The Magic of Middleware

As I mentioned in my blog about Certification verses Meaningful Use, there will be 9 data exchanges required in 2011

ePrescribing

Sending reminders to patients

Checking insurance eligibility

Submitting claims

Providing patients with an electronic copy of their record

Providing patients electronic access to their records

Capability to exchange key clinical information (e.g., problem list, medication list, allergies, test results) among care providers and patient authorized entities

Capability to submit data to immunization registries

Capability to provide syndromic surveillance data to public health agencies

It's unlikely that clinician offices and hospitals will rip and replace existing systems. It will take several years for vendors to create upgraded software versions which support all these exchanges and for organizations to deploy them. That means that in the interim, it's likely that we'll need middleware at the border of organizations which translates legacy standards and proprietary vocabularies into the data exchange standards which will be required by the December interim final rule.

Over the past few months, I'm met with many middleware companies. Here are the ones to watch:

Emdeon - provides clearinghouse services and analytics. Although it typically has focused on X12 administrative transactions, its infrastructure could easily be leveraged to transport clinical content

Surescripts - provides the eRx transactions among payers, providers, and pharmacies. Although this infrastructure transports chiefly NCPDP content, it could easily be leveraged to transport other types of clinical content

Intersystems - provides an integration engine for communication within and between enterprises

Edifecs - provides data transport and data mining/business intelligence services on transported data

Orion Healthcare - provides software which maps various standards from one to another and provides transport

Health Language Inc. - provides vocabulary translation services

Intelligent Medical Objects - provides vocabulary translation services and tools which enable clinicians to translate free text into controlled vocabularies.

Visionshare - provides transport of data to Medicare (CMS) using the internet and not a proprietary network. You can imagine a company like Visionshare providing a secure front end from clinician offices to the Nationwide Health Information Network.

Covisint - originally provided supply chain integration for the auto industry, but is now expanding into healthcare transactions such as automated clinician credential verification for the AMA.

Although at some future point, EHR software vendors will include standard content/vocabulary interfaces and the NHIN (aka "the Healthcare Internet) will provide secure transport, these middleware companies will help us with the glide path from the present to the future. I'm confident there will be disruptive innovation in the middleware market, including the notion of using PHRs such as Microsoft Healthvault and Google Health as hubs to collect patient data and exchange it as the patient wishes.

It's hard to predict the future, but if HIPAA administrative simplification provides us with lessons learned about adoption and implementation, middleware vendors will be very important in the years ahead.