Health Data Integration Challenges

"Once you've integrated with one instance of X EHR, you've integrated with one instance of X EHR" is a tired trope. Every healthcare business is different. At a minimum, they have different locations, different staff, different departments and specialties, different procedures, different workflows. So yes, they've bent the EHR to fit their unique operational needs. To ask them to be the same is to ask them to sacrifice innovation, too. Without trying new medications, new procedures, new devices, new workflows, we can't get to the point we identify the care models that work. Entropy is the feature, not a bug. It's not unique to healthcare. Salesforce integrations are still a nightmare of custom objects and fields. Every Shopify store has different product taxonomies. SAP implementations are notoriously bespoke. Yet somehow these industries manage to build thriving ecosystems of third-party tools and integrations. What's different in some other industries (and what we should be clamoring for) is that APIs exist specifically to expose the variance, not hide it. Shopify's API tells you exactly what custom fields this particular store has added to their products. Even Salesforce, for all its complexity, has robust metadata APIs that let you discover what custom objects and fields exist in any given instance. For so many EHRs, we lack the discovery mechanism. There's no easy way to ask "what departments exist here?" or "what custom order types have you created?" or "what flowsheets do this health system have?" APIs for foundational data are either non-existent or require archeological expeditions through implementation guides, CSV dumps, and tribal knowledge from IT staff who've been there since go-live. We don't need to pretend every ICU works the same way - we need EHRs to expose the APIs for their customers' customization. Let me query for all active departments, all order types, all flowsheet templates, all custom fields. Let me understand programmatically that your "cardiac stepdown unit" is called "3West" and uses different observation frequencies than your "surgical stepdown" called "PCU-2."  

It's time to get real: billions of dollars and 20+ years of health IT regulation has resulted in adoption of EHR systems with limited interoperability and data exchange capabilities, and has made it incredibly difficult to access complete patient records electronically. It's hard to convince providers to share across vendor networks by default, it's hard to break through digital roadblocks and end paper bridges, and it's hard to build new workflows that incorporate outside data and information. In a new article in the Journal of AMIA (American Medical Informatics Association) by Assistant Secretary for Technology Policy's Jordan Everson and Chelsea Richwine assesses the American Hospital Association's 2023 Health Information Technology Supplement survey, and find that most hospitals still experience at least one minor (81%) or major (62%) barrier to exchange, with the most common major barriers relating to different vendors and exchange partners’ capabilities. Rural and lower-resourced hospitals fared worse. Patient matching and cost to exchange were reported as major barriers. What works? Health Information Exchanges (HIEs), Health Information Service Providers (HISPs), and national networks. "...supplemental analysis indicated that use of HIEs was related to substantially lower rates of reporting barriers related to different vendor platforms, exchange partners, the need for customized interfaces, and data formatting. Use of national networks was related to lower rates of 6/8 barriers, with the strongest association with lower rates of barriers related to different vendor platforms, costs to exchange, and a need for customized interfaces."

This Is Where Most EHR Integrations Go Wrong (And How to Fix It) When we first set out to integrate with Epic and Cerner, we thought, “It’s just FHIR, right?” Wrong. What we learned: integrating with major EHRs isn’t just about APIs—it’s about navigating complex ecosystems, security layers, and data models that don’t always play nice. Here’s the real breakdown 👇 How to Integrate with Epic or Cerner 𝟭. 𝗦𝘁𝗮𝗿𝘁 𝘄𝗶𝘁𝗵 𝘁𝗵𝗲 “𝗪𝗵𝘆”  Know what data you need, what you’ll do with it, and who benefits. 𝟮. 𝗨𝘀𝗲 𝘁𝗵𝗲 𝗥𝗶𝗴𝗵𝘁 𝗧𝗼𝗼𝗹𝘀  • Epic: App Orchard, FHIR R4, HL7v2, OAuth 2.0  • Cerner: Ignite APIs, HealtheIntent, FHIR R4 𝟯. 𝗕𝘂𝗶𝗹𝗱 𝗠𝗶𝗱𝗱𝗹𝗲𝘄𝗮𝗿𝗲 (𝗧𝗿𝘂𝘀𝘁 𝗠𝗲) Your own translation layer is key for:  • Data mapping  • Token management  • App-to-EHR communication 𝟰. 𝗧𝗲𝘀𝘁 𝗟𝗶𝗸𝗲 𝗖𝗿𝗮𝘇𝘆 Use their sandbox. Push every edge case. Expect token issues and schema quirks. 𝟱. 𝗦𝗲𝗰𝘂𝗿𝗶𝘁𝘆 & 𝗖𝗼𝗺𝗽𝗹𝗶𝗮𝗻𝗰𝗲 HIPAA, encrypted pipes, audit logs. No shortcuts. 𝗣𝗿𝗼 𝗧𝗶𝗽: Treat integration like infrastructure, not a feature. It’s what makes your product work in the real world of healthcare. #Epic #Cerner #FHIR #EHRIntegration #SMARTonFHIR

This well-intentioned claim has killed more provider-focused healthcare startups than any other: "We'll integrate with any EHR!" The reality of healthcare integration: Epic integration isn't just technical – It's political. Without App Orchard certification, you're facing 6+ months of custom work per client. With it, you still need local IT champions and competing priorities. Cerner's domain model creates fundamentally different data structures across implementations. What works at Intermountain won't work at Ascension without significant customization. Meditech/CPSI/Athena customers often lack the technical resources to manage complex integrations – regardless of what your sales team promises. HL7 isn't a standard – it's a framework. Each organization implements it differently, with custom segments, Z-segments, and proprietary extensions. FHIR readiness varies wildly – Most health systems have implemented just enough to meet Meaningful Use requirements, not enough to support your full workflow. The operational blindspots: Integration governance means your solution competes against 50+ other projects. Interface engine capacity is a finite resource you didn't budget for. Testing environments that don't match production. Downtime procedures you didn't design for. This isn't just a technical challenge. It's a market architecture problem that must be solved pre-sale. The most successful healthcare technology companies don't have the "best" integration – they have the most pragmatic implementation strategy that aligns with how health systems actually work. If your deals are stalling during implementation, let's diagnose the real issues. #healthcareintegration #implementationstrategy #ehrimplementation