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This is a really difficult space because EHR/EMR companies are not incentivized to allow data-sharing. The moment they unlock those doors they lose the vendor l

This is a really difficult space because EHR/EMR companies are not incentivized to allow data-sharing. The moment they unlock those doors they lose the vendor lock-in that allows terrible solutions like Athena/Cerner/EPIC to retain their customers. They way they technically comply with FHIR data-sharing laws without actually allowing data sharing is by requiring a $100k API-key to unlock sharing, but they only issue it per-hospital or per-clinic. As an integrator you need to contact each individual care center that you want to integrate with, a process often taking up to a year per instance. There is no central "get all data from any EPIC instance in the US for a given patient" solution. Even after that point they often have separate APIs and technologies for read/write, and even different tech for different data fields within the same records, making efficient, seamless integration nearly impossible (intentionally). If all that wasn't enough, often these systems are very eventually consistent, meaning that to build a sync middleware between EHRs you end up with flip/flop race conditions where the lag between a write and the next read showing the update causes out-of-date data to be synced back on top of the original correct data. Because it's such a hard problem but so badly needed, there are plenty of existing companies specifically popping up in the FHIR/HL7 EHR integration/data-sharing space to try and solve this. I spent two years building one myself for a client, but it's not public, so these are my two public favorites: - https://www.redoxengine.com/ https://www.redoxengine.com/ - https://www.healthgorilla.com/ https://www.healthgorilla.com/ But there is a long tail of others, each with nuanced shortcomings and benefits: - https://www.interfaceware.com/iguana-integration-engine https://www.interfaceware.com/iguana-integration-engine or https://www.interfaceware.com/iguana.html https://www.interfaceware.com/iguana.html - https://www.humanapi.co/ https://www.humanapi.co/ - https://kno2.com/ https://kno2.com/ - https://www.healthcompiler.com/LP-API https://www.healthcompiler.com/LP-API - https://www.lyniate.com/ https://www.lyniate.com/ - https://www.clinicalpipe.com https://www.clinicalpipe.com - https://tigerconnect.com/ https://tigerconnect.com/ - https://www.qvera.com/hl7-interface-engine/ https://www.qvera.com/hl7-interface-engine/ - https://cliniconex.com/healthcare-collaboration/ https://cliniconex.com/healthcare-collaboration/ - https://clareto.com/ https://clareto.com/ IBM, Azure, and Google Cloud also offer FHIR cloud integration services. - https://cloud.google.com/healthcare/docs https://cloud.google.com/healthcare/docs - https://azure.microsoft.com/en-us/services/azure-api-for-fhir/ https://azure.microsoft.com/en-us/services/azure-api-for-fhi... - https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit https://www.ibm.com/us-en/marketplace/merge-hl7-toolkit And even more if you're interested: - https://www.mdisolutions.com/solutions/hl7-integration-and-interface-engine/ https://www.mdisolutions.com/solutions/hl7-integration-and-i... - https://www.mylinks.com/ https://www.mylinks.com/ (Record aggregator for patients) - https://www.healthwizz.com https://www.healthwizz.com (Record aggregator for patients) - https://careevolution.com/MyFhr/ https://careevolution.com/MyFhr/ (Record aggregator for patients) - https://www.nextgen.com/products-and-services/electronic-data-interchange-edi https://www.nextgen.com/products-and-services/electronic-dat... - https://www.mulesoft.com/integration-solutions/soa/healthcare https://www.mulesoft.com/integration-solutions/soa/healthcar... (API switchboard / triggers platform like IFTT for healthcare) - https://paxerahealth.com/products/pacs-broker/ https://paxerahealth.com/products/pacs-broker/ The best place to learn more about all this is the main FHIR standards Zulip chat I think: https://fhir.zulipchat.com/ https://fhir.zulipchat.com/

lofatdairy 4y ago
Thanks so much for your comment. As someone also working on problems in healthcare IT (and with many complaints about existing solutions), it's at least reassuring to know that other people also find it as asinine as I do. There's also a ton of solutions I haven't seen before so it's a really great reference. On another note for people starting healthcare SaaS targeting clinics and hospitals, the situation also becomes a somewhat awkward juggling act between oneself, the clinic, and the EHR provider, since any API access offered by the EHR is meant to be given to the clinic (which often is ill-equipped to actually make use of this). Coordinating some handoff is thus non-trivial since you'll likely end up talking to people who don't know what API access is and need to get bounced around for a bit. You're also basically operating in a black box without much information about the EHR system itself, and developers with experience on multiple EHRs are a bit uncommon.

lofatdairy 4y ago

Thanks so much for your comment. As someone also working on problems in healthcare IT (and with many complaints about existing solutions), it's at least reassuring to know that other people also find it as asinine as I do. There's also a ton of solutions I haven't seen before so it's a really great reference. On another note for people starting healthcare SaaS targeting clinics and hospitals, the situation also becomes a somewhat awkward juggling act between oneself, the clinic, and the EHR provider, since any API access offered by the EHR is meant to be given to the clinic (which often is ill-equipped to actually make use of this). Coordinating some handoff is thus non-trivial since you'll likely end up talking to people who don't know what API access is and need to get bounced around for a bit. You're also basically operating in a black box without much information about the EHR system itself, and developers with experience on multiple EHRs are a bit uncommon.