Is off-the-shelf integration to an EHR or EMR right for you?

Doctor holding digital tablet

Healthcare is a space ripe for innovation; there are many interesting problems to solve in terms of delivering healthcare and its administration. I often have clients ask, can off-the-shelf integration products support their healthcare record systems? Let’s discuss the answer.

Challenge: Integrating with Existing Systems

A major challenge in the healthcare space is integrating with existing Electronic Health Record (EHR) systems.

Healthcare integration poses many benefits, including streamlining workflow, reducing errors, lowering healthcare workers’ load, and promoting faster communication.

Yet it is extremely challenging for companies, especially small ones, to take on the burden of integrating with every health provider’s back-end systems. In large health systems, there can be many products with which to integrate for a single solution.

This need for healthcare integration has become more pressing in recent years due to the advent of FHIR and the 21st Century Cures Act.

What is the 21st Century Cures Act?

The Cures Act, signed into law in December 2016, is designed to promote and fund the acceleration of research into serious illnesses, accelerate drug and medical device development, and make sharing electronic health information the norm in the healthcare industry.

In an effort to improve the quality of care for patients, the Cures Act requires interoperability across EHR platforms and emphasizes that healthcare organizations give patients full access to their healthcare information.

What is FHIR?

Fast Healthcare Interoperability Resources is an interoperability data standard developed by HL7 International.

FHIR specifies how healthcare data is stored, organized, and ultimately exchanged between computer systems, ensuring information like clinical and administrative data is available securely to those who need to access it.

With the 21st Century Cures Act enforcing FHIR, is integrating for a single solution still a problem? 

The answer is, to an extent, yes. 

The Cures Act and FHIR have made the standardization of data in the healthcare industry much more commonplace than it was a decade ago.

However, the healthcare sector continues to struggle with integration. Challenges like EHR interoperability issues, data inconsistency, security risks, and lack of personnel resources are blocking many organizations from successfully integrating.

Overcoming Healthcare Integration Challenges

Thankfully, there’s a myriad of Integration as a Service (IaaS) products that support this kind of integration – mapping EHR systems to a set of canonical models abstracting complexity, typically handling connectivity setting up VPNs to the health system’s environment; and typically handle monitoring of the connection.

A couple of examples in this space are Redox and iNTERFACEWARE. This can be a desirable option for integration, but it may not always be suitable for your organization.

Considerations When Choosing Integrations as a Service (IaaS) Products

Development speed, supported interfaces

Simple products may require minimal integration surface area and may not be worth taking on the complexity of including an integrator into your systems. However, it will be worth creating an adapter layer in the application to handle different provider implementations. 

Depending on your integrator, you may not have all your data requirements covered. The integrator may develop new models for you, but it will be prioritized against their roadmap and other customer needs.

There’s potential complexity when it comes to organizations, reliability, and system monitoring.

Developing against a single model instead of every single customer’s individual model simplifies development.

That said, if not all of your data demands are covered, you have the complexity of using a partial roll-your-own and an integrator product, increasing complexity and your surface area for failure.

Vendor lock-in

If you choose to use an integration vendor, you’re choosing to use their model structure and operational paradigm. This makes changing vendors challenging.

Even if you plan architecturally, swapping out a key piece of technology is expensive and time-consuming.

Speed of customer rollout and experience

One of the key benefits of Integration as a Service ( IaaS) products is their experience navigating the complexities of integrating with a healthcare provider’s systems. Providing a smooth process, their expertise can be invaluable if not readily available within your existing internal teams.  

Products already in place can reduce implementation time, allowing for a quick connection to their services. However, the integration provider becomes an extension of your product, including customer experience.

You must be comfortable with how this approach is handled since it will directly represent your organization to customers. 

Another consideration is rollout availability – each vendor has limited implementation capacity. Your product rollout will be prioritized against their other customers; rollout timing may not be in your sole control.

Security and operational ownership

Rolling out to a healthcare system is not always straightforward. Oftentimes you need to go through a security review process. If your integration provider is new to their systems, it will likely mean two security review processes – one for your provider and one for your product.

When you outsource integration, you’re handing off ownership of security, reliability, monitoring, alerting, and all manner of operational context. Be certain that you are comfortable with a vendor team managing operational capability rather than your internal team.  


There are many different cost models, but one of the most common is a per-installation model.

When your customer base is small, this model can be hugely beneficial when you weigh it against all the operational overhead you take on managing it yourself. As your customer base expands, though, this cost increases dramatically.

If considering cost alone, consider the growth rate of your organization and customer base. 

So, How Do You Approach Healthcare Integration?

Largely, the choice depends on your operational readiness, your development capacity, and your customer projections.

If you’re a brand new startup with no experience integrating with the medical space, then the options above stack heavily in favor of using an integration product.

If you’re an established company with an existing customer base and existing operational capability, then you may want to consider your roadmap and the data requirements you have now and in the future.

AIM Consulting is a trusted advisor for EMR, EHR, RIS, and Healthcare Providers – building devices to generate, collect, analyze, and transmit data – creating a fully connected infrastructure of health systems and services.

Our team of experts is available to discuss Emergent Telehealth systems, Cures Act, FHIR, and projects aligned to MedTech & IoMT. We look forward to hearing more about your organization’s needs and how our team can support your internal teams. 

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