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BY VINCE KURATIS, BRENDAN KEELER, and JODY RANCK
Latest regulations have mandated using HL7 FHIR APIs (utility programming interfaces) to share well being knowledge. The regs apply to healthcare suppliers, payers, and know-how builders who take part in federal packages. Many incumbent healthcare organizations are viewing these mandates as a compliance burden. That’s short-sighted. We suggest a extra opportunistic POV.
APIs facilitate the sharing of well being knowledge throughout completely different units and platforms. By adopting APIs, healthcare organizations can rework themselves from conventional service suppliers into highly effective platforms that may join sufferers, suppliers, and different stakeholders in new and modern methods.
This weblog put up is the fourth within the sequence on The New Rules of Healthcare Platforms. On this essay, we discover the numerous advantages of API adoption for healthcare organizations and the important thing issues that should be taken into consideration when implementing APIs:
- Healthcare’s Knowledge Inflection Level
- APIs Allow Platform Enterprise Fashions
- Limitations, Challenges, Actuality Verify
Healthcare’s Knowledge Inflection Level
In comparison with different industries, healthcare generates a disproportionately great amount of knowledge. In accordance with RBC Capital Markets, “30% of the world’s knowledge quantity is being generated by the healthcare business. By 2025, the compound annual progress charge of knowledge for healthcare will attain 36%. That’s 6% sooner than manufacturing, 10% sooner than monetary companies, and 11% sooner than media & leisure.”
Over the previous 15 years, new laws have pushed digitization, knowledge interoperability, and knowledge sharing. The objective of laws has been to liberate affected person knowledge that has beforehand been unstructured and trapped in affected person silos. Enterprise capitalist Kahini Shah summarized these regulatory efforts in her article entitled Healthcare Data APIs – An Upcoming Multi-Billion Dollar Market?:
Latest regulation is forcing digitization, aggregation and transmission of medical data. Congress handed the HITECH Act in 2009, prompting the adoption of digital well being data. Earlier than that medical data have been paper primarily based. Healthcare knowledge is extremely siloed, each American sees a median of 19 suppliers of their lifetime. Connecting these disparate digital methods and having them alternate data is known as interoperability. In 2020, the HHS and CMS applied two guidelines that mandate affected person entry to their medical data and interoperability. These transformative guidelines give sufferers the correct to entry their knowledge once they want and make it out there by way of APIs. The interoperability guidelines state that there isn’t a blocking – EHRs should permit knowledge to be shared simply throughout completely different methods owned by completely different distributors.
Shah factors out that many early-stage firms already “get” healthcare APIs. There are a lot of firms connecting, aggregating, and transmitting medical data:

Healthcare knowledge is at an inflection level. After a decade-long regulatory march, COVID accelerated the adoption of digital well being applied sciences. Healthcare customers are demanding the degrees of service and responsiveness that they expertise elsewhere. Will incumbent healthcare organizations latch on to the alternatives introduced by APIs?
APIs Allow Platform Enterprise Fashions
“APIs are on the foundation of platforms enterprise fashions on which ecosystems are constructed.”—Paolo Malinverno, Analysis Vice President, Gartner
The Strategic Worth of APIs
APIs have gotten more and more important for attaining progress, driving innovation and gaining a aggressive edge in at this time’s enterprise panorama.
Deloitte defined why APIs should be seen extra broadly: “APIs have usually been handled as tactical property till comparatively lately… Reduce to at this time’s actuality of digital disruption and numerous know-how footprints. In lots of industries, making a thriving platform providing throughout an ecosystem lies on the coronary heart of an organization’s enterprise technique”
Success with APIs requires a broader perspective on how know-how can be utilized to help enterprise targets. Tiffany Xingyu Wang and Matt McLarty defined of their Harvard Enterprise Overview article entitled APIs Aren’t Just for Tech Companies:
Corporations which were most profitable with APIs show frequent considering patterns and practices, one thing we name the “methods of the API.” Following are three of probably the most impactful of those patterns.
1) The Unbundling Manner: Dismantling and Rebuilding Enterprise Capabilities By way of APIs. Jeff Bezos printed a company edict round 2002 mandating that from that time ahead, all product groups have been required to reveal their knowledge and performance by means of APIs. Not solely that, he insisted that groups have been solely allowed to speak with one another by means of these APIs. It was an excessive step supposed to advertise crew autonomy and product agility. It was a couple of years earlier than the mandate took maintain, but it surely created an unprecedented platform for progress….
