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Tri-City Medical Center: Achieving a Middleware First

Posted on March 2, 2018 I Written By

The following is a guest blog post by Adam Klass, Chief Technology Officer, VigiLanz.

In the age of value-based care, it’s all about performance as hospitals continually face increased financial pressure to meet a number of different criteria related to decreasing length of stay, hospital-acquired infection rates and hospital readmissions. Today’s hospital organization must improve healthcare analytics and core measures, avoid penalties, and secure reimbursement, so it can continue to grow and thrive. This shift means hospitals must now consider cost avoidance instead of expecting direct reimbursement for patient care.

The challenge then becomes how to support and enable next-generation healthcare providers by delivering real-time results from disparate platforms and technology into any clinical workflow. It’s no surprise, then, that 62 percent of hospital CIOs identify interoperability as a top priority and 80 percent of accountable care organizations also cite integrating data as a top challenge for their IT departments.

To accomplish this goal, medical facilities like Tri-City Medical Center, a 388-bed full service, acute care hospital in Oceanside, California, require a services-oriented architecture and open application programming interface (API) capability that enables efficient aggregation, interaction and exchange of disparate data throughout the healthcare enterprise and across any of its software technologies, including EMRs and third-party single-point-solution vendors.

APIs Versus HL7

APIs fit the bill by allowing access to all of the data a digital health application and a health system would need, in real-time. Clinicians and administrators can now rapidly integrate new clinical and business information for better decision-making and, most importantly, for improved patient care with new interoperability services.

Tri-City Medical Center, which also operates a primary care clinic and employs more than 700 physicians practicing in 60 specialties, is the first VigiLanz customer site to utilize our middleware API solution, VigiLanz Connect, to convert health data from its EMR into uniform, actionable intelligence in the VigiLanz Platform. The hospital organization’s use of this solution turns its closed EMR systems into open platforms through robust services that do not rely on HL7 interfaces. Instead, our platform handles connectivity and normalizes data structures across major EMR platforms, like Cerner’s, which Tri-City Medical Center uses, to quickly unlock the data. Benefits include reduced integration time from months to days, elegant workflows, decreased maintenance costs and minimized risk.

“An API is definitely the way to go,” explained Mark Albright, Vice President of Technology, Tri-City Medical Center. “Anytime we have a choice between an interface and an API, we always go with APIs. It’s just so much easier to install and get up and running.”

“Not only are APIs easy to use but they are a no-brainer when it comes to rapid and successful implementation,” continued Albright. “Using VigiLanz’s middleware API helped us maximize the platform in a different, modern way. Not only is it a simpler effort than using a solution like HL7 but it’s also stable and steady so it’s easy to maintain, despite the significant amount of data being pulled.”

Taking EMR Systems to the Next Level

Clinical intelligence and interoperability services complement today’s EMR systems which, on their own, may be insufficient to deliver agile, real-time intelligence services. In contrast, a middleware API can interoperate with EMR systems and is built with innovative abstract data architectures that help hospitals like Tri-City Medical Center improve patient care and operational performance.

In contrasting his organization’s middleware API experience with what would have traditionally been an HL7 integration, Albright noted, “Our hospital charged a non-programmer, non-developer, non-HL7 person with spearheading this project, something that could have not happened in an HL7 world. She would have never been able to master that.”

That “she” is Melody Peterson, a senior systems analyst, who stepped into the project post-decision, after Tri-City’s pharmacy, infection control and clinical surveillance departments had already made the decision to purchase the middleware API, separate from the organization’s IT department.

“I was tasked with making this middleware API work, without having been part of the research or purchase decision,” explained Peterson. “Because VigiLanz supports the clinical and business sides of our hospital, though, it was easy to implement this ‘plug-and-play’ integration solution, in a way that applied to all areas critical to optimizing care – from risk scoring to antimicrobial stewardship.”

A middleware architecture is often the best technological solution for addressing the problem of EHR interoperability because it facilitates the transparent, yet secure, access of patient health data, directly from the various databases where it is stored. No longer does a hospital organization like Tri-City Medical Center have to do all of the development itself, but instead can rely on off-the-shelf applications to solve problems. Middleware brings an application-agnostic approach to connecting EMRs to one another while allowing for specific development to enhance the significant investment by hospitals, health systems and physicians.

It’s Time For A New HIE Model

Posted on April 25, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Over the decade or so I’ve been writing about HIEs, critics have predicted their death countless times – and with good reason. Though their supporters have never backed down, it’s increasingly clear that the model has many flaws, some of them quite possibly fatal.

One is the lack of a sustainable business model. Countless publicly-funded HIEs, jumpstarted by state or federal grants, have stumbled badly and closed their doors when the funding dried up. As it turns out, it’s quite difficult to get hospitals to pay for such services. Whether this is due to fears of sharing data with the competition or a simple reluctance to pay for something new, hospitals haven’t moved much on this issue.

Another reason HIEs aren’t likely to stay alive is that none can offer true interoperability, which diminishes the benefits they offer. Admittedly, some groups won’t concede this issue. For example, I was intrigued to see that DirectTrust, a collaborative embracing 145 health IT and provider organizations, is working to provide interoperability via Direct message protocols. But Direct messaging and true bilateral health information exchange are two different things. (I know, I’m a spoilsport.)

Yet another reason why HIEs have continued to struggle is due to variations in state privacy rules, which add another layer of complexity to managing HIEs. Simply complying with HIPAA can be challenging; adding state requirements to the mix can be a big headache. State laws vary as to when providers can disclose PHI, to whom it can be disclosed and for what purpose, and building an HIE that meets these requirements is a big deal.

Still, given that MACRA demands the industry achieve “widespread interoperability” by 2018, we have to have something in place that might work. One model, proposed by Dr. Donald Voltz, is to turn to a middleware solution. This approach, Voltz notes, has worked in industries like banking and retail, which have solved their data interoperability problems (at least to a greater degree than healthcare).

Voltz isn’t proposing that healthcare organizations rely on building middleware that connects directly to their proprietary EMR, but rather, that they build an independent solution. The idea isn’t incredibly popular yet — just 16% of hospital systems reported that they were considering middleware, according to Black Book – but the idea is gaining popularity, Voltz suggests. And given that hospitals face continued challenges in integrating new inputs, like mobile app and medical device data, next-generation middleware may be a good solution.

Other possible HIE alternatives include health record banks and clearinghouses. These have the advantage of being centralized, connected to yet independent of providers and relatively flexible. There are some substantial obstacles to substituting either for an HIE, such as getting consumers to consistently upload their records to the record banks. Still, it’s likely that neither would be as costly nor as resource-intensive as building EMR-specific interoperability.

That being said, none of these approaches are a pushbutton solution to data exchange problems. To foster health data sharing will take significant time and effort, and the transition to implementing any of these models won’t be easy. But if the existing HIE model is collapsing (and I contend this is the case) hospitals will need to do something. If you think the models I’ve listed don’t work, what do you suggest?