In recent months, Gevity’s Health Data Exchange (HDX) practice helped multiple client organizations to upgrade their InterSystems HealthShare™ solution to the latest IRIS™ platform, delivering material benefits in just a few weeks. As the leader of our HDX Practice in the US, I wanted to share some of what we’ve learned in this post, for the benefit of current InterSystems clients as well as for organizations not yet on the latest version of any competing interoperability platform.

Why keep your interoperability platform updated?

Keeping up with the EMR quarterly update cadence is a familiar struggle for hospitals, but what gets much less press is the ongoing challenge with keeping up with HIE and interface engine software updates.

Most CIOs responsible for the health of their integration platform strive to be at the latest or n-1 version of their current interface engine software stack and underlying operating system. Practically, however, these upgrades can take a back seat to other time-sensitive clinical and business projects. Through our recent HDX work, I have seen several organizations be multiple versions behind their vendor's latest update.

Some healthcare organizations are blissfully unaware of the consequences such a delay in updates might have on their infrastructure's reliability and security, let alone the risk potential for compliance issues related to any regulatory changes. In some cases, organizations end up buying a second product to deliver functionality that is already included in their existing platform, simply because they haven’t applied their upgrades.

What is InterSystems IRIS?

InterSystems has released IRIS, a new version of its rock-solid HealthShare platform. IRIS stands for Interoperable, Reliable, Intuitive, and Scalable and it certainly lives up to its name. A unified data platform with a massively scalable database, built-in analytics integration & interoperability tools, IRIS also offers automated mechanisms for rapid and easy deployment.

If you want your applications to meet today's myriad of challenging requirements and optimize the use of your data, applications, and resources, consider an IRIS upgrade. InterSystems offers two flavors, IRIS Data Platform™ and IRIS for Health™. The latter is specifically engineered to extract value from healthcare data.

Compliance with ONC and CMS Rules

By now, you are no doubt familiar with the two new rules released earlier this year by the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) regarding certification requirements, information blocking, interoperability and patient access, and imposing penalties for non-compliant organizations.

CMS and ONC have identified Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR - pronounced "fire") Release 4.0.1 as the foundational standard to support data exchange via secure application programming interfaces (APIs).

InterSystems IRIS for Health supports FHIR 4.01 as well as the US Core Implementation Guide that sets out the standards and capabilities required by these new rules governing patients' ability to access their data through open-APIs using FHIR.

Moreover, patient event notifications to external health care facilities or community providers are also now required. They can be accomplished using simple event notifications or by addressing the complex event notifications in IRIS, using rules to provide near real-time actionable information.

A Provider Directory that can include National Plan and Provider Enumeration System (NPPES) data is accomplished with the “one source of truth” Provider Directory in IRIS. Provider information can be exposed using APIs, importing, and exporting from multiple sources including NPPES data. Exporting this data makes it simple for providers to comply with this new rule.

Allowing access to patient information as they travel along the care continuum is also addressed in the IRIS upgrade. The InterSystems unified care record can be accessed and viewed by any caregiver, enabling seamless coordination all along the care continuum.

Technical Benefits

Speed, Scale, and Flexibility

The IRIS database combines high performance with massive vertical and horizontal scalability. There is no record too large for IRIS to handle. It is eight times faster than Amazon Aurora and three times faster than their legacy Caché product.

Machine Learning and Analytics

Unstructured data such as blog posts, images, videos, clinical notes, social media content, etc. is the largest, most current, and fastest-growing type of information available. It cannot be easily fitted into rows and columns, which makes it challenging to capture, store, and analyze. But not with IRIS, which can store both structured and unstructured data.

Enhanced Developer Productivity

Application development in IRIS is not restricted to Caché Objectscript. You can use other languages like Java, .NET, RESt, JSON., C++, JavaScript, Python, and Node.js. IRIS connects to the IDEs of these languages like Visual Studio, offering a faster, better coding experience with improved Github integration. You can run objectscript class methods from your python or Node.js application and directly access the globals. Not having to run SQL also improves overall application performance.

Rapid HL7 Interface Development

IRIS now supports various tools that reduce interface development & maintenance cost/time. The HL7 Production Generator takes a CSV file as input and auto-generates a skeleton production. A simple table format is used to specify basic interface details. The HL7 Message Analyzer analyzes messages, reports matching schemas, and proposes specific changes to HL7 schemas, including Z segments. InterSystems IRIS 2020.1 provides support and performance enhancements for Sybase ASE T-SQL syntax and applications. Customers with existing Sybase ASE applications written in T-SQL can easily migrate their applications to InterSystems IRIS.

Security

InterSystems IRIS offers many desirable security features: it is containerized in non-root installations; passwords, hashes, and salts can be generated by a container-based Nano-service; values can be directly stored, without persisting the cleartext password anywhere; and a whitelist for endpoints offers control over what is and is not accessible.

Lessons Learned 

If you are considering upgrading your current HealthShare instance to IRIS, consider these lessons learned before you start:

  1. Determine if you have a single or multi-platform license and order the key in advance from InterSystems. This may take time and introduce unplanned delays to your upgrade.
  2. Identify any gaps in interface test plans before proceeding with the upgrade. Filling these gaps beforehand is important to ensure the conversion goes smoothly.
  3. Identify any existing custom code and plan for how the functionality will be replicated post-upgrade through custom development and testing.
  4. Consider implementing a code freeze before the upgrade and coordinating with other IT projects with ongoing builds or go-lives.

Recommendation

There is no better time than now to upgrade your interoperability platform to its latest version, before the looming September deadline for the next regulatory requirements release. To keep your integration platform fresh and ready for whatever clinical, business, or regulatory requirements present themselves, please connect with me to learn how Gevity can help: jwagner@us.gevityinc.com.