What makes healthcare integration so complex?

Posted December 17, 2018
By George McLaughlin

If you haven’t spent your career in healthcare, it is easy to wonder why everything seems so complicated. While there are many variables, we think five factors are the primary contributors to healthcare integration being more complex than other industries.

Healthcare “Standards”

We’ve explored this topic in deeper detail on our blog so we won’t spend too much time but the current state of “standards” in healthcare is a very real impediment to exchanging healthcare data at scale.

Healthcare data standards need to serve a broad and constantly evolving set of use cases. This means the way data is structured, stored, and accessed is always changing and varies wildly across systems that need to be integrated with. Healthcare standards aren’t like “Bluetooth”. They aren’t consistently implemented and made available to anyone that follows the standard. This inconsistency of implementation and availability of standards is a huge contributor to the interoperability problem plaguing healthcare. Below is an overview of the primary data formats and standard you will run into when integrating with EHRs and other software systems used by healthcare organizations.

A quick note on FHIR–while billed as the answer to all of healthcare’s interoperability woes, this new standard has very real limitations. Check out our whitepaper for more information.

Fragmented EHR Landscape

Unfortunately for integration simplicity, there are hundreds of EHR systems in use serving different customers across the provider organization landscape.

Image source: eVisit

Each of these systems is unique. What data they collect, how they structure it, what they make available, whether they support traditional interfaces or modern APIs, etc. varies by EHR vendor with no industry-wide consistency. We actually created an entire white paper highlighting these differences.

This makes serving a wide range of users across a diverse customer base difficult. It means accommodating quirks, learning procedures, and adhering to the whims of many third parties. Needless to say, it makes delivering a scalable integration strategy rather complex.

Provider Organization Resources

Most healthcare provider organizations are focused on running a very lean IT team. This means that your integration project will likely be competing for resource hours/prioritization (networking, setup, troubleshooting for live applications, end-user support, etc.) and working with non-specialized resources, who may or may not have a depth of experience with integration.

In many cases, you’ll actually end up working with an outsourced resource from an agency (e.g. an EHR reseller vendor) or the EHR vendor directly to complete an integration adding additional complexity. Due to the nature of healthcare provider organization IT availability, the more resources your integration project requires from the provider organization, the less likely it is to get prioritized.  Executing technical integrations with these organizations oftentimes requires high-level project management and integration knowledge to keep your project in front of mind and moving forward.

Compliance Requirements

All of healthcare is heavily influenced by three letters–PHI (short for protected health information). For obvious reasons, the authorization of access and use of PHI is heavily regulated in an attempt to keep individual privacy intact and prevent nefarious or negligent breaches.

Healthcare integration almost always deals with the exchange of PHI and is therefore subject to the microscope of regulatory and law enforcement officials. This means crossing your T’s and dotting your I’s for all things security and compliance. This requires extensive subject matter expertise and the understanding/ interpretation of complex and always changing legislation. Simply put, the expectations and risk of noncompliance is so great, all things healthcare move slowly and cost more than other industries.

In almost every scenario where you are implementing an integrated workflow in healthcare, you (as the consumer of PHI) will need to sign the healthcare organization’s Business Associate Agreement.

Specialized Personnel Required

All of the above leads to an inconvenient truth–healthcare integrations requires personnel with healthcare knowledge. There have been numerous high profile flameouts by otherwise wildly successful organizations that failed to acknowledge this reality. Here is a breakdown of what to expect across otherwise “normal” roles.

Full Stack Developers

  • Need aptitude to understand the context of healthcare (ie. standards, EHRs, personnel limitations, workflow requirements, etc.)
  • Need to be able to work in a regulated/compliance orientated space. This isn’t a “go fast and break stuff” kind of environment.
  • Willing to carry a pager – Healthcare doesn’t sleep. Around the clock availability is very much a thing.

We think the Shelby Switzer, the head of integrations at Healthify, got it right with this table.

Project Managers

  • Deep healthcare background and experience managing healthcare projects.
  • Experience managing integration projects is a plus.
  • Technical enough to understand the data ingestion/QA pipeline and help developers validate and map data
  • Knowledge of EHR workflows, shortcomings, vocabulary, and how EHRs differ from each other.
  • Understand how HL7 and API integrations differ from each other as well as the workflow implications around technical nuances and limitations.
  • Familiarity with all of the key stakeholders at a healthcare organization that needs to be engaged – legal, compliance, medical operations, IT, EHR analysts, affiliate relations, etc.

Integration Infrastructure

  • Top-notch infrastructure developers who can also understand, plan for and execute in a compliant/regulated environment
  • Experience in high throughput systems, especially with HA characteristics.
  • Willing to carry a pager.

Integration Engineers

  • Practical experience in various standards including HL7v2, CDA, X12, and web services.
  • Practical software development skills to perform customizations, build out new web services etc.
  • Deep healthcare knowledge – important to understand the why vs the what.

Realistically, personnel that meet all of these requirements are few and far between. This means they come at a premium or simply aren’t available and require extensive training to get up to speed.


At Redox, we’re out to make exchanging healthcare data simple and scalable so that these complexities can be avoided. If you’d like to learn more about how Redox addresses these challenges and frees our partners to focus on their core product and users, check out our latest whitepaper covering the essential jobs required to integrate with EHRs and exchange healthcare data at scale (and how Redox helps).