When Health IT Systems Talk to Each Other, Patient Safety Improves

Mario Hyland, Senior Vice President and Founder
It’s Tuesday morning in the ICU of a mid-size regional hospital where a doctor is treating a patient for a blood infection. The patient had been admitted with the same condition and successfully treated earlier in another hospital. The doctor tells the family that he is trying a few different antibiotics while waiting for lab results to identify the specific bacteria that’s involved. The family asks, “What about the records from last time—can’t you get those from the other hospital?” The doctor says, “We can put in the request, then we’ll have to wait for the fax to come through.”

One of the most pressing challenges facing healthcare IT community today is interoperability; that is, safely and accurately sharing patient data, when appropriate. Major hospital systems frequently share patient information by fax machine.“The status quo is not good enough. We need to bring the technology closer to the patient where it really matters,” says Mario Hyland, Senior Vice President and Founder, He is on a mission to bring true interoperability of electronic health information into common practice.

Interoperability among systems depends upon standards. It’s critical that the systems that want to share information conform to the standards otherwise they can’t understand each other. Assuring interoperability and conformance depends in turn upon effective testing. “A big problem we see today is that too often testing for interoperability is limited to what we call ‘happy path’ t esting,” says Mario. “ Even worse, testing is usually considered ‘one and done,’ meaning if a system successfully tests interoperable today, it’s considered interoperable tomorrow. That is a reckless assumption,” he adds. This points to a need for testing that takes into consideration such an ecosystem and offers the means to test under scenarios that simulate real world environments.

Recognizing the need, designed and built the Developers Integration Lab (DIL). Currently in its third release, the DIL provides a cloud-based, Testing-as-a-Service (TaaS) model that’s always available for developers, implementers, and even certification bodies to use for testing interoperability. The DIL is the only testing solution that performs conformance testing at the level of overall message, discrete message element, message segment, and complete end-to-end message exchanges.

This results in seamless coverage of all stages of testing: from development through User Acceptance Testing (UAT) and pre-production or certification support.

As Mario explains, “DIL goes far beyond happy path testing. It applies ‘negative testing,’ meaning it tests for those real-world conditions that are not supposed to happen—but do. They are the things that happen in the middle of the night when a patient is being rushed in to the ER and the IT support guys are not around. Systems that test interoperable through the DIL have a much better chance of remaining interoperable when it counts—when lives are on the line.”

The DIL is used today by the Healtheway eHealth Exchange to test the interoperability of systems that want to join its Exchange. This makes sure each new participant is following all the rules and will be an effective sharer of health information within the Exchange. The DIL is also being used by Health Level Seven (HL7) International in its Conformance Testing Program that ensures member organizations adhere to HL7’s standards. The DIL recently added support for HL7’s FHIR (“fire”) standard which is rapidly gaining popularity in the industry.

Future plans for the DIL include adding testing for document standards such as CDA/C-CCDA including CCD. “As the momentum around the DIL grows with more and more organizations testing within this ecosystem, there is a sort of national return on investment or ROI. In fact, I believe true sustainability of interoperable health information exchange depends on it,” concludes Mario.

The DIL applies ‘negative testing,’ meaning it tests for real-world conditions that are not supposed to happen—but do


Rockville, MD

Mario Hyland, Senior Vice President and Founder

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