Middleware: The Missing Link


By: Paul Remke

If you have been anywhere around the world of healthcare and IT, chances are that you have heard of the term “middleware”. But what exactly is it? The answer is: it is lots of things, but at its simplest form, middleware is the software that links disparate systems together and allows them to talk to each other.

The concept of middleware has been in use for quite some time, especially in the financial and retail industries where large, antiquated software applications are tied into newer, more robust solutions. Think of the systems in the 1980s where the user interface was a green-screen terminal. That backend “system” may possibility still be in use today, but the user interface is now a modern-looking web interface.

In the healthcare industry, the use of middleware can be quite different when it comes to the care provider’s day-to-day workflow. In this case, while middleware is still mainly used for the collection and sharing of data; it is often used to help optimize staff workflows to make the hospital operate more efficiently and effectively. One of the main concerns that Healthcare organizations have in regards to communicating amongst themselves and with their patients is a comprehensive communication platform that enables care teams, both inside and outside the hospital, to access and exchange information securely. Middleware can help make this happen.

As a simple example, hospitals are required to have a nurse call system to allow patients to call for help. In the past, when a patient needed a glass of water they had to 1) make the call, 2) talk to a nurse (after they answered the call), 3) the nurse would then contact a nursing tech 4) the tech would then bring the water to them. There would also be no record that the task was accomplished nor how long it took. This inefficient process also took time away from the nurse from their normal duties to simply pass a task on to someone else. With the right systems and middleware in place, a patient could press “water” on a bedside tablet and the request would go (as a text message perhaps) to the nursing tech who is assigned to that room. When the tech delivered the water, the real time locating system (RTLS) would automatically cancel the call. The task and time to respond would all be recorded in the patients Electronic Medical Record (EMR). This solution requires middleware to tie the nurse call, wireless telephone, RTLS, and EMR systems together as one efficient solution.

To make use of middleware, you must clearly understand what your final processes and requirements are and then understand what information needs to be passed between each system. In some cases, the middleware solution is simple and can even be accomplished with the software already provided with one of the systems. The nurse call system, for example, may already have the links built in to tie it into the wireless telephone system. However, for many solutions, there will be multiple systems requiring data to be passed between them, and also be recorded into the patient electronic medical record (EMR). By developing a map of all of the technology systems and workflows between them, an understanding of how each system integrates and impacts the clinical care process is made. This identifies opportunities for process improvement and integration for the care providers. With this solution, the middleware is then integrated and used to:

  • Provide faster care delivery
  • Manage alarms and alerts
  • Improve process efficiency
  • Improve patient flow
  • Improve bed management and turnover
  • Streamline communications between care providers
  • Streamline communications between patient and providers
  • Interface with clinical system (lab, pharmacy, radiology)
  • Track patients, staff and access

While the communications systems designed are robust as standalone solutions, middleware provides the missing link for these disparate systems to operate as a collective whole, enabling the care providers to ultimately provide a more efficient and effective healthcare solution for their patients.