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Seamless vs. Seamingly Integrated: Clarifying the Misunderstandings of EMR Integration

Thinking about EMR integration always reminds me of the potato - potahto /tomato - tomahto song, especially when they suggest that it’s best to “call the whole thing off”.

That’s usually what I hear from providers regarding EMR integration.

It makes sense, too. For most of healthcare technology’s history, integration has been complex and costly. Worst of all, no one has come up with a clear definition of “integration” in the first place. Interoperability is so bad among healthcare systems that the only way to feel good about it is to throw a bunch of nothing into a grand description called “integration.” But a buzzword-title doesn’t make the problem go away. In Texas, we call that putting lipstick on a pig.

Integration doesn’t have to be this way.

True integration is when all things come together to achieve the goal of improved efficiency, quality, and effectiveness.

The Secret Challenge of EMR Integration

One of the most misunderstood aspects of EMR integration revolves around scheduling.

Not all EMR integration is alike and integration does not fit all scheduling functions, even in the same EMR. This means that when your HIT vendors tell you they are absolutely capable of exchanging information, what they really mean is certain information, and usually just information related to clinical documentation. Rarely does this incorporate every aspect of patient scheduling.

I hear your gasps. It was a shocker for me too when I first found out, and I am still surprised today by the lack of consistency with this specific data set.

Jake McCarley, Blockit’s founder and CEO, helped illustrate the inconsistency for me using a transportation analogy. Even my tiny brain could handle that!

Suppose three transportation providers come to you and say, “we provide seamless real-time transportation.” As you dive into it, you learn the first provider uses non-motorized children's’ scooters, The second leverages the public bus system and gives you a bus pass, and the third provider hands you the keys to a Honda Accord.

All three providers are indeed transportation and could be considered “seamless” and “real-time”, but your experience and what expectations you have will vary significantly based on what you need to accomplish.

Offering “seamless, real-time transportation” does not provide enough information to know the differences. Choosing the children’s scooter to get from Dallas to Houston would be a very bad experience.

Not all EMR integration is alike and integration does not fit all scheduling functions, even in the same EMR.

The same thing happens with EMR integration. Just a few weeks ago I was working with a mid-sized suburban healthcare system with a “highly interoperable” well known EMR / PMS that has all the leading interfacing technologies (see table below). It is “so interoperable” that they have built impressive tools that “seamlessly integrate” with the EMR / PMS for some pretty impressive use cases, except for one.

The health system couldn’t schedule patients across their dual (acute and ambulatory) EMR infrastructure.

“The EMR / PMS solution has an API,” they said. “Look at all this great interoperability.”

These things were true for everything except for appointment status, patient insurance and consistently providing schedule availability. Without incorporating each method, the goal of digital care coordination would never actually happen. Sure, aspects of scheduling are doable, but in care coordination, having some data elements is just not enough to deliver on a true continuum of care. They thought they were getting the Honda Accord but were given a scooter instead. Suddenly, it’s not so seamless.

Making EMR Integration Work

This challenge does not make integration healthcare’s enemy, though. Integration, when done properly, can vastly improve the patient experience and simplify scheduling for providers and their staff. Integration is not the problem. The way things are integrated is. Overcoming the challenge means finding a better way to integrate.

Blockit’s integration engine uses multiple methods combined to truly provide a “seamless integration experience.”

Our process incorporates all inputs - ranging from native database access to HL7 to proprietary APIs and the latest FHIR APIs.

Blockit takes all these inputs and converts everything to the latest FHIR standard. Our own internal applications communicate in FHIR only. This enables us to do four things:

  1. Create a normalized experience across multiple EMRs,

  2. Ensure security,

  3. Speed up the implementation process

  4. Make our connections readily available to our healthcare partners for re-use.

This is true integration. All things come together to achieve the goal of improved efficiency, quality, and effectiveness.

Each time we erode the automation by requiring human intervention, we materially erode the overall value of the whole in such a way that one must reconsider the value of doing it at all. Like the potato, potahto argument, we might as well call the whole thing off.

But it doesn’t have to be this way.

You can have seamless integration that leads to a complete digital care coordination experience with Blockit.

To discuss how you can utilize Blockit’s platform to overcome the challenges of EMR integration, click here.


Dave Gregorio is the Chief Customer Officer at Blockit and the author of the Purpose Quotient®, a nationally recognized framework for Organizational Development. A 30 year healthcare industry professional with a passion for people, Dave is the founder of the Heroes to Healthcare mission and CEO of ImPowerQ Associates LLC.


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