Over 96% of US hospitals now use various Electronic Health Records systems. These systems save doctors tons of time on patient data exchange and other miscellaneous aspects of clinical workflows. Therefore even the smallest add-ons to these systems – like chat-bots for scheduling appointments or payment gateways – have to be compatible with the local EHRs. No wonder that every HealthTech innovator developing a product for medical providers needs to think about its EHR integration strategy as early as they start looking for the first customers.

For amateur startups just starting out in the healthcare field, approaching this matter may be a great challenge, as carrying out an integration project from scratch may often be just as difficult (if not even harder!) as developing the product itself. In this article, we will go over some of the most common challenges faced by healthcare innovators on the way to EHR integration, and what are the two main ways of handling such an important step toward your product adoption.

Challenge #1: Collaborating with Big EHR Vendors

Get Them to Talk to You

To gain access to the APIs of the EHRs that you are looking to integrate with, you would need to work directly with the vendors – and that’s where the first issues arise. With thousands of aspiring innovators striving to work with the most popular EHRs, it’s going to take you some time and effort to reach out to them and hear back. If it’s your first time getting in touch with the EHR vendors, you will have to be patient and keep trying. Aside from contacting them via official email and LinkedIn channels, whenever possible, make use of offline connections at trade shows and conferences.

Prove Your Competence

Integrating with major EHR vendors like Epic or Cerner can also help you gain more visibility by being listed in their official app marketplace. However, proving your eligibility to earn that place will take some effort. No EHR vendor would risk integrating with an unreliable third-party provider that doesn’t bring real value to healthcare. This means that you must really polish your presentation materials and make sure you articulate clearly what your offering is. What may help you gain credibility is finding potential clients before approaching the EHR vendors: having hospitals backing up your proposition will definitely speak in your favor.

Establish Communication on Both Sides

Throughout the whole process of integration, you will need the vendors to provide you with the right APIs and permissions. Equally, you need to liaise with the hospital stakeholders to have their team cooperate with yours. Achieving this synergy, particularly if it’s your first time orchestrating the integration process, may require much more time and resources than you may anticipate at the start.

Challenge #2: Each EHR integration is different

Every EHR System is Different

No two EHR systems are the same – each of them has its own sets of APIs and permissions. If you have already integrated with one of them, you won’t be able to use the same framework to integrate with another – it’s going to be a whole new project to carry out. Moreover, there is currently no default interoperability designed for different EHR/EMR systems, and there are a number of reasons for that – from a historical lack of unified EHR standards to maintaining the high cost of switching between vendors. There are currently several key EHR/EMR vendors operating in the US market, with a market share distribution as follows:

Epic: 32.9%
Cerner: 24.4%
Meditech: 16.7%
CPSI: 8.7%
Allscripts: 4.3%
Medhost: 3.1%

Epic and Cerner remain the two most popular certified EHR vendors in the USA, with the latter one steadily losing its market share to its leading competitor. However, it’s highly unlikely that at any time in the near future, we will see the whole market overtaken by one vendor. Therefore, you will need to integrate with at least two of them to have a bigger market share.

Each Hospital Has a Highly Customized Version of EHR

Integrating with the default EHR systems is just the tip of the iceberg, as they are usually heavily modified for each hospital. The processes and data access regulations may vary from one clinical provider to another. These differences mean that:

Even if your solution is already generally compatible with Epic, Cerner, or other EHRs, you may have to do quite some additional work to integrate it in a particular hospital or clinic.

The exchange of medical data between organizations (even if they use the same EHR system!) may be far more complex than you think. This is particularly important if you onboard multiple clinical providers onto one ecosystem. The patient’s medical records won’t just migrate between two different entities on their own – you will have to take care of the mechanisms that enable data sharing.

Challenge #3: Data migration may be hard as different data structures and fields can be used in different EHRs

Lack of standardization remains one of the biggest interoperability problems in the US healthcare sector. It’s not easy to transfer clinical data out of the EHR that stores it. However, failing to facilitate the data exchange will mean that the hospital staff will be forced to perform double input – like typing in the patient details or uploading the patient’s documents rather than transferring them straight from the system. Double input creates an unnecessary workload on the clinicians, pretty much scrapping the whole benefit of the HealthTech product. The lack of universal interoperability standards means that you might have to work with an array of them (such as HL7 FHIR, and USCDI) as well as other data migration tools for exporting patient records from different resources in a variety of its formats.

