key role in helping improve patient care, while aligning these organizations with the broader industry movement toward value-based care.

A followup to this article will be a step-by-step guide to extending these resources to create a patient API on top of an EHR that can expose data across a variety of channels––from IoT devices to IVR systems. Doing so can provide enormous value, unlocking siloed data in a way that eliminates the need for custom point-to-point interfaces between each clinical or non-clinical data endpoint.  

While healthcare faces unique challenges when it comes to interoperability, digital transformation provides an opportunity to make a massive impact on patient care, and on society writ large. Hospitals and health systems employ some of the brightest clinical minds in the world, and by providing clinicians with the right technology and information to inform patient care, there’s no limit to the impact that can be made in the hospital, and in our communities.

Learn more about how MuleSoft accelerates IT innovation in healthcare.