2) The Exterior-In Manner: Designing and Creating with the API Shoppers in Thoughts. Stripe entered a crowded funds market in 2010. Figuring out cellular app builders as an underserved buyer phase, Stripe targeted on delivering probably the most helpful and usable APIs attainable. It labored. Stripe has shut to twenty% of the web funds market share (a quantity that’s rising), and the corporate is valued at over $100 billion. One of many pillars of their success has been an unwavering dedication to designing their merchandise outside-in from the patron’s perspective….
3) The Ecosystem Manner: Cultivating a Digital Ecosystem with APIs. Borrowing one other Clayton Christensen idea, Twilio envisioned the “worth community” for cellular purposes, the digital ecosystem inside which apps would exist. By wanting on the varied stakeholders (app customers, app builders, third-party service suppliers) and the worth exchanges between them, Twilio recognized a spot that might be crammed — combining and accelerating provider companies — to the advantage of all ecosystem members.
Bezos’ 2002 decree described above has been extensively quoted, but it surely’s not at all times defined in plain phrases — that Bezos explicitly mandated the adoption of inside and exterior APIs at Amazon. He ended the mandate with: “Anybody who doesn’t do that shall be fired. Thanks; have a pleasant day!”
APIs Can Assist a Extensive Vary of Enterprise Fashions
There are a lot of potential makes use of for APIs. APIs: A Strategy Guide listed a few of them:
- You want a second cellular app
- Your prospects or companions ask for an API
- Your website is getting display screen scraped
- You want extra flexibility in offering content material [and data]
- You will have knowledge to make out there
- Your competitors has an API
- You wish to let potential companions take a look at the waters
- You wish to scale integration with prospects and companions
It’s past the scope of this put up to enter element, however we wish to provide you with a way of the big selection of inside and exterior enterprise fashions that APIs can help:

The graphic (above) is from Programmable Web’s 2020 Guide to API Business Models. Right here’s a quick rationalization:
The tree hierarchy makes an attempt to logically set up API enterprise fashions in line with a number of groupings and sub-groupings. To your monetization conversations, it facilitates necessary questions like “Ought to this API be externally uncovered exterior of our firewall and, in that case, ought to it’s productized for consumption by most people, reserved for accomplice use, or each?”
Advantages of APIs
Extra broadly, there are numerous advantages of adopting APIs in healthcare. Listed here are a few of the most notable benefits:
1. Environment friendly interoperability and knowledge sharing: One of many main advantages related to API adoption in healthcare is improved knowledge sharing amongst healthcare suppliers, sufferers, and different stakeholders. APIs can allow seamless knowledge alternate between completely different healthcare methods and disparate know-how platforms, making certain that every one events have entry to correct and up-to-date well being data.
2. Elevated affected person engagement: By offering sufferers with entry to their very own well being knowledge by way of APIs, healthcare organizations can empower sufferers to take a extra lively position in their very own well being administration. This may result in improved affected person outcomes and better ranges of affected person satisfaction.
3. Innovation and scalability: APIs can allow healthcare organizations to extra simply collaborate with third-party builders to create new digital well being options. This can lead to the creation of modern new instruments and companies that may assist enhance affected person care and scale back prices. Moreover, APIs can assist healthcare organizations scale their operations extra effectively by leveraging the experience of different organizations within the business.
4. Elevated Profitability: Boston College researchers examined The Impact of APIs in Firm Performance. They discovered that “API adoption – measured each as a binary remedy and as a operate of the variety of calls and quantity of knowledge processed – is expounded to elevated gross sales, working revenue, and decreased prices. It’s particularly tightly associated to elevated market worth. In our most popular specification, binary API adoption predicts a ten.3% enhance in a corporations’ market worth.”
A Healthcare Instance — Affected person-Going through APIs
Writing within the Journal of Medical Internet Research, Aaron Neinstein and his colleagues carried out interviews with 10 high well being methods to achieve insights into their strategy in the direction of patient-facing APIs. The target was to grasp the preliminary experiences of healthcare methods and establish insights that might be useful for coverage and observe. Their key findings:
Our outcomes counsel a purpose for optimism in regards to the prospects for patient-facing APIs and their affect on the US well being care system…The well being methods we interviewed all deliberate to extend using patient-facing APIs, and lots of acknowledged that this was “the correct factor to do.” Two use circumstances emerged because the strategic driving forces for well being methods: the power for the affected person to create an aggregated longitudinal well being file and higher digital affected person engagement.
