HL7 Survival Guide - Chapter 4 – Your EHR Strategy and Working with Vendors

HL7 SURVIVAL GUIDE

CHAPTER 4

A publication of

A supplement to the HL7 Survival Guide, available at http://caristix.com/blog/category/hl7-survival-guide/

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HL7 SURVIVAL GUIDE CHAPTER 4

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CHAPTER 4: Your EHR Strategy and Working with Vendors



Many organizations use third-party vendors when implementing a new system or when migrating from

one system to another.

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Nine Critical Questions You Need to Ask Your Clinical System and Interface Vendors

Get answers to these 9 questions to stay in control of your projects and avoid hidden

expenses.



1. “Who provides the hardware, if any?”– Validate that your new EHR or clinical system doesn’t need

extra hardware– If it does, validate any hidden costs– Determine who does maintenance

• Verify the response time – How do you determine who is accountable for arising issue?

• If there is a problem with data exchange, is the vendor going to help troubleshoot?

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Question 1



2. “What standard does your system use for data exchange? HL7? Which HL7 2.x version are you using?

(A no-brainer at first glance – but you need this information!)

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Question 2



3. “Can you supply a list of customizations to the HL7 v2.x standard you are using?”• You will find deviation in several ways:

• Custom messages, Z segments, customized data types, customized data sets, etc.

• Understanding these customizations help you grasp the overall interface and the amount of work required to integrate to other systems

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Question 3


HL7 SURVIVAL GUIDE CHAPTER 4 8

Question 4

4. “Within your HL 7 2.x based interface, can you tell me which elements and values are configurable?”

• Get the details• If not, you face longer testing cycles with trial-and-error

interface validation


HL7 SURVIVAL GUIDE CHAPTER 4 9

Question 5

5. “When you send us the interface spec for sign-off, do we get a fully documented list of gaps and exceptions for specific data values and data elements?”

• Get the full list or face lengthy validation• Avoid black-box syndrome (http

://caristix.com/blog/2012/06/interface-black-box-syndrome/) wherein the vendor maintains control of the interface

http://caristix.com/blog/2012/06/interface-black-box-syndrome/





6. “Will you provide a list of the interface customizations you create for us?”

• What’s been customized for your environment?• You need this list for troubleshooting and maintenance• If not, you’ll be waiting constantly on vendor trouble tickets

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Question 6



7. “How do you document changes and upgrades throughout the lifecycle of the interface? Do you automatically provide us with updated documentation?”

• What you get at go-live is not usable 2 years later• Spell out the responsibility for document updates

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Question 7



8. “Does the interface you built contain any intellectual property?”

• Crucial point • Does a license apply to the code?• Will you own the interface or does the vendor?• If the vendor is the owner, you will need to engage the

vendor for every costly tweak or new project.

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Question 8



9. “How guaranteed is message delivery? Does each message get an “acknowledge” (ACK) or “no acknowledge” (NACK) reply?”

• Part of the HL7 standard• No guarantee of message delivery without it

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Question 9



1. “If an application makes an information request, does the replying system acknowledge that it received the message or does it just reply?”

• In the case of information requests (query messages for instances), the system will respond with one or several messages containing the information. In most scenarios, no ACK/NACK is involved as few systems implement Query/Response messages.

2. “ What happens if the replying system does not have the requested information?”

• The response format allows systems to return a message stating no information was available based on the criteria requested, rather than just sending a reply with blank fields.

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3 Bonus Technical Questions



3. “What happens when a message requests data be updated or inserted?”

• Let’s say the lab system sends results to the EHR but the patient ID is not recognized at the EHR – what happens? The role of a message is to publish an event once it occurs and provide related information. How the information is handled is system specific and in some cases, the system might do nothing. While the system is responsible for handling the information received, the interface needs to provide information the system can handle.

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3 Bonus Technical Questions (cont.)



• Chapter 5 in the HL7 Survival Guide• Vendors, Consultants, and interface

specialists– If you’re building your interfaces in house, you’ll

be dealing with clinical system vendors. And if you’re outsourcing interface development, you’ll be working with consultants. Either way, you want to know what issues to avoid. Learn more in Chapter 5.

– Blog link: http://caristix.com/blog/2012/11/hl7-survival-guide-chapter-5/

– Slide deck on Slideshare: coming soon.

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UP NEXT: CHAPTER 5

http://caristix.com/blog/2012/11/hl7-survival-guide-chapter-5/

http://caristix.com/blog/2012/11/hl7-survival-guide-chapter-5/



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HL7 Survival Guide - Chapter 4 – Your EHR Strategy and Working with Vendors

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