Duration: 2 hours Prerequisites: Technical system knowledge helpful Session Type: Technical Deep-dive

• Understand healthcare data standards (HL7, FHIR) and their business applications
• Design effective integration solutions for HMIS environments
• Plan comprehensive testing approaches for healthcare system integrations
• Evaluate integration architecture options and their trade-offs

• HL7 v2: Legacy messaging standard still widely used
• HL7 v3: Complex standard with limited adoption
• HL7 FHIR: Modern RESTful API standard gaining rapid adoption
• C-CDA: Continuity of Care Document for information exchange

• RESTful APIs: Modern web-based integration approach
• Resource-Based: Modular data elements (Patient, Observation, Medication)
• JSON/XML: Flexible data formats supporting web technologies
• OAuth 2.0: Secure authentication and authorization framework

• DICOM: Digital Imaging and Communications in Medicine
• IHE Profiles: Integrating the Healthcare Enterprise specifications
• SNOMED CT: Clinical terminology standard
• LOINC: Laboratory data identification codes

• Direct Connections: System A directly communicates with System B
• Pros: Simple implementation, low latency
• Cons: Complex maintenance, difficult to scale
• Use Cases: Critical real-time interfaces (lab results, alerts)

• Enterprise Service Bus: Central integration layer
• Message Routing: Intelligent message distribution
• Protocol Translation: Converting between different standards
• Benefits: Centralized management, easier maintenance

• RESTful Services: Standardized web-based interfaces
• Microservices: Modular, independently deployable components
• Cloud-Native: Scalable and resilient integration patterns
• Developer-Friendly: Easy to implement and maintain

• EHR to Pharmacy: Medication orders and administration
• EHR to Laboratory: Test orders and result reporting
• EHR to Radiology: Imaging orders and report distribution
• EHR to Billing: Charge capture and coding integration

• Health Information Exchanges (HIEs): Regional data sharing
• Laboratory Partners: Reference lab result integration
• Insurance Systems: Eligibility verification and prior authorization
• Public Health: Reportable disease surveillance and immunization registries

• Medical Device Data: Vital signs monitors, infusion pumps
• IoT Sensors: Patient monitoring and environmental controls
• Mobile Applications: Provider and patient-facing apps
• Wearable Devices: Continuous monitoring data streams

• Code Set Mapping: ICD-10 to SNOMED CT translations
• Unit Conversions: Laboratory values and vital signs
• Terminology Services: Centralized vocabulary management
• Value Set Management: Maintaining consistent reference data

• Completeness: Ensuring all required data elements are present
• Accuracy: Validating data against business rules
• Consistency: Standardizing formats and values
• Timeliness: Managing data freshness and synchronization

• Master Patient Index (MPI): Unique patient identification across systems
• Provider Directory: Centralized physician and staff information
• Location Registry: Facility and department master data
• Service Catalog: Standardized procedure and service definitions

• Interface Components: Individual integration modules
• Data Transformation: Mapping rules and business logic
• Error Handling: Exception scenarios and fault tolerance
• Performance: Response time and throughput testing

• End-to-End Workflows: Complete business process testing
• Data Flow Verification: Confirming accurate data transmission
• Error Scenario Testing: Network failures and system outages
• Security Testing: Authentication, authorization, and encryption

• Clinical Workflow: Real-world usage scenarios
• Performance Validation: Acceptable response times
• Data Accuracy: Clinical staff verification of integrated data
• Training and Documentation: User readiness assessment

• Design and Documentation: OpenAPI specifications and developer portals
• Version Control: Managing API changes and backward compatibility
• Testing and Quality Assurance: Automated testing and validation
• Deployment and Monitoring: Production deployment and performance tracking

• OAuth 2.0 Implementation: Secure token-based authentication
• HIPAA Compliance: Protecting patient health information in transit
• Audit Logging: Tracking API usage and data access
• Rate Limiting: Preventing system overload and abuse

• API Documentation: Clear, comprehensive usage guides
• SDKs and Libraries: Language-specific development tools
• Sandbox Environments: Safe testing and development spaces
• Support and Community: Developer assistance and collaboration

Scenario: Mapping patient admission data to FHIR resources

• Identify relevant FHIR resources (Patient, Encounter, Location)
• Map local data elements to FHIR attributes
• Address missing or additional data requirements
• Consider security and privacy implications

Scenario: Connecting new laboratory system to existing HMIS

• Analyze current system architecture and capabilities
• Choose appropriate integration pattern (API, messaging, file-based)
• Design data flow and transformation requirements
• Plan testing and rollout strategy

Common Integration Failures:

• Network connectivity issues
• Authentication failures
• Data format errors
• System downtime scenarios

Design Considerations:

• Retry mechanisms and exponential backoff
• Dead letter queues for failed messages
• Monitoring and alerting systems
• Graceful degradation strategies

• Idempotency: Ensure operations can be safely repeated
• Asynchronous Processing: Avoid blocking operations
• Circuit Breakers: Protect against cascading failures
• Caching: Improve performance and reduce system load
• Monitoring: Comprehensive logging and metrics collection

• Stakeholder Alignment: Ensure all parties understand integration goals
• Change Management: Plan for system and workflow changes
• Training: Prepare staff for new integrated workflows
• Performance Monitoring: Track business metrics post-implementation
• Continuous Improvement: Regular assessment and optimization

• Healthcare integration requires understanding both technical and clinical contexts
• FHIR is becoming the standard for modern healthcare integrations
• Integration architecture choices have long-term maintenance implications
• Comprehensive testing is essential for patient safety and data integrity
• API management and governance are critical for scalable integration programs

• Integration Platforms: Mirth Connect, Rhapsody, Corepoint
• API Management: Azure API Management, AWS API Gateway, Kong
• Testing Tools: Postman, SoapUI, JMeter
• Monitoring: Splunk, New Relic, Application Insights
• Development: FHIR servers, terminology services, testing sandboxes

Session 9 will address cybersecurity and compliance in digital health, focusing on the 725 healthcare breaches reported in 2024 and strategies for implementing robust security frameworks.