All interface hubs may be filling the same gap in the integration process, but consultants say the method of choosing one depends on how it fits with a network's stage of evolution and the strengths of the providers' technical staff.
Healthcare executives also should consider buying from the source best suited to the type of integration projects they're considering, said Michael Kreitzer, national director of systems integration services for the Chicago-based healthcare practice of Coopers & Lybrand.
Major information system vendors such as Shared Medical Systems and Cerner Corp. market their own hub products for system integration. Niche vendors such as laboratory system purveyors also may have hub products, Kreitzer said.
The rest are marketed by vendors that promote system integration as their main function and independence from information system vendors as a main advantage, he said.
Of those, four are generally recognized as the leaders:
Century Analysis, or CAI, Pacheco, Calif., marketer of the TDM interface engine as well as other software tools that tie together diverse information systems in a network.
Healthcare Communications, Dallas, creator of an interface engine called HCI-Link, and a more powerful successor introduced last December called Cloverleaf.
HubLink, Columbus, Ohio, maker of a product called the Integrator.
Software Technologies Corp., Arcadia, Calif., which makes and distributes the DataGate interface engine.
Sorting itself out.Despite the proliferation of about integration hub vendors, "it's still an emerging industry," Kreitzer said. "Some are much easier to use and modify. Some are going through major upgrades."
Of the major independent vendors, "any of the four can meet your basic requirements," said John Vitalis, a healthcare consultant with the Kennedy Group. "It comes down to some of the bells and whistles, how they do it, what approach they take, what's easier for the technical analysts to do."
For example, Emory University Hospital in Atlanta weighed three offerings and decided all could do the base-level conversion and translation tasks required. It went with the Healthcare Communications product mainly because of how it facilitated programmer tasks and because it fit well with the IBM mainframe platforms being integrated, said Gary Bartlett, who's heading Emory's technology team. He also was impressed by the Cloverleaf upgrade.
On the other hand, St. Louis-based BJC Health System was interested in wider integration issues such as the means to build a master patient index for its six hospitals undergoing interconnection. BJC chose CAI for its ability to use the interface engine as the starting point for the larger task, said Sara Lafrance, CAI's president.
If most of a network's computer systems are in place and all that's needed is the integration component, then the independent route makes sense, Kreitzer said. But if a major information system addition or replacement is in the works, it may be better to go with that vendor's integration hub or with the vendor's choice of an independent maker's product, he said.
The new healthcare information system "will be the hub of system interfacing anyway, and it's through that vendor that interfacing will have to be written," said Kreitzer.
Pre-packaged.Some vendors pre-package the data formatting and other necessary interfacing specifics with an interface engine as part of the deal, said Michael Cataldo, spokesman for Software Technologies. That saves time on implementation and reduces the amount of synchronizing that a health network would have to do on its own, he said.
Package deals on interface engines illustrate a paradox facing vendors of integration technology and vendors of major software systems.
Though makers of integration hubs promote the advantages of technical independence from major software systems, they've struck deals to have the hubs incorporated and distributed by information system vendors as part of the implementation of new software products (See chart, p. 58).
And though the major vendors would like to lock up sales of their entire product line, the market is moving toward integration of the best components available. "They know they really gotta have an (interface) engine, and they've got to be fairly neutral about it," Cataldo said.
Major vendors usually rename the hubs that they resell. HBO & Co. offers an engine called Interface Manager, First Data Corp. uses one called First Connect, and Alltel Information Services markets OpenHub. All are DataGate products, Cataldo said.
As major vendors carve out a niche in an expanding roster of network information system needs, they're viewing interface engines as operating systems that enable their patient-record applications to work as envisioned, Cataldo said. "They're application vendors. They'll relinquish control on the interface in order to get access to information to run on their applications."
The distributor strategy isn't universal. HubLink has made "a conscious decision" not to develop partnerships with software vendors, said spokesman Robert Kington. "We think we're better off not having those kinds of agreements. We're trying to remain as independent as possible." Kington contended that such alliances "compromise the vendor-selection process."
As advances in computing speed and software innovation intensify demands on healthcare computerization, the enabling capacity of integration hubs also will have to keep up, said Jerry Scott, president of Healthcare Communications.
Interface engines could become bottlenecks if they can't handle an increasing volume of clinical and financial transactions in bigger and more complex health networks-where new and more powerful information systems are being added continually. "Each time you do that, you get geometrically more complex," Scott said.
Integration hubs "will have the transaction volume of an airline reservation system" once networks are fully grown, he said. Current interface engines "are just Tinkertoys compared to where they need to go."
Upgrades important.Integration hub vendors will have to demonstrate the ability to upgrade their product incrementally so they can respond to gradual changes in the network in general, Vitalis said.
The decision for healthcare executives thus becomes much the same process as for any other state-of-the-art information system, said Kreitzer. The product must serve immediate needs but be able to handle future demands.
And, ironically, in seeking independence from vendor influence through integration hub technology, networks are introducing another vendor whose fortune will be tied to theirs, said Vitalis.
Those vendor fortunes could be determined in the next few years, as they slug it out for a client base. The market has a limited window of about 18 to 20 months, Vitalis said, after which most customers for the integration product will have bought what they need.
Sales will then reach a plateau, and vendors will need a steady stream of ongoing revenues from other sources, such as maintenance contracts with existing clients, if they're going to stay capable of providing support and upgrading their product, he said.
That's not to say you're stuck with whatever vendor you initially choose. It's probably easier to replace a vendor for an interface engine than for, say, a laboratory system, Vitalis said.
The move would seriously affect information systems professionals behind the scenes, but it wouldn't require hundreds of users to change their computer practices the way a lab-system replacement would, he said.