Chris Reddick (president, CEO, and co-founder of Clarity Ventures) and Ron Halversen (vice-president sales and marketing) continue their discussion of integration architecture.

Part 2 of a 4-part series. (Click to return to Part 1)

RON: Well, since we've gone through what's in the platform, let's talk about the different types of architect. I mean, it sounds like just from the cursory explanation that, that's a pretty big enterprise level platform. Does it have to live in an enterprise? What's the different types of architectural installations that we can handle with a platform like this?

CHRIS: Yeah, that's a great question. Typically, with most integration platforms that you see out there nowadays, most of them offer a SaaS-based scenario. That's typically referred to as iPaaS, Integration Platform as a Service. There are platforms that also offer hybrid or network or On-Prem, and they can offer kind of hybrid scenarios where they're not just On-Prem and they're not just cloud based, but they can live in both as an on-premis Cloud solution. And I would say that's really what we've found to be the most powerful, is being able to check the box on being hybrid, pure SaaS or pure network, depending on the client's needs and being scalable and performant and redundant within a particular environment. The biggest takeaway that we've seen over these many years is that most clients don't need a complicated solution.

But there are a handful of client scenarios where they do. They need a robust scenario where they have high availability, maybe there's a significant security requirement that requires a certain level of VPN, Point-to-Points configuration. And the environments, maybe it is a hybrid scenario where those hybrid systems are talking to each other have to be through a VPN tunnel of some kind. These are just kind of examples here. But generally speaking, the types of architecture that we've found that are least limiting our hybrid and the ability to be able to be pure SaaS or pure network where needed. And the big takeaway is that going through discovery, which we typically will do is if you wanted to think of it like this, if you're going to build a house, you need to get a blueprint and we'll probably work with an architect for certain parts of the blueprint and then use a really well-designed plan. We do the same thing with choosing the architecture for a project.

what is hipaa

CHRIS: And the other big thing is looking at the types of integrations. This can really, really make a big difference just as far as the overall just concept of what makes sense for architecture? What systems are we integrating? Where do they physically reside? And what type of interactions can we have with those systems? Are they SaaS based and do they have certain limitations? Is there security concern or a high availability requirement? Is there a performance or scaling concern? These are all areas that we really need to get into and whatever Clarity Connect or integration platform you're working with, you really want to work with your vendor to make sure to flush these things out in advance. And Ron, I would love to hear some of the scenarios that you hear about that might exemplify some of these situations.

RON: That's kind of interesting, because there are different types of integrations and I don't mean like integrating with an ERP or a CRM. I'm talking about the actual physical connections themselves, because you may not always need a platform if a tool does exactly what you need. I kind of break them into three different categories when I get these, I call a simple API call, single persistent, and bidirectional persistent. Let's briefly just break those down and talk about it.

A simple API call, for example, if I went to install a quick WordPress site with WooCommerce. And in the checkout cart, I wanted to connect to UPS so that I could say, how much does it cost to ship this package from X to X? Or I wanted to connect to an API that could say, what's the exchange rate right now with the Canadian dollar? And it gives me a value back. I'm making a simple API call across the internet. They're giving me a value. I'm plugging that value on the screen, and then I'm going on. I'm moving on through a workflow. I don't need to persist that connection. I literally asked a question. It gave me an answer and off I go.

Typically, those types of API calls don't need an eCommerce integration platform. It just has to the checkout card or the form or whatever you're doing has to be able to make that call and have the appropriate credentials to get that call, get the response and use that data. Those ones are usually straightforward. And when we're really talking about these integrations, we're typically not talking about those types of integrations, although that's probably the most important or common, not most important, the most common, because we're connecting things like a [inaudible 00:21:43], sales, tax and carriers and LTL carriers and credit card companies and things like... We're connecting with simple API calls all the time.

