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Christopher Jason


API adoption can streamline patient access to data, promote the use of clinical decision support tools, and boost both interoperability and patient data exchange between providers.


Application programming interface (API) adoption in healthcare will give clinicians and patients access to patient data and allow third-party applications access patient information and boost patient care, according to Ben Moscovitch, project director of Health Information Technology at Pew Charitable Trusts.

Although EHR adoption is becoming more widespread throughout the healthcare industry, interoperability and patient data sharing still pose challenges to providers.

As a result, a portion of the ONC final rule calls on medical providers and device developers to promote patient data access using third-party apps and APIs.

ONC proposed to adopt the HL7 Fast Healthcare Interoperability Resources (FHIR) standard as a foundational standard and requested comment on four options to determine the best version of FHIR to adopt.

Ultimately, ONC adopted FHIR Release 4.

Moscovitch said to address interoperability and patient data exchange challenges, the healthcare industry can adopt similar a technological approach that industries, such as finance and travel, have adopted. For example, APIs allow travel services to compare flights from separate airlines without the user visiting each website.

“If standard APIs were broadly adopted in health care, patients could access and compile their data from multiple providers while clinicians could process complicated information and make care recommendations,” Moscovitch said. “APIs would also offer other benefits, such as facilitating the exchange of clinical data among health care providers.”

BENEFITS OF API ADOPTION

Moscovitch gave three key healthcare benefits for API adoption, which include patient access to data, the incorporation of clinical decision support (CDS) tools for prescribing antibiotics, and patient data exchange between providers.

API adoption can give patients access to data. Patients can utilize APIs to track and manage their healthcare outside of the doctor’s office on their smartphone or computer.

Using APIs, providers can integrate applications into the EHR to give users a broader range of CDS tools that would allow the user to pick one that works best.

APIs can allow clinicians to pick and choose the needed or important patient information to exchange, rather than sending full clinical history

CURRENT API ADOPTION CHALLENGES

Although APIs can be beneficial, health IT professionals still face integration and usability challenges.

First, health IT developers could increase API adoption if they code them differently for each EHR system. But this approach would be limited because it would only allow adoption on one EHR system or application, Moscovitch said.

“But standards—such as the industry-developed Fast Healthcare Interoperability Resources (FHIR), which is a standard for exchanging health care information electronically—ensure easier use of APIs,” explained Moscovitch. “FHIR can offer access to individual pieces of information—such as a list of medications—instead of a broader document containing more data, some of which might be unnecessary or patients may not wish to share.”

Additionally, not all APIs can read EHR data and most do not have write access functions to input information back into the EHR. Moscovitch said once APIs receive write access functions, clinicians and patients could utilize CDS tools to edit portions of the EHR, such as changing an address, correcting errors, or updating symptoms.

“Federal regulations finalized in 2020 require the use of FHIR and expand the dataset that must be available for exchange via APIs, but the rules did not address write access,” Moscovitch explained.

“Those regulations are scheduled to take effect in 2022. Although these regulations are critical, they do not mitigate the need for significant additional policy and technology developments in order to successfully integrate and prioritize APIs within health care. Policymakers can take additional measures to promote the use of APIs and incentivize new capabilities through both legislation and additional regulation,” Moscovitch continued.

FUTURE OF API ADOPTION

Pew partnered with RTI International, a research institute, to analyze and evaluate the current and future API uses by interviewing health IT professionals.

Respondents said they most commonly utilized APIs for patient access and CDS. Some respondents even said they have not utilized APIs for other use cases, such as patient data exchange.

Next, respondents said health IT vendors vary on the permitted data elements for patient data exchange. This variance impacts the type and amount of patient information that clinicians can exchange.  

Pew learned many of the terms and conditions from providers, EHR vendors, and third-party app developers were incomplete and did not have critical details, such as costs. Because of this, those three groups of individuals can dictate costs and these costs vary.

Last, the respondents said API use could improve by enabling EHR data entry, integrating applications into clinician workflow, and implementing standardized data elements.

In order to accelerate API adoption and enhance both security and usability, Moscovitch recommended lawmakers focus on developing policies that:

  • Advance privacy and security
  • Develop the ability to enter data into EHRs
  • Grow API use for data exchange among providers
  • Expand more data elements for exchange
  • Monitor costs
  • Protect health inequities with CDS tools

“Increased use of APIs—particularly those based on common adopted and consistently deployed standards—has the potential to make health care more efficient, lead to better care coordination, and give providers and patients additional tools to access information and ensure high-quality, efficient, safe, and value-based care,” Moscovitch concluded.

“Yet obstacles remain, such as some hospital hesitation to grant patient access to data, lack of bidirectional data exchange, confusion around the process of implementing APIs, and potentially prohibitive fee structures.”