EMR Middleware

Client - Nidek, CO, Ltd., Nidek, Inc., Eyefinity - OfficeMate, MDoffice Healthcare, NextGen Healthcare

 

EMR systems support the creation, viewing and editing of medical records.  The EMR system may or may not have interoperability with other software or hardware systems. There is a general consensus that EMR systems that interoperate are needed in modern medical practices.  Physicians really don’t want to shuffle papers around anymore than normal people in their general lives.  And even though there are cited barriers to adoption in hospitals that include physician’s resistance, they know all too well that electronic methods of maintain patient information is here, needed, and improves overall the quality of patient care.  However, the burden to make the EMR experience an enjoyable one falls squarely on the shoulders of the EMR vendor and the instrument manufacturer.  The physician, who in this case is the software consumer, doesn’t care why it doesn’t work properly, or why it is difficult to use.  He only sees it as a tool, much like Microsoft Word or Adobe Photoshop.  It is installed to perform a job, make some effort easier, and it needs to perform flawlessly.

NAVIS is a Japanese based ophthalmology company that builds medical instruments that have limited communication capabilities with the EMR based systems in hospitals. We built a proof of concept system to educate them on the need for such a communications system and how to guide them through the process of incorporating EMR capabilities in their medical instruments

The EMR Middleware acts as a proxy between the hosptal EMR systems that are HL7 compliant in electronic communications and the NIDEK instruments, allowing for basic patient metadata exchange such as during the process of patient registration.

The project objectives may be broadly divided into three categories.  The first is the type and method of data interchange between NAVIS and the EMR system.  The second is the architectural implementation of the controlling process.  The third is to work directly with each vendor and implement its preferred method of data communication.

To achieve these goal, a middleware solution was recommended as a proof of concept.  The middleware is an application level product that communicates with both NAVIS and the EMR systems.  It is responsible for making the intelligent decisions on what instruments to connect to (via NAVIS) and what EMR systems to communicate with.  All data (patient demographic metadata as well as images) are transformed and marshalled by the middleware application.

 

The following figure shows how a middleware application relates to the EMR vendor applications and NAVIS.
The resulting EMR Middlware application begins with an opening window.
The application is highly customizable to different variants of HL7 that it may encounted.
One the EMR Middleware is started into listening mode, it monitors for incoming HL7 based messages and processes tham accordingly to the connected NIDEK medical instruments.
The EMR Middleware is configurable to multiple HL7 vendors.
The Parse HL7 Message window shows the fields associated with each segment in the HL7 message. SEQ is the sequence of the field.