To build or not to build? If you need an integration solution for EHR or Practice Management systems, this question may be looming over you like a dark storm cloud. How do you confidently prepare a strategy for EHR integration when you haven’t done it before?

After extensive research, I was left with more questions than answers and it is clear to me that the struggle is real. Honestly, it was nearly impossible to determine whether building one yourself or buying one is the better option.

My name is Morgan Watson, and although I am a marketing expert here at Healthjump - I am certainly not an integration expert. Fortunately, the humans of Healthjump are, so I knew exactly who to talk to about integrating systems!

I sat down with Laura Stewart, our Director of Product Delivery, to get her advice on this topic. Laura has over a decade of experience with EHR data and currently leads the Healthjump team that is responsible for customer success. During her time at Cerner, she managed many complex projects moving hundreds of petabytes of data, and became known for her successful and pragmatic approach.

Her strategy for determining whether it's better to build an in-house solution or hire an outside vendor to help you achieve EHR interoperability is outlined below:

  • Prepare for the worst-case scenario because it’s harder than you think.
  • It’s essential to evaluate each EHR system individually.
  • Don’t be afraid to consider alternate data integration methods.

EHR Integration is Harder Than You Think (Here’s Why)

Laura’s top piece of advice for someone who has never done an EHR integration before?

“If you are just starting, you’ll find out quickly that it’s not as easy as you think. Each EHR system should be evaluated separately. Be prepared by educating yourself on the possibilities.”

This was not news to me, I’ve heard it before first-hand from conversations through networking communities like Health Tech Nerds and HIT Like a Girl, and frankly, even from our own customers regarding their experiences before using Healthjump.

Many people are optimistic at first when they decide they want to build their integration solution in-house. How hard can it be? Almost every time it turns out to be much more work than they expected.

Evaluating Whether to Build an EHR Integration Or Not

There are three main categories you should consider - cost, timing, and the EHR and Practice Management systems themselves.

Cost

One of your largest expenses for building integrations in-house is the salary for the employees dedicated to building and maintaining it.

According to an article from U.S. News, lead software developers are in high demand and their salary reflects that. Not to mention, you'll likely need a few additional software engineers to round out the team.

You may have known this already, but have you factored in the other functions this team will need? Laura identified four areas that people tend to overlook, which include the following:

  • Security
  • Project management
  • Ongoing support
  • Partnership development.

Speaking of partnership development, getting access to EHR data from an EHR vendor can incur additional costs. The costs are determined based on various financial models, including usage-based, revenue-share, and fixed price. Although, it is becoming more volatile now due to new regulations associated with the Trusted Exchange Framework and Common Agreement (TEFCA). The goal of TEFCA is to establish a universal floor for interoperability across the nation.

Anthony Leon wrote a great piece called The Dirty Secrets About Interoperability No One Talks About. In it, he said: 

“Some may charge to open a port for basic HL7 v2 information, some may charge to get access to certain APIs, some may encourage you to become a partner first but then there are partner costs and at times long waitlists before they'll even talk to you. Even more frustrating, this is if you can even talk to the EHR.”

If you have one or two EHRs or Practice Management systems you need to connect to, all of that may be completely doable with a four-person team. But, if you plan to scale your EHR connections, it gets harder and harder to manage and maintain without increasing your budget. Don’t forget to factor in the cost it will take other departments to help support this initiative, like getting legal to review contracts with EHR vendors. 

In addition to all that, it's essential to also consider the cost of labor burden, including taxes, benefits, etc., as well as hardware and software licensing costs that the company incurs for that seat.

In the long run, building a team in-house may cost you more money than you’d like.

Timing

Hiring Can Be Slow

It will take time for you to hire people that fit your culture and have the right skills, which is to be expected in the hiring process and something you can plan for.

Did you know though that an experienced developer from within the healthcare industry may not understand clinical workflows?

Your newly hired team will need to be onboarded to your company and then also trained with that clinical workflow knowledge (likely taking time away from your in-house subject matter expert).

Data Can Differ From Practice to Practice

To make things more complicated, the same EHR can be set up differently for each practice. Data can be stored in different places or different ways.

And that can change over time.

Laura said: 

“I have worked with many customers who underestimate the amount of upfront investment it takes to stand up a data feed and then support it long term. Connections are like gardens. They need tending to every day, otherwise “weeds” creep in.”

So the time that you thought was going to be dedicated to new EHR integrations can quickly get pulled over to adjusting and maintaining previous integrations, slowing progress, or even bringing it to a halt. Each month that is spent focusing on existing integrations extends the timeline for new customers to be onboarded, which ultimately leads to a loss in revenue. 

EHR Vendors Might Not Prioritize Your Needs

EHR vendors are competing on data integration, user interface, clinical platform builds, and network effects. Epic, Cerner, athenahealth, and Veradigm (formerly Allscripts) all host their own app marketplaces, embedding external applications and data related to remote patient monitoring, digital therapeutics, community support, clinical decision support, and preventative health into their native EHR workflows.

They are busy, and you can rarely set up a connection without the EHR vendor.

Make sure you have a good understanding of their implementation backlog timeline to get work started and also the duration of projects. Be prepared for delays. If you have one or two key EHRs this shouldn’t be an issue.

EHR and Practice Management Systems

What EHR/PM systems are you currently connecting to? Something people often forget to consider - what systems will you be connecting to in the future? What market could you expand into that may be using different EHRs than you originally planned for?

EHR systems are built differently from one to another and it’s hard to accurately predict cost and timing. At the time of writing, there are over 600 certified health IT products listed. This number increases if your target market doesn’t use a certified EHR.

Brendan Keeler (aka The Health API Guy) wrote in his excellent sub-stack How to Win Friends and Integrate Systems:

“They are as varied as the ocean is deep - a vast array of niche tools, unique workflows, and small technical nuances that (when viewed in aggregate) defy generalizability.”

At first glance, you may not consider the wide range of formats, standards, and connectivity options that need to be accommodated, but once you dive in, it will feel like a never-ending process. 

Consider Alternatives to Building Your EHR Integrations In-House

Does becoming an EHR integration expert make sense for your company?

Laura’s advice:

“From my experience when you have dozens to hundreds of integrations, it’s better to find a platform you can scale with. This way, you can focus on the provider relationships and operations side and not be distracted by integration issues.”

Choosing a vendor for your EHR integrations could be the right move. Solutions for achieving interoperability tend to be more cost-effective than reallocating or hiring an inside team because of the complexity of the EHRs that exist.

Many of these solutions have pre-built integrations that you can take advantage of. This can make it quicker and easier to connect with multiple EHRs.

If you do choose to pursue the vendor route, make sure you evaluate them on how they ensure data quality, both completeness, and consistency.

Laura posed a few important questions to keep in mind as you conduct your vendor evaluations:

  • How can the vendor achieve those things listed above?
  • What does each of those steps entail?
  • How long does each step take? 

There’s No One-Size-Fits-All Integration Strategy

I’ve realized that there is truly no one-size fits all integration strategy for EHRs. Some of our customers still maintain a few integrations in-house (as they had already invested the work in building and maintaining it) but use us for new integrations.

In the end, only you can determine if it’s worth the time, money, and effort to build your EHR integrations in-house or not.

Healthjump is a cloud-hosted platform for the collection, standardization, and delivery of EHR data. We don’t have the same limitations and complex setup of traditional interface engines. Because of that, we can save you money, and time. Not to mention an added sense of relief, since adding a new connection or EHR system will be more predictable. 

With thousands of active connections and 60+ pre-built EHR integrations, Healthjump can simplify your data journey. Click here to set up a free consultation with one of our integration experts.