Data Communication Methods in Healthcare: Modernizing Health Data Delivery

It’s pretty much a given at this point in time that every health IT professional knows there are different standards in healthcare like HL7 and different ways to “follow” these standards. That’s been the case for several years and is unlikely to change any time soon. Luckily for most healthcare providers, there is a #1 in KLAS interface engine that can help you overcome interoperability issues with HL7 data.

I’ve always been told that health IT is 5-10 years behind other industries. That’s hard to argue with and we could fill the web with opinions on why this is the case: privacy, security, data standards, data complexity, and the existence of closed/walled healthcare systems are the common culprits.

Thanks to the electronic cattle prod that is Meaningful Use, times are changing.

An IT area currently undergoing tremendous growth is data communication methods, or data transport protocols. Previously, few health IT departments dabbled with the communication methods that were commonplace throughout the rest of the IT landscape until the concept of external health information exchange was included in the HITECH Act.

How, exactly, are we going to electronically send our unique health data to Memorial Hospital down the street?

The answer is using modern protocols like Web Services, and to a lesser extent Direct Project, which Rob Brull has discussed previously on this blog.

Web Services is considered the most flexible and modern communication method and is used for both internal and external communication. Its popularity is rising quickly as more and more health IT professionals realize it has several advantages over more traditional methods used in health care. Methods such as:

TCP/IP over a VPN

The most widely used communication method to connect applications in healthcare. When it comes time to connect with partners outside the hospital’s four walls, one choice is to continue using TCP/IP and protect that connection with a VPN tunnel.

By continuing using this traditional method, the facility can utilize the same protocol they are familiar with, TCP/IP, and extend it outside the facility in a secure manner. However, VPN connections can be time consuming to set up and costly to maintain.

Web Services is a direct substitute for VPNs. Patient health data can be sent securely, on demand, using Web Services. The HL7 message payload can be parsed and sent/received automatically using Corepoint Integration Engine.

FTP (secure)

File Transfer Protocol (FTP) often involves moving large file batches to and from external systems securely. Utilizing FTP might be useful if your interface cannot connect through a VPN and thus cannot utilize TCP/IP to deliver messages. FTP uploads a message to an FTP server and also enables files on an FTP server to be downloaded at a specified time interval, or by request.

The FTP can transport data securely using encryption settings based on SSL/TLS (FTPS) or SSH (SFTP). A user must be able to control the FTP server, or coordinate with those in control, to be able to create, delete, overwrite, and rename files and create directories.

Web Services can be used, just as FTP, to transfer large data files. Just as with FTP, the owner of the target server must supply details about how to connect and to deliver the files. In the case of SOAP-based Web Services, a WSDL (Web Services Description Language) would be provided to define the procedures for delivering messages and files to the target server, which is also called a Web Services Producer

Secure e-mail/Direct Project

True, Direct Project is a newer transport method required by Meaningful Use (and also available in Corepoint Integration Engine). It is, however, considered the “minimum threshold” for data exchange. It has many use cases, as do the other methods listed above, but it is not the most interoperable method of communication.

Secure e-mail, or Direct Project, can be utilized to send patient health information from application to application. Direct Project also defines a transport method based on Web Services, referred to as the XDR and XDM profiles for Direct Messaging. XDR and XDM profiles are specifically defined by IHE for communicating healthcare data in a push-based fashion.

While secure e-mail uses SMTP transport as the backbone, XDR and XDM profiles are based on Web Services. Both are equivalent methods of pushing healthcare messages from one place to another.

One advantage Web Services (beyond XDR and XDM) has over SMTP is the built-in complexity to handle query-based communications. Query-based communications are common in an emergency department scenario: A patient arrives at the hospital and the physician needs to query the local HIE for all medical information available about the patient. Web Services communications will be necessary to perform these query-based scenarios. 

We'll take a closer look at Web Services in a future post. In the meantime, feel free to read our White Paper, "Web Services in Corepoint Integration Engine."