In today’s world of rapidly emerging value based care reimbursement models, healthcare interoperability is essential. Yet in virtually every conference and client discussion about healthcare data integration projects, the high cost of interoperability invariably comes up as a big problem.
Why does healthcare interoperability cost so much today? What can the industry do about it in the future? What can your organization do about it now?
Few organizations kicking off an interface project requiring interfaces between two or more EHR vendors understand all the possible cost “gotcha’s” they will face. A key cost driver for interoperability is that most healthcare software companies today hit clients with 3-4 different types of fees for interfacing projects: 1) Software License fees to “turn on” certain types of interfacing capabilities, which routinely are “optional” software modules 2) Software Maintenance fees associated with those modules 3) Professional service fees for the vendor to implement the interface(s), and 4)possible “per transaction” fees.
By definition, an interface project that needs to move data from one healthcare software platform to another, will have at least two vendors involved. That means – double the fees!
Ouch. So even if you are using a low cost interface engine like Mirth® Connect (available free for anyone to download) to facilitate the project, you still may face significant fees from the source and destination system vendors.
In fairness to the vendors, interfacing just isn’t easy. Despite the wider adoption of interoperability standards in the past few years, there is too much variation in the standards themselves and how those standards are deployed in the real world. Until there is better industry alignment around a preferred, smaller menu set of standards, or until newer standards emerge that lend themselves to less variation – interfacing will continue to be a challenge for vendors and providers alike.
Here is the good news.
First – the availability of a free, open source Interface Engine with the robustness of Mirth® Connect is still a really good thing for the healthcare industry. Mirth® has not received enough positive press in my opinion for being part of the “solution” as it relates to reducing healthcare interoperability costs. Even their commercial licenses are designed to minimize costs for higher volume clients, with no licensing or maintenance fees related to the interfaces themselves.
Other integration vendors may seem less expensive if you are standing up a handful of interfaces, but if they have a pricing model based on number of interfaces, you may quickly find your costs escalating over time and becoming unsustainable. And Mirth® lets you “self serve”. With their “import/export” feature – you can build a library of common interface types and reuse them. It’s a pretty cost effective approach.
From an EHR vendor perspective, their business policies and associated fees for interfaces has received significant attention this year. At a congressional hearing in March of 2015, Epic was in the hot seat, given that they represent a significant market share.
Their “per patient” fee seemed reasonable at $2.35/patient, regardless of how many downstream providers received the data and they made a strong case they weren’t engaging in data blocking. However, no mention was made about other fees that might apply – such as the fee to “turn on” the CCDA functionality in the first place. But the fact that vendors are being called on to testify in front of Congressional committees about interoperability capabilities, policies and costs creates industry pressure that may be starting to pay off.
For example eClinical Works recently announced that they are offering free connectivity to hospitals who have systems that can support the IHE (Integrating the Healthcare Enterprise) standards for CDA (Clinical Document Architecture) exchange.
And NextGen Healthcare is waiving interface license fees for providers who are connecting to any Mirth® powered Health Information Exchanges (HIE’s). Mirth® has a growing list of state, regional and community HIE’s, both public and private – so this is not insignificant in terms of impact, especially for on-boarding smaller practices who may not have been able to afford to connect to their local HIE’s previously.
Perhaps the cost tide is turning.
Arguably, the most important lever to lowering the costs of interoperability is the federal government (CMS/ONC) and the Meaningful Use of EHR’s program. Meaningful Use 3 Final rules require participating providers and their EHR vendors to achieve at least some level of interoperability. And the MU3 rules include a more flexible approach to how interoperability is achieved while also encouraging the move to what could eventually prove to be a lower cost approach to interoperability using API’s.
EHR vendors who want to achieve MU3 certification will have to address underlying software issues that impede 3rd party interfacing, or they will not be able to “scale up” to meet the increased demands for interoperability. I have heard some internal EHR vendor discussions. To say the interoperability requirements in MU3 have their attention is an understatement.
But what about you and your organization. What do you do today to lower the costs of your healthcare data integration projects?
Here are some recommendations to consider:
Understand that “EMR vendor fees will apply” – and can be negotiated. Don’t accept the first quote. And be sure they are giving your organization insights into all the potential costs related to the interface project.
Don’t keep paying over and over again for the same interfaces. The problem with point to point interfaces is that you never achieve economies of scale. That is where a tool like Mirth® Connect comes in. It can “catch” a data feed from your primary EHR vendor, then route to multiple destinations, handling needed transformations. You are able to turn one interface into many.
If you are shopping for an interface engine, watch out for vendors who sacrifice robustness for ease of use. The variation in healthcare data and messages means you need a swiss army knife – not just a screw driver. The robustness of Mirth® Connect to handle a huge number of possible data types and connections is why it is our favorite tool here at Zen.
Finally – remember that you are not in this alone. There are healthcare IT consulting companies (like us here at Zen Healthcare IT, for example) that have the “been there – done that” expertise that get healthcare data integration projects completed faster, cheaper, and with less headache.
Or, as we like to say around here, when it comes to interoperability, it’s all about finding that Zen moment.
Contact Details:
Zen Healthcare IT, LLC
949.396.1295
marilee@consultzen.com
www.consultzen.com
