Integration hubs are credited with reducing the expense of computer interfaces, shortening the construction time and shaving the cost of maintaining and monitoring connections.
Health networks also no longer have to rely on an information systems vendor to walk their programmers through every twist and turn of the software package, as vendors once did when interfaces were custom-built, according to consultants and integration vendors.
With interface engines-the technical piece of the new integration technology-all the necessary interfaces are built and interconnected in the same place, using far easier programming methods than were available during the custom-construction era.
But while interfaces may be much easier to build, the implementation of an integration hub into an existing network requires an upfront investment of time and expertise. Users of the new technology caution that the implementation is still a complicated maneuver for a network's technical staff.
Bringing cost down.
The cost of building a conventional interface between two information systems varies widely, depending on the breadth and sophistication of the software.
An easy connection could cost $10,000 to build, but the expense more likely runs about $40,000 to $50,000 per direction, said John Vitalis, vice president with the Kennedy Group, a Redwood City, Calif.-based healthcare consulting firm.
These connections don't operate as two-way links-they're like one-way bridges. That means a provider could spend $80,000 to $100,000 connecting, say, a laboratory system to the admission/discharge/transfer system and back, Vitalis said.
"You build two or three interfaces, and you've paid for an interface engine," he said. After an upfront licensing fee, which can run $50,000 to $100,000, the cost of connections through the hub amounts to about $5,000 per interface, except for laboratory or radiology, which are more complex, Vitalis said.
For one system, the HubLink Integrator, an unlimited license covering all systems in a network is just less than $100,000, though the fee can be lower for a more limited license involving a subset of a network's information systems, said Robert Kington, spokesman for the Columbus, Ohio-based integration vendor.
Once installed, the expense of building connections runs $5,000 to $8,000 depending on their complexity, he said. HubLink can do the work for that amount, or a provider's technical staff can do it in-house for about the same expense, Kington said.
Software Technologies Corp. sells a services package that provides for training of in-house staffers and builds the first few interfaces to get them started with its DataGate interface engine, said spokesman Michael Cataldo. The services package can run anywhere from less than $20,000 to as much as $100,000 depending on what's done, he said. The unlimited license for STC's interface engine is $70,000.
Healthcare Communications charges a license fee of $65,000 for its original HCI-Link product, or the upgraded version, called Cloverleaf, said Christopher Little, spokesman for the Dallas-based integration technology vendor. A maintenance agreement that costs $15,000 a year gives a health network's technical staffers access to a library of interfaces, he said.
Century Analysis, or CAI, charges mainly by the interface up to a maximum, rather than an upfront fee. After a $10,000 charge for the interface engine shell and tools, the cost is $4,000 per connection up to $60,000 for unlimited interfaces, said Sara Lafrance, president of the Pacheco, Calif.-based integration services company.
The freedom factor.
Besides the lure of savings, makers of integration software tout their licenses as veritable declarations of independence from major healthcare software vendors.
The independence pitch is twofold: less reliance on vendors to supply the bulk of know-how for interface construction, and more freedom to choose software products without having to worry about how they hook up with those of a network's dominant vendor.
Healthcare providers have long complained about delays in scheduling interface appointments with vendors and about the fees involved in interface development, said Deborah Davis, vice president with the Clearwater, Fla., office of Superior Consultant Co. Now they pay the vendor once to get the details and then take control of the process, Davis said.
That also can avoid the headache of relying on two vendors to cooperate on a complicated interface that connects their products, which can lead to blame-athons when the interface doesn't work right. "When you net it out, it does tend to reduce the finger-pointing," said Vitalis.
An interface engine "has no ties to any vendor, and it isn't limited to what vendors are able or willing to provide," said Lafrance.
And since it provides the translation vehicle for making disparate systems understand each other and the room for new systems to link, the integration product allows providers to "take out and put back at will" instead of being limited to a dominant vendor's products or technical requirements, said Jerry Scott, president of Healthcare Communications.
"This is the modern-day way of saying, `Let me get back control of the healthcare delivery system,"' Scott said.
Writing interfaces to a hub could merely put providers at the mercy of a different vendor. But one of the selling points often stressed is that networks don't need to rely on the hub vendor. The product's programming is packaged as something provider staff can handle.
