Spurred by a plethora of healthcare reform initiatives including meaningful use, health information exchanges (HIEs), accountable care organizations (ACOs), healthcare providers are considering bigger interoperability goals for their integration engine solutions that involve multiple technologies to affect seamless data flow within and between facilities, according to a report from the Orem, Utah-based KLAS Research. Interface engines are becoming the hub in which provider organizations are funneling myriad patient data systems in order to leverage existing patient information internally and externally.

Healthcare organizations like Banner Health, a Phoenix, Ariz.-based, 23-hospital health system, are now scaling their interoperability infrastructures to keep up with the pace of growth and regulatory requirements and using interface engines for multi-application and multisite interoperability. Most healthcare organizations, including Banner Health, do not have a fully integrated EHR across their system and are opting for integration engines to achieve that level of interoperability, instead of spending the tens of millions of dollars to purchase an enterprise EHR.

Banner Health, which has received its Stage 7 Award for 17 of its 23 hospitals, is located in seven western states: Alaska, Arizona, California, Colorado, Nebraska, Nevada and Wyoming. The health system has been using an interoperability solution (the Cloverleaf product from the New York, N.Y.-based Infor) since the mid-’90s to route messages for the organization’s critical clinical systems (including EHRs, pharmacy systems, ADTs, and more). Using the solution, the organization sends and receives messages to and from more than 90 distinct systems, with a total of 750 individual system connections and 3.5 million transactions daily.

“Especially being a multi-hospital, multi-regional environment, we’re operating in multiple states and multiple time zones, so doing point-to-point feeds between different systems that need to share information would be completely unmanageable,” says Steve Drozdowski, IT integration analyst and head of the four-member Cloverleaf team at Banner Health. “We’ve taken the approach that Cloverleaf is our hub of clinical information; so we route all the different data sources from all of our different clinical systems into Cloverleaf, and from there, if anyone needs it downstream, we route that back outbound.”

Banner Health is using its integration engine as a basis for its own internal HIE that then connects to outside HIEs, like Arizona’s state HIE, Health Information Network of Arizona (HINAz). In those instances the integration team creates new feeds to link to the external partners through VPNs or dedicated circuits. “We just started sending HINAz patient demographic information, lab results, and radiology reports just fairly recently,” says Drozdowski.

Drozdowski recommends that health systems look for an interoperability solution that is flexible, scalable, and robust enough to serve their particular environment. He notes that Banner Health has grown over the years through mergers and has had to convert the integration products of acquired facilities. Most recently, the system acquired a two-hospital system with 30 different feeds, which took about six months to connect to its integration engine.

Current challenges for Banner Health include adapting its integration engine to respond to requests for XML continuum of care documents (CCDs), where historically all feeds have been in HL7. Banner Health is currently enhancing its interfaces to send XML CCD data directly to Active Health Management, a Medicare Pioneer ACO programpartner and point-of-care clinical decision support service provider. “It has been more challenging, specifically because they were the first driver for us to need to start communicating in CCDs to the outside world, so that was sort of a learning curve for us,” says Drozdowski.

CCDs, like any other standard, can be implemented differently by vendors and organizations, says Drozdowski, which provides another challenge for his organization. “Our hospital EMR [Cerner] CCDs are going through Cloverleaf, as well as our ambulatory NextGen CCDs, and although they both claim to be C-32 compliant, there are some differences,” he adds. “But some of the specific challenges with the Active Health [ACO] program have been with the code sets like LOINC, SNOMED, and CPT4 codes. The CCD is flexible to accommodate any of those, but it’s the source system that’s generating those different codes.”

Banner Health is now deciding whether to choose its EHR vendor, integration engine, or its downstream recipient to perform the necessary code translations for the Pioneer ACO program.