- Provider organizations tend to hang on to legacy IT infrastructure longer than other business verticals because of budget and compliance restrictions. Healthcare middleware is a vital piece of HIT infrastructure that can help bridge the gaps between new and legacy systems.
Middleware is software that provides services to software applications that can’t be obtained from the operating system. Middleware.org describes middleware as “software glue.”
“Middleware manages the interaction between disparate applications across the heterogeneous computing platforms,” explained Middleware.org. “Middleware can be used between application programs and other software facilities such as database managers.”
This software is intermediary and used in complex environments such as healthcare and is essential to enterprise application integration (EAI). EAI is essential for healthcare organizations so applications with different purposes can communicate and share data with one another.
The healthcare industry has mostly focused on using middleware to improve EHR interoperability and clinical workflows. AHIMA states that middleware is needed to help better connect EHRs with other health IT systems in order to gain more insight into patient health.
“The most promising value from health data comes from connecting the pieces,“ Donald M. Voltz, MD wrote for AHIMA. “Middleware can help connect those pieces and make disparate EHRs interoperable. Enabling real-time access to patient data by the providers who are making decisions in the office, in the emergency department, on the wards, or in the operating room is no longer a luxury, but a requirement for patient safety, quality, and cost-effective care.”
Middleware plays a critical role in collecting data into a single database, developing an interface for various EHRs, and giving organizations the ability to respond and comply with new technology that will inevitably be introduced onto the health IT infrastructure.
Connecting unrelated health IT systems into a single user interface is what makes middleware so valuable in this scenario. It gives IT staff visibility into how their disparate IT systems interoperate. This is especially important when newer technology is being layered on top of legacy solutions that were never designed to be compatible with current solutions.
“Middleware is also the development of mainframe systems where data and integration come from importing and exporting data in some standardized way,” said Voltz. “Distributed computing, supported by changes in data centers, information, and communication technologies, has led to new platforms and the need for integration.”
“Middleware solves the problem of interoperability by building a platform to connect current EHR systems while allowing for a single path to add additional emerging healthcare technologies,” he continued. “Middleware also supports development on access and display of the information in a unified manner so healthcare providers can obtain health data that is supportive of their workflow without the need to switch between applications or understand how the data is brought together.”
This display of health data significantly decreases the time it would take to relate data without middleware by organizing it an easy to view and digestible way.
Middleware really allows organizations to develop on top of data to make the best use of it, Voltz explained to EHRintelligence.com in a previous interview.
“No one is going to develop for 75 different EHR platforms when they come out with some sort of idea,” said Voltz. “But instead if we can develop into a system that then has its fingers or tentacles into all the different EHRs, then now as a clinician I don't care what I'm accessing — I just know that I’m accessing the patient data that I need.”
“Middleware could actually allow communication to everybody on the care team even if people join the team later on and there is a piece of information out there that hasn't been addressed.”
There will always be a need for different IT infrastructure technologies and vendors that need to be used on top of or along side one another.
When these tools don’t work together a lot of time is needed to perform simple communication tasks. When these tasks are done by staff, mistakes can be made, and clinicians may be advised with misinformation.
Middleware gives organizations a much needed view of their systems so providers can take advantage of the data produced on all fronts. Middleware also lets organizations take advantage of new IT infrastructure tools while still getting the most out of the legacy solutions that still provide valuable support.
Providers still facing crippling interoperability issues need to make plans to either introduce or improve current middleware solutions to gain control over information sharing within their organization.