TPJ Systems Healthcare Consulting and Healthcare Interface Design


Healthcare Integration

Integration Engines

A future of opportunities

The hub of any complex clinical system's multiapplication data operation is its integration engine. Experts agree on many of the factors driving integration development and deployment in healthcare IT architectures, but there is no consensus on a future direction. Even the present state of the industry is debatable, according to Barry Runyon, research director at Gartner, Stamford, Conn., and a former health system CTO. He says that most providers are "still doing message-oriented middleware" and are not on integration platforms. "They're doing mostly transformation and broadcasting of messages. They're not even using XML. Very few are."

The advent of HL7 version 3.x will mandate that integration engines have full industrywide XML capabilities, and they also must remain capable of dealing with the pre-XML messaging standards of HL7 2.x, Runyon and vendors agree. But beyond these basics, what an integration engine must do, or be, in the future remains wide open.

Gradually replacing the interface engines familiar to healthcare executives are fully featured integration platforms, such as the J2EE-based Integrated Composite Application Network (ICAN) Suite from Monrovia, Calif.-based SeeBeyond. (In late June, Sun Microsystems, Santa Clara, Calif., announced acquisition of SeeBeyond, expected in fall 2005, subject to regulatory approval.) Version 5 includes the popular eGate integration engine, plus 10 other components enabling such elements as business-to-business communication, multiapplication patient cross-referencing and Web Services connectivity adapters.

SeeBeyond CEO and founder Jim Demetriades says capabilities like those in the ICAN suite will be the building blocks for a durable electronic medical record. And Runyon sees many vendors "moving to SeeBeyond-like platforms," eventually. "It took 15 years to get HL7. How fast do you think it'll take service-oriented architectures, which a lot of these new platforms are based on, to catch on? It'll take a while." He predicts about five years, and "It'll be driven by the clinical vendor, not the healthcare IT department."

Leading vendors say there is as much standards work as technological work to do before interorganizational integration via service-oriented architectures becomes routine. Maybe more. "The issues at the root haven't changed," says Joe Auriemma, senior director of integration engineering for Siemens Medical Solutions, Malvern, Pa., which manufactures the OPENLink integration engine. "Does my syntax match yours? Does my vocabulary match yours? Those fundamental things still have not been solved. There's still heavy debate in the standards organizations."

Mike Epplen, vice president of product management for integration solutions at Quovadx, Englewood, Colo., makers of the Cloverleaf integration engine, says, "Integration connectivity is not just about HL7 within the four walls but also about NCPDP [National Council for Prescription Drug Programs] SCRIPT and the way that's going to affect the prescribing vendors. It's about adoption of the real-time HIPAA transaction set." He continues, "There's a general sense HIPAA is over. They've solved the claims portion, but capturing the real-time transaction set and integrating it into a physician's workflow hasn't been solved at all."

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Greg Goth is a freelance writer in Oakville, Conn.

**"A future of opportunities"
by Greg Goth Healthcare Informatics August 2005