Single persistent would be like we do a lot of medical. And so we have a HIPAA compliant pharmacy app that we're doing. And I sign up on that app and I get a new prescription and I go to get that prescription filled. And let's say, it's a controlled substance like OxyContin or something like that. Well, as soon as they put that prescription into the system, that system could have a one-way, read-only to the FDA's API saying, "Hey, Ron has this, can you check all of his other prescriptions and see if there's a conflict with Oxy, with any of the other medications he's taking." That's extremely helpful information. That would be a single persistent integration. where we're either pulling data one direction or potentially pushing data one direction. I have a lot of affiliate integrations where people are, I need my own eCommerce store, but "I want to be able to push a button and push that to make it for sale up on Amazon or eBay." That's an affiliate one way connection where we're pushing things up there.

The bidirectional persistent, that's where most of our integrations really lie. And that's when people are, hey, "I want to connect the doctor patient portal with the hospital. I can pull data from the EMR and have all the doctor appointments available so the patient can look in, see the available time schedule their appointments. Those appointments get pushed back up and scheduled. The doctor can then send them an invoice for their co-pay that goes back down. And then they pay their co-payment, and then it gets pushed back up. Reminders can be sent down to the user to let them know their appointment's coming up. Their lab results can be pushed into the EMR that could then be pulled down to the portal and then notified." It's this truly bidirectional persistent integration where these become extremely important because we can literally automate and make sure that the old cliche, get the data where it needs to be, when it needs to be. But that's really what the key is about integration. Do you agree with that?

CHRIS: Absolutely. It ends up typically being some form of bidirectional in most cases for most business, just because they, otherwise, are going to have to do things manually. And that's kind of what we're trying to do. Most cases with these integrations is make things self-service for the end-users, make things automated for the internal team and just try to maximize value for time that's going in and allow the business and the customers to focus on value add activities versus monotonous tasks, right?

RON: Yeah. Well, another way to say it, we build high-end websites. Why do we build websites? Well, because all of our clients is, their customers are clients. The UI for them, either they have to pick up the phone or email or come visit them. Or if they hit the website, the website becomes that user experience. It's kind of the front of the house. And if we can get all of the information to the front of the house, or if we can get the collection of data to the front of the house, like when I go to my dentist now, I don't have to go to the dentist, sit in the waiting room for 15 minutes anymore to fill out all the paperwork the first time, do I? I can literally go to the portal or go to the website and click on initial forms or ongoing forms or onboarding forms, whatever email they send me, I can print them out, fill out the forms and take them with me and hand them that. Or I can fill them in online before I even show up the first time.

I think the big thing for us when we go to do this is not only automating a lot of the business process, it's because we are interfacing as our clients, they're interfacing with their customers and they interface now, instead of phone and fax and email and brick and mortar...the only UI these customers have is a doctor-patient portal. And so in order to get the data to and from that portal, that's the key to the entire thing working, isn't it?

what is hipaa

CHRIS: That's right. And this next slide really kind of talks about some of these different systems that we integrate with. And this is really something whenever you're evaluating an integration platform that you really want to ask yourself is, as you were saying earlier, Ron, these different translations that are possible, what are these systems that the integration platform can talk to? And the way I would say it with our Clarity Connect integration platform is really anything. Anything that your team wants to integrate with. We're showing here integrations that we've commonly worked with and completed many projects with, in some cases, dozens and dozens of projects with these different platforms. But essentially, any system that does have a pretty standard kind of API basically—this can be EDI XML, SOAP, REST. Can be database. Really the list goes on, PunchOut Catalogs. Any kind of newer API framework like gRPC or FHIR, HL7v2 HL, HL7v3—we can integrate with. But whether you're looking at Clarity's platform or another platform, we do encourage you to think ahead and think about where you're going with your business and where you're going long term.