Limitations, Challenges, Actuality Checks
“Right this moment, a agency with out utility program interfaces (APIs) that permit software program packages to work together with one another is just like the web with out the World Extensive Net.” –Bala Iyer and Mohan Subramaniam, Harvard Business Review
Regardless of the advantages, APIs aren’t a foregone conclusion. There are a lot of challenges to the widespread, ubiquitous adoption of APIs.
Realizing the Worth of APIs Requires a Mindset Shift
We imagine the largest problem to broad API adoption in healthcare is “mindset”. Healthcare strikes slowly. The business has been immune to sharing knowledge and property. Deloitte defined the shift that’s wanted:
APIs could be a car to spur progress, and even create new paths to income. Viewing APIs on this manner requires a shift in considering. The brand new integration mindset focuses much less on simply connecting purposes than on exposing data inside and past your organizational boundaries. It’s involved much less with how IT runs, and extra with how the enterprise runs.
Healthcare organizations have to undertake a self-discipline for creating APIs strategically, quite than making level connections on a project-by-project foundation.
Monetary Incentives are Misaligned
The gradual shift in the direction of value-based care and funds has been ongoing for many years, but its tempo has been sluggish. That is largely as a result of misalignment of economic incentives, notably beneath the prevalent fee-for-service reimbursement mannequin.
Below fee-for-service, incentives for knowledge sharing are minimal. Traditionally, suppliers have thought of knowledge as their proprietary asset. There isn’t any direct monetary reward for sharing knowledge, and APIs and different data-sharing ecosystems, like Carequality and TEFCA, are sometimes perceived as burdensome compliance necessities quite than alternatives for enhancing affected person care and enterprise operations.
Will New Regs Be Enforced?
As beforehand famous, a lot of the momentum towards API adoption in healthcare has been spurred by federal laws In 2022 Troy Bannister, former CEO of Particle Well being, posed the query of whether or not there shall be sources and an urge for food to vigorously implement these laws:
To date, no actual fines have been issued towards violators, and truthfully, I don’t know the place they’d even begin. I don’t know a single hospital, observe or clinic adhering to the rule at this time. How can we really feel, as a rustic, a few system of presidency that creates guidelines, legal guidelines and insurance policies however permits whole industries to disregard them utterly—both immediately by means of abstinence or not directly by means of lobbied, hyper-specific loopholes?
Healthcare Lags in Attracting Builders
Regardless of the rising digitization of healthcare, the business has struggled to draw top-tier software program builders. In comparison with sectors like finance and media, healthcare has been slower to undertake know-how, usually because of complicated laws and the need to adjust to a number of requirements. The intricate nature of EHRs, the variety of integration capabilities, and the technical density of healthcare requirements current vital challenges to builders. Coupled with this, the business’s fragmentation and inconsistent tempo of know-how adoption might deter builders who might in any other case drive innovation.
Knowledge Privateness and Safety Points
An enormous problem of API adoption in healthcare is making certain the suitable safety of delicate well being knowledge. Sustaining confidentiality and safety of affected person well being knowledge is paramount, and making certain that healthcare organizations stay in compliance with privateness laws could be a main hurdle.
Knowledge High quality is Inconsistent
EHRs have constructed on differing knowledge fashions, vastly limiting their potential to alternate knowledge that’s “understood” by different EHRs. For instance, a latest JAMIA examine reported solely 22-68% interoperability across EHR platforms.
The United States Core Data for Interoperability (USCDI) is a standardized set of well being knowledge lessons and constituent knowledge components for nationwide interoperability of well being data know-how (IT) methods. The USCDI units a minimal customary for the information components that should be shared to help affected person care and facilitate entry to well being IT.
Nonetheless, the USCDI has limitations. It doesn’t cowl the entire obligatory knowledge components required for affected person care or analysis. It solely focuses on structured knowledge, which might exclude necessary medical data that isn’t captured in a structured format. Lastly, the USCDI just isn’t a complete knowledge set.
Limitations of the FHIR API
Implementing and using the FHIR API requires superior technical information and infrastructure. The FHIR API solely gives an ordinary format for exchanging particular kinds of well being knowledge, which means not all knowledge components could also be out there by means of the FHIR API.
Conclusion
The API financial system is rising and altering quickly, with new enterprise fashions, instruments, and techniques being developed to fulfill the wants of sufferers, healthcare organizations, and builders. As APIs develop into extra ubiquitous throughout industries, they’re reshaping the best way companies develop and innovate.
It’s time for healthcare to hitch the thriving API financial system.
Vince Kuraitis, JD, MBA, is a well being care guide and first creator of the e-CareManagement weblog, the place this put up first appeared.
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