With health records, much of the problem has to do with different data structures and input fields, which may cause vital errors during the export. Understanding and correctly mapping the data to ensure its seamless migration is one of the key challenges of EHR integration. Moreover, the original data sources can often turn out to be outdated, or the data itself may be inconsistent or inferior in quality. All these obstacles may increase the amount of manual work you would need to perform to make sure that none of the precious health records of the patients are lost in this process.

Challenge #4: Complying With HIPAA Regulations

According to HIPAA (Health Insurance Portability and Accountability Act of 1996), medical providers are not allowed to share sensitive patient health information without the person’s consent or knowledge. The act also establishes standards for patients’ rights over controlling the use of their medical records. While it goes without saying that all clinical HealthTech products have to be HIPAA-compliant, innovators need to ensure that the process of the EHR integration is just as much in line with the Technical Safeguard standards.

Aside from obvious aspects such as protecting your software from patient data leaks, there are numerous other nuances such as storing the patient’s data on your servers, third-party access permissions, and so on – all of which need to be compliant with federal laws and disclosed to patients.

Challenge #5: Handling Each Integration as A Project

Performing an EHR integration for your innovation is a complex and lengthy process that can take months. It’s a big project which needs to be handled as one – so you would need a designated project manager to supervise it, ideally with a corresponding experience in EHR integrations. Here are the two common ways to approach EHR integration:

Do It Yourself

One of the common ways to handle EHR integration is to handle the project in-house. You will need to hire or allocate a project manager to lead the project, plus assign a few team members to work on it. Once you’ve managed to get hold of the EHR vendors and established the ground for your collaboration, the actual integration process may take up to six months. There is currently no universal developer-friendly way to approach the EHR integration process Although there are certain widely used standards like HL7v2, C-CDA, and FHIR, they mostly only outline a set of resources and frameworks and generally are quite loose. Check out this article to gain valuable insights from our Head of Professional Services - Olga Ryzhikova, and dive deeper into EHR integration essentials for startups.

There is no plug-and-play solution to syncing your product with the local EHR and extracting the data you need, so prepare to solve a lot of new issues coming up with each consequent integration. That’s why it’s best to have specific staff members assigned to this task rather than making your product development team tear apart between working on your innovation and its compatibility with the future client’s system.

Hire an Expert Team

Rather than knocking on the doors of the vendors by yourself and figuring out the whole process on your own, you might want to consider delegating the whole hassle around EHR integration to someone who’s already been through this process many times before. There are many EHR integration service providers out there willing to help HealthTech innovators with the adoption of their products. Typically they have experience working with different EHR systems, established relationships with the vendors and established workflows for tackling all kinds of issues arising in this highly complex process.

To Sum Up

Performing an EHR integration by yourself is not the easiest task to handle, so prepare to invest much of your team’s time and resources into it. On the bright side, gaining in-house expertise can be beneficial in the long-term perspective, as you won’t have to seek help integrating with new clients with the same EHR. To better understand the various EHR systems, how to leverage APIs and how to comply with security requirements, check out this article where we offer a comprehensive guide for healthcare startups looking to integrate their solutions with EHR systems.

If you have limited time and team availability to focus on such complex operations, delegating this project to an external provider can help you save a great deal of time and money – and extra splashes of cash are almost inevitable if you are learning from your own mistakes in the process.

Having an experienced team taking the pain of figuring it all out for you in a matter of weeks can be a lifesaver – particularly if you’d rather have your brilliant squad concentrate on the core of your business, that very product you’re trying to bring into healthcare to make it better.

At Kepler Team, we offer integration services with all the leading EHR systems in the US. Many of our clients turn to us when seeking a reliable team that can help them transform their solution into a versatile, universally compatible innovation that can easily fit into different clinical workflows. Learn more about our Integration services here or get in touch for a free consultation and quote!

Top 5 Challenges in EHR Integrations and How to Tackle Them