When we meet healthcare executives to discuss clinical digital innovations, EHR integration is always a hot topic. Integration with an Electronic Health Record (EHR)–or Electronic Medical Record (EMR)–fosters clinical adoption by allowing for seamless data exchange of patient health information, and increases clinical workflow efficiency for providers. Despite the universal recognition of the importance of integration, there are still several common misconceptions regarding the feasibility and process of executing EHR integrations for digital health solutions.
Reality: Unfortunately, integration with one provider doesn’t necessarily make for easy implementation elsewhere.
EHR implementations are like fingerprints – unique and specific to each health system, regardless of the EHR vendor in question. A ‘patient visit ID’ may be sent from Epic implementations in different health systems across different data fields in the interface messages, or an EHR supporting pediatric clinical workflows could look different from that of an adult practice. Therefore, integration with Epic at one health system may be different from integration with Epic at another.
BrightInsight’s regulated digital solutions are built on a modular platform that can be adapted to most EHR implementations. With our interoperability partner network, our solutions have connective capabilities with all the major EHR vendors, including Epic, Cerner, MEDITECH, AllScripts, athenahealth, AdvancedMD, and more, along with 2,000+ provider networks, including most of the top 100 US health systems.
Takeaway: We ask our customers to contract with each health system, and we will own the end-to-end implementation of their BrightInsight-hosted regulated solutions at each health system. It takes some time, but our experience and partners have figured out how to make it as lean and effective as possible.
Reality: There are various standards and protocols that enable the functionalities, but the EHR interoperability space is still evolving and most health systems rely on an array of standards to meet integration needs.
All clinical decision support (CDS) solutions are integrated with EHRs for three core purposes:
1. Enabling data exchange
Synchronizing all patient information available in other parts of the health system with our digital solution and sending newly generated data (e.g., output of an algorithm) back to the EMR.
Most popular standards: HL7 v2, FHIR
2. Lowering barriers to use
Enabling Single Sign On (SSO) so all clinical users can launch your digital solution with one click from the EMR, without creating and entering a new username and password.
Most popular standards: OAuth, SAML, SMART (OIDC)
3. Driving workflow efficiencies
Embedding the BrightInsight hosted CDS solution inside the EMR to reduce screen and notification fatigue for clinicians. For example, Epic and Cerner allow third-party apps, such as BrightInsight, to launch within context in an iframe. It works similar to a YouTube video embedded on a web page, as opposed to clicking a link that pops up as a new web page displaying YouTube.
Most popular standards: JSON Web Tokens, SMART
We are often asked if BrightInsight solutions are SMART or FHIR ready. The short answer is yes, BrightInsight solutions are capable of bidirectional data exchange with the EMR, SSO and embedding into the Epic or Cerner iframes. Or they can be available as a standalone web portal, using all of the popular standards listed above.
The reality, however, is more complicated. While newer standards like SMART on FHIR aim to bring all functionalities to work together in a standardized way, most recent SMART on FHIR integrations in the market are a combination of HL7 v2 and FHIR data feeds for information exchange. For example, most EHR systems’ implementation of FHIR standards do not accommodate a wide variety of write functions yet, so HL7v2 is used to complement this deficiency.
BrightInsight works with our interoperability partners and each health system to identify the most convenient paths to integrate our regulated digital solutions with the health system’s current capabilities and IT strategy. In some cases, this could mean we use a combination of HL7 v2, FHIR, SAML and SMART to enable the above functionalities.
Takeaway: We ask our customers to think about the user experience and purpose of EHR integration, rather than focus on the standards used to get there, as it may vary by health system.
Reality: While Epic’s App Orchard and Cerner’s App Gallery have more than 600 publicly available third-party apps listed, there are more than twice as many applications with live EMR integrations at health systems that are not listed on either app store.
Both the App Orchard and App Gallery provide additional brand visibility, preferred technical support from EMR vendors and additional certifications. However, a public listing is not required for integration with EMRs, including Epic and Cerner. For example, some of BrightInsight’s live regulated digital health applications that are well integrated into health system EMRs are not published on the app stores. It does not preclude these solutions from any functionality or user experience, and we are able to deliver the solutions faster to market, with the highest level of regulatory, quality, privacy and security certifications possible.
Moreover, third-party applications that are publicly listed on the Epic and Cerner app stores still have to go through integrations with each health system’s EMR individually, as the EMR implementations at these health systems are unique. However, for customers that insist on a presence on Epic App Orchard and Cerner App Gallery, BrightInsight platform enables public listing as a value-added service.
Takeaway: Successful EMR integrations do not require your digital solution to be listed on Epic’s App Orchard or Cerner’s App Gallery. We regularly implement end-to-end digital solutions hosted on BrightInsight’s regulated platform at health systems, with best-in-class global privacy, security and quality certifications.
Reality: Medtech companies have been integrating hardware and embedded software with EHR systems for more than a decade.
In terms of digital solutions, the number of third-party digital apps integrated with EHRs is soaring, increasing 20% from 2019 to 2020 alone. Several large health systems have more than 30 EHR integrations at one time. To simplify integration with EMRs, BrightInsight employs a five-phase implementation process for our solutions: Planning/analysis, Build, Test, Train, and Go-Live.
Two major players – Epic and Cerner – account for more than 50% of the U.S. acute care EHR market. In Europe, the market is much more fragmented, and specific to each country. BrightInsight works with the best interoperability partners across the globe and our regulated digital solutions are ready to be deployed at more than 2,000 provider networks across all major EHR vendors.
Takeaway: You get the health system signatures and we’ll take care of the rest.
BrightInsight can support your needs for building and launching regulated digital health solutions, with EHR integrations. Reach out to learn more.
Ankit Agarwal is Director of Venture Consulting at BrightInsight, helping customers conceptualize digital solutions that will drive the most value to their organizations, patients, and health systems. He has nine years of experience in healthcare, biopharma and medtech, including launching comprehensive condition management solutions for health systems. Ankit is based in New York.
Caroline Cornelius is a Solutions Consultant at BrightInsight with eleven years of experience in the health IT interoperability space. She currently helps customers with technical roadmaps and envisioning a solution on the BrightInsight platform. Caroline has worked and led teams at Epic, Isirona and Baxter. Caroline splits her time between Chicago and Johannesburg.