The integration illusion: Why connecting to EHRs is about value, not standards

Digital health companies are often guilty of putting the cart before the horse. They’re so focused on how to integrate that they forget to ask why they’re integrating in the first place. These groups are often working backward, deriving their product from tools available to them. This is functionally equivalent to asking “should I use Postgres or MongoDB?” or “Should I use Python or JavaScript?” before you’ve thought about what the app will do. When it comes to technology, there’s very rarely one perfect tool across all use cases and variants of a problem – this applies to integration standards and platforms as well.

These decisions of “how to accomplish something in a technical sense” are downstream of the more important questions – what you are building and why you’re building it. No matter what the integration technique, every tool needs to solve a problem and actually be useful enough to warrant the time and investment from a provider organization to turn it on.

The popular narrative in digital health is that integration is hard and EHR vendors block access. While there are undoubtedly some anecdotal stories to back this up, the far more common root cause is that solutions attempting to sell to health systems fail simply by failing to provide unique, differentiated value. Agnostic to cost considerations or specific EHRs – almost any workflow is possible in some way – via API, interface, flat files, screen scraping, or direct to database. The more valuable you are, the more a health system will be willing to invest to accomplish deeper and more difficult integrations. If your value proposition is light, then accordingly they will invest less and put you deeper on the priority list.

Before you even think about integration, ask yourself:

1. What problem am I solving?
2. Why should healthcare organizations care?
3. How am I different from the 17,000 other apps claiming to “revolutionize healthcare”?

Ultimately, if you cannot concretely answer the question of differentiated customer value, it’s time to step away from the API documentation and do some soul-searching. Integration is the wrong thing to do at this point. Learning from prospects and customers and building a product thesis you are confident in. It is almost always better to create a product with little to no integration to validate hypotheses and gain traction than to saddle your product with the technical debt of unused integrations.

Understanding what problems you solve will funnel into the next important question – What specific workflow are you enhancing or replacing? As discussed in “How to Win Friends and Integrate Systems”, workflow drives dataflow. At HTD, we help applications plan out their integrations by defining their ideal workflow in these three core categories:

How is an application getting the list of patients relevant to them?
Common enrollment mechanisms include orders for a specific procedure, all visits scheduled in specific departments, or just all patients that the organization creates

What data does the application need for enrolled patients?
Generally, applications need additional data beyond the enrollment information, such as a patient’s medications, allergies, problems, lab results, or notes.

What needs to be pushed back into the EHR to close the loop or reduce double documentation?
Oftentimes this is as simple as a note or PDF document, but more involved integrations may include vitals or discrete results

How are core data elements (such as provider directories, location/facility lists, and service catalogs) kept in sync between systems to ensure the application is using the right codes when writing back into the EHR?

• For initial integration scopes, this synchronization may be manual or may not even be necessary, especially if the application is not writing back into the EHR.

How can context such as the user’s EHR login credentials, the active patient, and the active encounter be shared with the application, improving user experience and security?

These additional integration types, while valuable, are usually implemented after the core workflow integrations are in place. They enhance the overall system interoperability and user experience but are not typically critical for the initial deployment of a new healthcare solution.

Along those lines, as a last step before diving into technical specifics, applications should think about their minimum viable integration (MVI). This approach mimics the minimum viable product approach – if you believe there’s a minimum workflow to unlock value for your customers, you can reduce unnecessary rework if you develop only the integrations necessary for your minimum workflow. This has a few direct benefits:

• Applications that are live with integration are sticky and stay live at a higher rate.
• More complex and less necessary integration that requires more testing and operational investment can better be validated by customer needs.
• Once developed, advanced integration capabilities and associated workflows naturally fall into higher product tiers.

MVI is a powerful framework to unlock quicker integration projects, faster iterations, and better alignment with your customers what’s needed most.

Before you dive headfirst into the integration ocean, make sure you’ve built a boat worth sailing. Focus on value, understand your workflow, and start small with MVI.

If it still seems challenging, we’re here to help. At HTD, we’re not just cheerleaders on the sidelines of your integration journey – we’re your co-pilots, navigating the turbulent waters of healthcare tech with you. Here’s how we can help:

• Strategy: Our team of healthcare veterans can help you refine your value proposition, identify your target market, and develop a rock-solid integration strategy. We’ll work with you to define your MVI, ensuring you’re not building the digital health equivalent of a Swiss Army knife when all you need is a simple screwdriver.
• Design: Once we’ve nailed down the strategy, our UX wizards and workflow whisperers will help design an integration approach that fits seamlessly into existing healthcare workflows. We’ll create user-friendly interfaces and intuitive data flows that make providers wonder how they ever lived without your app.
• Development: With a solid strategy and design in place, our crack team of developers will bring your integration to life. Whether it’s HL7, FHIR, or some obscure standard that only three hospitals in Nebraska use, we’ve got you covered. We’ll build robust, scalable integrations that can grow with your product and adapt to the ever-changing healthcare landscape.

In the world of healthcare integration, it’s not about how many standards you can juggle or how many APIs you can connect to. It’s about solving real problems for real healthcare organizations and patients. At HTD, we’re committed to helping you do just that – without losing your sanity (or your funding) in the process.