Lifen.Engineering
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Lifen.Engineering

How to fix Interoperability in Healthcare

Meet our team of interoperability product managers, developers, experts, and operations & QA managers

Welcome to this two-part article explaining who are the people behind the interoperability at Lifen. In this first part, we’ll see what interoperability is in the first place, and how we are fixing it with our Cloud Integration Engine. Then we’ll meet our Interoperability Product Managers, Interoperability Experts, and Interoperability Developers behind this engine.

How medical data is shared in the real world

Sharing data between healthcare practitioners is a broken process

Medical data is shared between healthcare professionals at each step of the care pathway. When you are hospitalized, your general practitioner gets notified after your discharge with a surgery report, a discharge letter and other reports relevant to what happened during your hospitalisation.

Although in 2021 most practitioners are equipped with a secure messaging system, the health ecosystem still struggles to seamlessly connect Electronic Health Records (EHR) in clinics and hospitals, official patient platforms (MonEspaceSanté), and secure messaging systems.

Therefore, reports are being printed and sent by postal mail (sometimes manually) and scanned back into the doctor’s patient management system (PMS):

The sad truth about interop in most cases: postal mail is the default link

This actually happens at a scale that is quite large: hundreds of millions of documents are sent each year in France by postal mail.

Hopefully, recent initiatives and government fundings such as the Ségur, which are focused on usage rather than equipment, might well change things for the better.

Still, in a world where foreign systems in healthcare organizations need to communicate, between different versions, sometimes with outdated software and protocols, you need a common language to make the architecture work.

Sneak peek at the infrastructure in the largest hospital in France, © APHP

The current state of Interoperability in healthcare

This common language is the core of what is interoperability:

© Creative Commons:

In an open system with many components, you need a common standard with which components are able to communicate, in order to reduce the complexity of integrating a new component into the stack.

Some of the most common standards for healthcare are:

  • HL7 v2, a pipe-separated flat-file standard, found in every large healthcare organisation to communicate internally between healthcare services
  • CDA, an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents for exchange
  • FHIR, a (relatively) new standard, based on modern HTTP Rest APIs, which is gaining traction all over the ecosystem, from GAFAs to startups

Why we need better interoperability

In healthcare, there are many standards (which is usually not a good sign). Most of these standards are very permissive because, well, health data is quite complex. From this permissivity comes differences in the way standards are interpreted and implemented.

Because of that, large healthcare organisations partner with Enterprise Application Interfaces (EAI) which develop connectors and mappers between different standards (or different ways of speaking the same standard). Each new component in the infrastructure needs a connector, and consequently, global upgrades to new standards are out of reach (financially and operationally) for these organisations.

Finally, eHealth is a booming market (with more than 400 products, and 2B$ in fundings over the past 5 years, just in France). Hospitals need to jump on that train and integrate these cloud-based innovations to become more efficient, and ultimately provide better care. These great tools, developed in many verticals (Teleconsultation, Teleservice, Medication Intelligence, Care coordination, Digital Therapeutics, Administrative Digitization), need to be deeply integrated into organization IT systems to deliver their value, but each integration is time-consuming and complex.

Our vision of interoperability

Lifen’s Integration Engine

Enter Lifen’s Platform for Digital Health App Developers and Healthcare Organizations.

The Lifen suite of interoperability tools has connected cloud-based solutions to hundreds of electronic health records and patient administration systems. Once a connector is in place (SFTP, HL7, CDA-r2, FHIR, etc.), it can be leveraged for future integration of products and services, massively reducing the time to value for both apps and healthcare providers when integrating additional technology. Users and administrators will simply “click and connect” to unlock new and innovative services.

We built an integration engine that enables digital health apps to implement our Standard Fhir APIs once, and be one click away from deployment in hundreds of organizations:

Lifen’s Integration Engine: Interoperability factorized between app

That’s a lot on our plate! Let’s see what are the different jobs needed to build this Integration Engine. We’re building connectors to ingest Data Streams from organizations, translate them into our external standard API, FHIR, and then monitor them to make sure they are reliable.

To do that, we need to:

  • Understand all the different standards used in healthcare facilities, and build our product roadmap regarding which data streams we want to support, and what are the high-level services we offer through our API (Search Patient Database, Send to EHR, …). That’s the job of our PM & Interoperability Experts!
  • Understand specific client setups (from infrastructure requirements to different implementations of the same standard), install connectors and provide technical support to our clients. That’s the job of our Solution Engineers!
  • Distil the interoperability standard knowledge (from our beloved PM) into connectors and high level APIs written in typescript and rails, deployed on our lambda framework, or onsite (by our beloved TPM) That’s the job of our Interoperability Developers!
  • Maintain quality SLAs, monitoring and alerting on these datastreams, as they will be key to delivering care as more and more partners integrate them in their flow. We have strict Quality Assurance processes, doubled by rigorous operational monitoring. That’s the job of our QA & Operations Managers!

That’s all for the first part. See you in a few days to introduce each profile!

It takes the expertise and know-how from a lot of different experienced (and junior) people to get interoperability right. We’re trying hard to provide better communication in the healthcare IT ecosystem (we just raised 50M€ to do just that !), and we’re always looking for motivated people to join in. If you would like to contribute to changing healthcare and experience hyper-growth in the process, we’re hiring! Come, check out our Open Positions.

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