Healthcare News & Insights

Middleware solutions gaining popularity as interoperability sling shot

GettyImages-507179266A major source of safety issues and frustrations in the healthcare industry is the lack of electronic health records (EHR) interoperability. In this guest post, Thanh Tran, CEO of a medical software company, offers up middleware solutions as an option to bringing this problem to an end.


The lack of EHR interoperability continues to pose a serious threat to healthcare initiatives, according to a recent report published by the American Hospital Association (AHA). The report discusses the various aspects of the healthcare industry and care delivery that are negatively impacted by a lack of interoperability.

The Partnership for Health IT Patient Safety, a branch of the ECRI Institute, has released safe practice recommendations for using the copy and paste function in EHRs that can adversely affect patient safety, such as the use of copy and paste that can overpopulate data and make relevant information difficult to locate, according to the partnership’s announcement.

Meanwhile, a survey of 68 accountable care organizations (ACOs) conducted by Premier Inc. and the eHealth Initiative found that despite steep investments in health information technology (HIT), they still face interoperability challenges that make it difficult to integrate data across the healthcare continuum.

User frustration over lack of interoperability standards

The Office of the National Coordinator for Health Information Technology (ONC) is once again asking the healthcare community for its thoughts on establishing metrics to determine if or to the extent to which EHRs are interoperable. The push to achieve interoperability is in response to last year’s mandate by Congress, contained in the Medicare Access and CHIP Reauthorization Act (MACRA).

In its annual interoperability survey of hospital and health system executives, physician administrators and payer organization IT leaders released in April 2016, Black Book Research found growing user frustration over the lack of standardization.

Those looking at touted standards such as Fast Healthcare Interoperability Resources (FIHR) point out that it’s only capable of connecting one medical facility to another and requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, FIHR is really a point-to-point customized interface requiring extra steps and ties developers to specific hospitals or EHRs and without universal access.

Doug Brown, the managing partner of Black Book finds that FHIR standards can allow EHRs to talk to other EHRs, should standard definitions develop on enough actionable data points, centering on the capabilities of open network alliances, mobile EHR, middleware and population health analytics. Black Book evaluated middleware vendors in an associated Q1 2016 user survey.

Can middleware solve interoperability?

Patients are at risk, common interoperability solutions aren’t solving the problem and healthcare providers aren’t given the best life-saving tools. Some 2.0 healthcare vendors are offering middleware solutions that have proven themselves in other industries. Vertical markets, such as retail, banking, transportation and others, have long ago solved interoperability with middleware.

Dr. Donald Voltz is an advocate and authority on middleware. He believes middleware should be the standard operating system for EHRs to finally bring lack of interoperability to an end, and that middleware is the technology to drive change, innovation and disruptive transformation to solve EHR interoperability challenges.

Dr. Voltz finds that middleware architecture has been shown to be the best technological solution for addressing the problem of EHR interoperability. The middleware platform facilitates the transparent access of patient health data directly from the databases where it’s stored. A server-based middleware framework supporting access to the various patient health data stores allows for a scalable, unified and standardized platform for applications to be developed.

Every stakeholder in the healthcare continuum cannot establish the infrastructure needed to support interoperability. This is evidenced by 83% of physician practices responding and 40% of hospitals that currently admit they’re still in the planning and catch up stages of sending and sharing secure, relevant data.

The challenge of turning silos of medical and financial information into a linked, complete, accurate secure lifetime medical record is still tenuous, the Black Book survey finds. The survey also notes that middleware is gaining popularity fast by hospitals using EHR-dependent health information exchange (HIE) systems with extremely expensive custom development for data sharing outside the network.

Middleware being considered by hospital IT leaders

Interoperability middleware is also a fast growing consideration according to 16% of hospital systems IT leaders. Middleware software sits within the data pipeline and translates data from disparate EHRs, which shows promise for private HIEs, particularly payor-centric enterprise models. It creates a business intelligence layer that provides information to all stakeholders in real time.

The survey reports that the global healthcare analytics market is projected to grow to $18.4 billion in four years and the need for that complex data will propel the interoperability requirements of providers and payors. The only way to accomplish that is robust bidirectional interoperability, ultimately forcing comprehensive interoperability into reality. Approximately 57% of providers in the survey also confirm their beliefs that the whole interoperability industry will evolve in leaps by 2018 if bidirectional interoperability is addressed.

Thanh Tran is CEO of Zoeticx Inc., a medical software company. He’s a 20-year veteran of Silicon Valley’s IT industry and has held executive positions at many software companies.



Subscribe Today

Get the latest and greatest healthcare news and insights delivered to your inbox.