Two years ago, Alexian Brothers Health System in Arlington Heights, Ill., decided to upgrade its integration software to allow four hospitals to communicate across 50 different applications. At the time, three Alexian hospitals had their own hospital information systems (HIS) and a variety of standalone financial and clinical applications.

Alexian Brothers eventually made Westwood, Mass.-based Meditech Inc. the HIS for all its hospitals, but the infrastructure still needed an integration engine. Fred Henning, senior technology analyst, helped select Middleton, Mass.-based BridgeForward Software Inc.'s ClearSpan Server because of its ease-of-use and ability to be customized for different IT environments.

“It's a fairly simple interface that allows us to be able to do just about anything,” he says.

Integration or interface engines provide large hospital systems such as Alexian Brothers a way to coordinate data from multiple information systems. Employing hub-and-spoke or distributed network architecture approaches, integration engines allow for messaging between applications.

Michael McLeod, president of Pottstown, Pa.-based consultancy McLeod CG Inc., recalls that the first integration engines were developed in the mid-1980s to facilitate the transfer of information between hospital “silos.” McLeod sees a new emphasis on integration being driven by a need to comply with HIPAA standards for healthcare communication and a desire “by the hospital industry to reduce redundancy and medical errors.”

Integration engines “are becoming more important now that integration and interoperability are what people are increasingly focused on,” he says.

Recently, the development of protocols — such as HL7, XML, ASTM and NCPDP — for data transfer has helped create better pathways for integration, says McLeod.

Propelling interface engines has been a growth of hospital mergers, a push by the government for electronic medical records and the creation of national and regional health networks, adds John Moriarty, CEO of BridgeForward Software Inc. Taken as a whole, he sees the market more in hospitals, less in regional networks. “RHIOs are interesting but less real than everyone believes, they're high on the hype curve,” says Moriarty.

Even so, “Integration engines are a much bigger deal than five years ago,” he says. Hospitals being merged, or using best-of-breed applications, are the two sweet spots for his firm. “You see one hospital with one integration engine merging with another with a different engine,” he says. Those situations, along with much larger hospital mergers, are creating “replacement opportunities.”

The growing popularity of “enterprise master patient index” applications or EMPI — which gives users an opportunity to collect data on patients from a variety of databases — has only helped integration engines since hospitals need one to employ EMPI technology, he notes.

The integration market itself has gone through a transformation over the past several years as Microsoft (Redmond, Wash.) has jumped into the field with BizTalk, says McLeod, and, ironically, several mergers of existing integration providers occurred, among them: Healthcare.com and Excare.net became Quovadx ISD (Greenwood Village, Col.); Sybase Inc. (Dublin, Calif.) added CAI and Sun Microsystems Inc. (Redwood City, Calif.) purchased SeeBeyond.

Moriarty's own tale is one of development and merger. He started MicroScript Corporation in 1993 to provide application integration technology on Windows' NT platform. He sold the company to New Era of Networks, Inc. (NEON), and it later became part of Sybase. Moriarty re-acquired “e-biz 2000” from Sybase — a product he developed while at MicroScript.

Today, the new e-biz 2000 software (now BridgeForward ClearSpan Server) is part of the company's application suite. And Moriarty's casting his eyes as much on Europe as the United States, having recently inked deals in the United Kingdom, among them an implementation of EMPI for two-way communication in the 50 hospitals of BMI Healthcare. Says Moriarty: “There's a very active integration market in the United Kingdom that's expanding to Scotland.”