Interface vs. integrate – is it an either-or?

When working in the complex healthcare environment, the devil truly is in the details.
Written by Thom C. Blackwell,, Contributor

Commentary - In today’s hospital setting, the chief information officer (CIO) manages technology to serve a variety of departments and requirements. While each one has highly specialized needs, in order to maximize efficiency and improve patient care, departments cannot operate within information silos. They must be able to share patient information. The end goal is to provide technology tools that allow healthcare providers to do their jobs, document their efforts in an efficient way and assure the hospital gets paid for the services it provides.

CIOs tend toward one of two basic strategies: choose departmental software based on individual merits (referred to as “best-of-breed”), and link these systems together with interfaces or follow one primary vendor with intent that their departmental systems will naturally work together.

Single vendor option
So which is better, best-of-breed or single vendor? I work with hospitals in each camp. Hospitals opting for the single vendor solution seem to be locked into specific workflows and sets of information; they don’t have many options or much control if the workflow needs to be customized or changed.

Even if a hospital purchases an integrated system from a single vendor, it’s likely going to include or require interfacing. To gain customization, a hospital may request a product change from the vendor. However, these special requests can be expensive or require specialized technical and communication skills. Many of these vendors have grown through acquisition, purchasing what used to be best-of-breed applications and adding them into their own system.

Even for the pure single source vendors, we find that there are holes in functionality, as they discover variations in workflow among their customers. The strong market for niche bolt-on applications proves this point. A hole in functionality typically requires manual effort to complete a workflow. Sometimes this effort crosses multiple modules of the system, other times it’s between a human content-builder and the application. That’s when desktop level interfacing often comes into play.

This example of interfacing within a single vendor solution is saving IS staff and users as much as a thousand hours each year. When South County Hospital in Wakefield, R.I., purchased its MEDITECH system, Gary Croteau, Assistant Vice President/CIO, and his IS team realized that one major component missing from the HIS was the ability to put reports into production. At the time, Croteau and his team were managing report production manually, which was time consuming for the IS resource side. In addition, the demands of teaching and assisting staff to run reports were not efficient. In order to run daily reports, the IS staff uses technology to automate their production and push them out to the Intranet. It does not require additional resources from the IS staff to run reports because the process is automated.

The issues hospitals face with a single vendor solution don’t seem as prevalent from best-of-breed adopters. However, an ill-fitting application will have these problems.

Interfacing best-of-breed applications has gotten easier. In pre-HL7 days, simply moving data was a challenge, as the network architectures and applications weren’t as sophisticated as they are now.

In reality, many hospitals need to purchase or develop a point-to-point interface to send or accept a message feed from a vendor or third-party consulting firm. To customize their workflow, a hospital may request a product change from the vendor. However, these special requests may require specialized technical and communication skills and be an expensive proposition.

Standards such as HL7 have helped tremendously with the ability to share information, as have the development of standards- and non-standards-oriented interfacing software such as Boston WorkStation and interface tools. There will always be specific interfacing situations where a standard simply doesn’t exist, is too inflexible or is not supported by a vendor for a given workflow. We help hospitals and vendors solve these challenges every day.

Interfacing does not always mean behind the scenes data movement using messages or files. Interfacing can also occur at the user’s desktop. These types of interfaces maximize productivity and increase accuracy by linking helper applications with the main systems, especially in registration and the business office. This desktop level interfacing can enable additional functionality that may not be a native feature of the application. Examples include: insurance and address verification, document scanning/archiving or even custom-built productivity enhancements.

Seemingly simple interfaces linking applications on a user’s desktop can yield huge productivity gains. Take a walk to the business office and see how often users are alt-tabbing between applications on their desktop to work accounts. Many times, they are typing the same information multiple times or using copy / paste to move data. Desktop level interfacing can automate a lot of this, which equates to significant productivity gains.

Saint Clare’s Health System in Denville, N.J., interfaces and automates different applications almost daily, even outside its clinical practices. The organization has recently rolled out an invoice-scanning system that uses automation technology to connect the invoice scanning system to the materials management system, from which approved invoices are forwarded to another system for payment. Automating this workflow streamlines the handoff process between the scanning system and the materials management system. The Human Resources department is using automation to integrate spreadsheets received from individual departments into the human resources software system to be automatically updated with approved salary adjustment information.

The reality is there is no either-or choice between single vendor and best-of-breed. Every healthcare organization must study its own processes and count on needing interfacing skills – both standards and non-standards based, back-end and desktop. In order to maximize workflow and increase productivity, hospitals will need to interface applications to bridge the gaps in functionality no matter what system is used. It is a cliché but, working in the complex healthcare environment, the devil truly is in the details.

Thom C. Blackwell, is the vice president of technical services at Boston, MA-based Boston Software Systems which specializes in workflow automation and system integration software. He may be contacted via email at thom.blackwell@bossoft.com.

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