And this is the really interesting thing, Ron, that I like to ask people to think about. Does your team internally have the ability to expose the APIs with these systems? And if you don't, what's your plan? And at Clarity, we have dozens and dozens of pages in most cases for these platforms that we're showing on the screen and many others that we've written of internal documentation for how to securely and in a very high-ability performant way, expose the APIs for these different respective systems and how to work with your vendors, if you have a vendor. Or how to work directly with the companies that are shown here to get access to a sandbox, development environment, non-production first, and then be able to kind of turn that on for development and testing. And then to be able to switch to production and complete the right steps to respect the business logic and the workflows that are part of your particular implementation of these different respective platforms.

And that's really a key missing ingredient, like we were talking about earlier, right, Ron? Whenever people are looking at platforms, they myopically focus on, what does it say that it can do, you need more than that. You need a partner who can actually take the blueprints and the raw materials and turn it into a beautiful executed build. And that's really what we want to encourage you to think about looking at all these scenarios.

RON: That middle one there, it appears to be the shortest, but that's even the most important. I see that a lot where clients will come in and I'll start talking to them and they've taken a swag at these plugins, and they've done some integration. And they're integrating and exposing and breaking HIPAA compliance rules by connecting an email to an EMR, and now they're violating HIPAA, sending out protected data. Yeah, like you said, one of the most important things is make sure you've got a partner who actually knows what they're doing so that you don't put yourself in a legal position of internally going, "well, we're smart enough to figure this out. All we really need is this little tool." You grab this tool. And the next thing you know, that tool helps you literally violate some government regulations. Make sure you find a vendor that plays in that space, understands the rules and can help ensure to protect your business legally. That's a big one.

Obviously, we've done 3000 integrations over the 15 years, and I've been here 10 of them. But it used to take us, I remember, gosh! Even seven, eight years ago, it used to take us a long time to build these connectors. And it felt to me like every time I had to estimate a connector, it started from scratch, right? But it doesn't seem to be that way anymore. Aren't a lot of these now using the same basic workflows or API protocols? How does that all work?

CHRIS: Basically, you tend to see a lot of rest and you tend to see a lot of, in some of the older platforms, SOAP-based APIs. But man, whenever you get into the details with how you would customize something, most of the time, what we find with our clients is that they come to the table thinking that these different platforms that are using REST or SOAP or maybe FHIR, or they have EDI, etc, it's just as easy as mapping some fields and maybe doing some data transformations inside of the integration platform. But most of the time, what we find is to really enable self-service for customers or to enable full automation, or significantly full automation, with internal objectives for fulfillment or for other workflow processes, for example. They have to actually have the ability to customize these different respective systems because they don't actually do what needed off the shelf.

And so you really end up needing someone that you're working with for each of these particular integrations that can utilize the REST and the SOAP that's very common, but have the depth of knowledge with each respective system around how to customize them or at least point a vendor that's working with them in the right direction on how to customize these systems. Many times, Ron, in my experience with executing on these projects, the vendors who are specialists in these particular ERP, EMR-EHR, CRM systems, eCommerce systems, they don't actually have specific knowledge with customizing the way their clients need.

RON: Yeah, that's true.

CHRIS: It's pretty surprising. Yeah.

RON: Well, it is. And half of our integration jobs that come to us aren't the clients. It's the partners that come to us and they're like, "hey, we're in working on and we'll just take the one right in the middle of Epic. We're in here working on Epic at our client and now we don't know how to hook that up to a patient portal or a mobile app or online billing," like you said, they either don't know how to customize that application on the end to automate or get the benefit out of the potential automation or the other way around,they know how to customize the heck out of their application, Epic, but they don't know anything about the API.

And now, how to turn that customization that they've done inside of Epic, into real profitable processes, like putting it into a patient portal where you can allow patients to schedule their own appointments and pay their own bills and see their own lab results and invite and do their own consent forms to allow their information to be shared with another doc. All that kind of stuff can now just be easily all automated. And we do that readily. Right?

Continue to Chapter 3 to learn about the difference between On-Prem and Cloud Hybrids.