Systems Integration: The Electronic Records Linchpin
May 2005
The term "electronic medical records system" is something of a misnomer. While many health care information technology vendors sell products by that name, no such software comes in just one box. In reality, it's the combination of various clinical information systems-documentation, dictation, computerized physician order entry, laboratory, radiology and many others-that together make up an "electronic medical records system." Consequently, all the various systems must be made to work together to present physicians and nurses with the complete record of a patient.
Just like a linchpin is used to hold together a complex set of parts, systems integration technology bands together the clinical applications needed to create an electronic medical record. The technology enables CIOs to facilitate data sharing among information systems or present disparate data in a common application.
Many say the solution to bringing systems together is to go the "single-source" route-buying all clinical applications from the same vendor, which offers them in an already integrated fashion. However, most organizations that choose the single-source strategy quickly discover that one vendor simply cannot offer all the requisite systems. Or they find clinicians in some departments want to use an application they consider better than that offered by the single-source vendor.
Deceptively simple
What clinicians see when they access electronic records is a deceptively simple view of an information technology infrastructure. Data is neatly arrayed in columns and tables, and a few mouse clicks can set off an amazing chain of events-lab tests are ordered; radiology images pop up on screen; prescriptions are checked and sent to the pharmacy in a matter of seconds.
Typically, though, electronic records users don't know the effort required to get all the information from disparate systems in one place at the same time.
For example, do clinicians using the electronic records system at Montefiore Medical Center know that their single view of clinical and demographic data requires more than 400 interfaces to operate? Or that each time they click "send," bits and pieces of data are being parsed to numerous information systems through the delivery system's interface engine?
On a mission
"We used to joke that our bathrooms would be paperless before our nursing units. But when we decided to implement an electronic record, we really went on a mission with our information systems," says Jack Wolf, Montefiore's CIO. The Bronx, N.Y.-based, two-hospital delivery system uses Carecast electronic records software from Burlington, Vt.-based IDX Systems Corp. and an interface engine from Software Technologies Inc., Monrovia, Calif. "If you really want to create a seamless electronic record, there is an enormous amount of work to be done before that's even remotely possible."
Behind every successful electronic records implementation is a backstory of systems integration-a tale full of inspiring highs and depressing lows, heroes and villains, treasure in the form of clinical data and sometimes vendor paychecks.
If the industry is serious about widespread adoption of electronic records, this is a story that will be told again and again. CIOs and I.T. experts agree that integration technology-coupled with increased and uniform use of messaging standards-has made systems integration a more manageable task.
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