Continuing on with the series on what is a patient portal, I want to talk about integration. This represents a large effort for any true patient portal. By integration I mean, the effort and services necessary to pull data and complete transactions to one or more back end systems. In other words, a patient portal shouldn’t house the data for any one system. It’s goal should be to pull the right data from the system that already owns that data. In today’s more connected world it shouldn’t cause too much time and effort…………….unless you have no services layer (keywords SOA and ESB). Unfortunately for most hospitals, they have no services layer so building one adds to the short term expense while decreasing long term costs.
Here’s a list of potential integrations a patient portal could drive:
Any EMR like Epic, Cerner, Meditech, GE, Siemens, and a host of others comes to mind as the first integration you will do. You need this integration for MU2. Most vendors however, don’t have the API’s to make this simple. They are happy to provide HL7 messages in batch mode which you can harvest. But you cannot make a real time query. At the same time, most EMR systems are not sized correctly for real time transactions even if they did have an API.
You have two options at this time. First, you can pull those HL7 messages and put them into some sort of data warehouse or hospital specific information exchange (HIE). This can add a lot of benefit from a reporting standpoint and this system could pull patient interactions from multiple systems like the Hospital EMR and your local clinic’s EMR. Of course, it can be an expensive approach whose benefits will only be realized in a couple years.
Your second option consists of harvesting the HL7 messages from the EMR and putting them in your own database so you can make real time queries. This cheap and easy options lets you get hospital specific transactions from a Continuity of Care Document (CCD). However, it doesn’t give you the long term flexibility and agility of the datawarehouse above.
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Behind the EMR integration, integrating to your billing system drives the most value. Anything that lets drives down your Day Sales Outstanding (DSO) or increases the number of payments makes a lot of sense. But to do so, you need an API of some sort that you can call. If you want to get really spiffy, then you also want either the PDF bill or a streamed bill to view. Now add on the fact that any payment must be from a system that is PCI compliant. I mentioned this in the regulated post. It’s not a healthcare standard. It’s a commerce standard that ensures that you never lose or expose credit card information. PCI compliance demands a yearly re-certification as well.
When you put these all together, bill pay integration will take a significant amount of effort.
Find a Doctor
Every hospital has a different way to create find a doctor. Your patient portal will need to find that data source (Salesforce.com, custom db, in the EMR, etc>). Once you’ve found the data source, you will want to extend the data model to capture things like your favorite doctors. Then you will want to surface it in your portal.
You may get lucky and only have one appointment system. But if you are like most hospitals, you will have acquired a few Doctor’s businesses and clinics. You may also have acquired one or more hospitals. Finally, you probably have affiliated physicians who have their own systems. You could certainly try to create an integration to each of these systems but you are probably better off going to companies like MyHealthDirect (and a whole bunch of other companies) Regardless, you will spend a lot of time making it work and a lot of effort convincing your Doctors to support it.
Classes and Events
Just like Find a Doctor, almost every hospital has a different place to store and manage classes and events. You need to find the data source, create API’s or services for it, and bring it to your patient portal. Like Find a Doctor, you will want to enhance the application to display old classes and upcoming classes.
I add this to the possible integrations list despite the fact that I’ve never seen an actual integration. Those hospitals I see doing it just take the pre-registration form and do manual data entry into the EMR. For reasons why, look at the EMR paragraph above. EMR’s don’t like others to do data entry and they have no incentive to provide those API’s.
I’m not going to go into a whole bunch of other options but integration could come from almost anything including:
- Web Content Management tools
- Third party content. (possible trend to make it contextual rather than a wholesale dump)
You cannot do a true patient portal without thinking about integration. You will probably spend more time understanding, defining, and implementing the integration than you will creating a nice user interface on your portal.