HubLink, for example, offers a four-day training seminar for computer pros, taking them through the process of developing and testing a connection.
Healthcare Communications has sent 200 people through its training program, the goal of which is to "allow customers to do their own integration, sometimes in a matter of hours," said Scott. "We would like very much for end users to support themselves," though an implementation and support staff is available. He said the work "should be done with internal labor rates, rather than those rates that you hire consultants for."
The technical underpinning for this ease of use is a concept called "object orientation," which groups all the intricate codes for specific tasks into mini-programs that can be linked.
Using icons of these "objects" and familiar tabular menus on computer screens, integration can be formulated without having to know everything that goes into the pieces being put together.
But while the hub itself is getting simpler, its integration into the overall computer network takes state-of-the-art knowledge that networks may or may not have.
"You don't just go out and build a black box and hook everything up," said Andrew Lederer, a senior associate with the Kennedy Group. "The solutions (to integration) are possible, but there's a significant degree of complexity in those solutions."
BJC Health System in St. Louis is implementing its first set of interfaces after five months of work, said David Weiss, vice president for information services. With all the existing experience of the technical staff, the work could have been done faster the old way, building interfaces point to point, he said.
"I don't want people thinking this is easy," said Weiss. "It's not that simple." For example, staffers need to be proficient in object-oriented and client/server computer technologies, he said.
But once the initial investment in time is completed, the incremental cost of adding information systems goes down, and interfaces are quicker to replicate, said Weiss.
Integration efforts at Emory University Hospital in Atlanta are picking up steam now that the provider's computer code-slingers have a dozen interface notches on their belts.
Since implementing an integration hub from Healthcare Communications in June 1994, the provider's information specialists have completed a project to make data from its two admission/discharge/transfer systems available to a central repository and to other information systems in the developing network, said Gary Bartlett, the development team's technology expert.
When the repository was installed, vendor Cerner Corp. of Kansas City, Mo., was writing interfaces one by one, and the process was too slow, Bartlett said.
By introducing the integration hub, the network was able to get data more quickly into the repository from separate admission systems at Emory University Hospital and Crawford Long Hospital of Emory University, he said. Ten more interfaces sent that information from the central hub to systems that needed it.
The overall effort to connect the patient-information system's data to all the desired destinations was a 16-month project requiring identification of every piece of computer code that touched the admission/discharge/transfer systems.
But the actual programming of the interface engine to facilitate the connections took only about eight weeks of that time, Bartlett said.
Emory is now working on consolidating laboratory systems onto one computer platform that hooks into the hub. In all, 60 different systems have lined up to be connected to the data repository, which will be done on a priority basis with pharmacy systems next in line, he said.
"It's not magic. It does require some effort," said Bartlett. But work done once can be replicated, which minimizes the development time and expense, he said.
Once interfaces are implemented, they have to be monitored and maintained so they work as designed and keep functioning under stress, said Bartlett. If volume gets too high or a glitch develops, important data such as medical orders can back up or send the connection crashing.
These interfaces used to be spread throughout the computer network, making it difficult to monitor and react to problems in a timely way. But a single interface engine is "the place to put your finger on the pulse of how all these interfaces are operating," Bartlett said.
Hub vendors are making the monitoring simpler by reporting critical data graphically on a computer screen. For example, information on data volume changes colors on-screen when the load reaches a certain threshold, he said.
A precipitous decline in data volume can indicate problems getting data through an interface, said Hal Scott,
Emory's director of corporate computing and acting chief information officer.
If the connection to the admissions system is down, patients won't have an admissions record in the system, and the computer receiving the order will kick it back, he said. The hub monitoring system senses and reports that problem, and it can be programmed to issue an alert and page the computer pro on duty, he said.
The monitoring features and programming shortcuts made possible by such technology can help chief information officers reduce computerization costs and improve their strategic reaction time, said J. Steve Rushing, an Atlanta-based healthcare partner with Andersen Consulting.
Interface engines in healthcare over time will allow top information executives to concentrate on higher-level software application issues instead of getting bogged down in basic maintenance and programming chores, Rushing said.
That'll give CIOs a chance to "rethink how they become part of the strategic picture," he said-enabling them to apply computer innovations to healthcare networks' overall efforts to compete in the integration era.