Wednesday, December 4, 2013

Why Can't Medical IT Systems Share Data Better?

It is FAQ Wednesday, when I try to get through the most plaintive of cries I encounter in the course of my workday.

Today's question is "why can't medical information systems share data better?"

This is a good question: why in this day and age of Webly interconnectivity are lab results and diagnostic images and calendar appointments and other data not easily accessible?

Specifically, let us consider why the prototypical Hospital Information System (HIS) cannot share data better (more effectively) with the prototypical Laboratory Information System (LIS).

There are two basic ways to share data between computer systems. I will call these two methods "linking" and "transferring." Let us call the system with the data the "server" and the system which wishes to display data from the server "the  client."

Linking is pretty easy and pretty useful: The client opens a window, sends a query to the server and the server replies with the data.

Transferring is more involved: the client gets data from the server, parses that data and loads that data into the client's own database where that data can found and used by the client's own software.

Linking is easier and real-time, but does not lend itself to a consistent look-and-feel. Transferring is harder and often done in batch mode, but it does lend itself to consistency and the data is available "natively" on the client, ie in more ways.

Since this is healthcare data, we have issues of privacy, authentication, display rules and all the requirements of HIPAA. This makes using Web technology, which is inherently insecure and open, a bit tricky. It also makes the transfer option more attractive: authentication across information systems is a pain and access logging across information systems, especially ones from different vendors, downright difficult.

However, transferring is more overhead to implement, more overhead to maintain and requires actually settling questions of data model mismatch.

We try to support linking when we can, but we often end up having to support someone else's authentication model and someone else's data model and someone else's design aesthetic. That's rather alot of flexibility which is why most bigger vendors won't go that route.

So here we are: most of the time the only data shared between systems is data everyone agrees must be shared. Data sharing tends to lag behind other developments and other requirements. It isn't better because it isn't easy to do.

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