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

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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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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.)

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• 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

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Is a recommendation unclear?
Disagree with something we said?
Let us know! We thrive on feedback.
Contact Us
support@caristix.com
1-877-872-0027
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© Caristix 2013. All rights reserved.

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

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