How to turn healthcare into an API-first industry
The key to effective use of APIs, application programming interfaces, in healthcare is learning how to reuse APIs in healthcare.
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By - Application programming interfaces (APIs) play a significant role in the average consumer's world, whether they know it or not. How might the API takeover look different for the healthcare world?
While interest in employing APIs in healthcare abounds, there are various barriers to implementation. Some healthcare organizations use healthcare data as leverage and see APIs as robbing them of that advantage. Others have pointed to obstacles as simple as a lack of motivation among C-suite executives who do not see the need to invest more than the bare minimum in these tools.
On this episode of Industry Perspectives, Don Rucker, chief strategy officer at 1upHealth and former National Coordinator for Health Information Technology, explains the current status of API implementation in healthcare and why these tools are important for patient care and clinical data exchange. He emphasizes the need for collaboration among healthcare stakeholders. He also discusses the role of Fast Healthcare Interoperability Resources (FHIR) in data exchange and the resources available for organizations seeking to adopt APIs.
Don Rucker, MD:
If we're really going to take care of patients effectively, you're going to need to communicate with the outside world. An API-first world is going to happen to healthcare for the people who are successful healthcare providers and payers.
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Kelsey Waddill:
Welcome to Season 2 of Industry Perspectives coming to you from HIMSS 2024 in Orlando, Florida. I'm Kelsey Waddill, multimedia manager and managing editor at Xtelligent Healthcare.
API adoption is essential and required in many areas of healthcare today. Nevertheless, healthcare professionals continue to experience roadblocks. What role do APIs play in healthcare and what needs to change about healthcare stakeholders' collaboration in order to take full advantage of this technology? Learn all this and more on today's episode with Dr. Don Rucker, chief strategy officer at 1upHealth and former National Coordinator for Health Information Technology.
Kyle Murphy, PhD:
Dr. Don Rucker. How are you? What have you been up to since you used to be in the ONC days back when I first interviewed you? What are you up to nowadays?
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Don Rucker, MD:
Yeah. Hey, Kyle. So I'm chief strategy officer at 1upHealthcare. We are a FHIR data in the cloud. We're implementing in the API world the CMS APIs, payer-patient, payer-provider, payer-payer, and of course all the backend cloud computing that is now available in FHIR. So, really, just the logical outgrowth of the CURES Act rulemaking I had the opportunity to work on with the ONC team.
Kyle Murphy, PhD:
Awesome. Let's talk about APIs, and before we get into an API-first world in healthcare, let's just talk about how APIs are really empowering a lot of the interoperability we see in other aspects of our lives.
Don Rucker, MD:
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Yeah. So API, application programming interface, so the software that bridges between two pieces of other software--basically, it's the world we live in. You look at a smartphone and you see all those little icons, those little icons are just placeholders for APIs back to enterprise servers, and it's a sea of those. So we're interviewing here at HIMSS in Orlando, and if you flew down, on your airline app, those APIs are talking to their server, is the flight on time, probably talking indirectly to servers at the airport, to the seat, to how much you paid for your seat, what they're trying to sell you, buy some more internet, something. It's all an API world.
We haven't had that in healthcare. For the most part, we've had monolithic, documentation-centric EHRs on the provider side. And on the payer side, we've had these sort of claims engines and affiliated databases. But if we're really going to take care of patients effectively and not just when they're in the office visit and certainly not just when they're sitting in the ICU, you're going to need to communicate with the outside world. An API-first world is going to happen in healthcare for the people who are successful healthcare providers and payers.
Kyle Murphy, PhD:
Kind of like status check, where are we in terms of progress, in terms of adoption, implementation of APIs in healthcare? You mentioned FHIR. FHIR obviously came in, quick adoption, got the federal government seal of approval more or less. But where are we now and then where do we need to go? What are the next steps?
Don Rucker, MD:
Yeah, so FHIR, Fast Healthcare Interoperability Resources, is the first time you can really put truly clinical stuff into the API payload. In the past we've been able to put lab results or imaging results, which are very tightly defined machine-generated results. The radiologist or the radiology tech is not diddling with the pixels to generate an MRI. Clinicians are diddling with the pixels to write a note or to generate a code or to process a code or today to do prior auth or quality measurement. So having FHIR as an enabler for all of that allows it. And as you might imagine, the adoption is pretty rapid. NCQA is going there. I was just at a session where the Undersecretary of Health for the VA spoke. They now have APIs in EHRs to tell whether somebody's eligible for veterans benefits, things like Agent Orange. And of course the CMS rule with prior auth, which is a huge bugaboo.
And maybe in a negative sense, as we're sitting here with one of the clearing houses not being able to process a large tranche of pharmacy claims, that's all API stuff. So maybe you could say work needed or security, I'm not sure we know what the issue is there. But it shows the importance of APIs even today for some of the classic show me the money kind of transactions.
Kyle Murphy, PhD:
One hundred percent. I mean, it's shown a light on just how easy of a roadblock you can get by just squeezing that one pipe.
Don Rucker, MD:
Yeah.
Kyle Murphy, PhD:
I'm curious about what we talked...
Don Rucker, MD:
But of course, people say, well, maybe I'm not ready for APIs. Don't forget the comparison is to faxing something. So just let's be clear what the comparison is here.
Kyle Murphy, PhD:
What are some easy wins in terms of think about maybe I would say patient-centered but also provider-centered when it comes to APIs? I know there's no shortage of data out there, but the connection points aren't necessarily always being made easily.
Don Rucker, MD:
Well, obviously we have huge incentives for delivery systems to not share information. Our current American payment model is to make sure that high-margin profits from cardiology, neurology, potentially oncology, that that business never, "leaks" out of the system. So the dominant economic incentive for delivery systems is to not share information, we just have to be real about that. That's not patient-centric. It's not payer-centric, payers being employers or individuals or taxpayers most of the time. But that's the system we have. So we're forcing some of these on.
To your question, I think the real thing is how do we reuse these APIs and the data made available? I think for your audience, the trick is to be smart. And some folks are very smart on that, and some folks are not really. I'm not going to mention the agency, but one public health agency has a vast sea of individual duplicative reporting requirements, when our health information exchanges could provide all of that for them elegantly. So we have to be smart about it.
The winners are going to be the people who use the data. And cloud makes this really powerful. You have one platform with all kinds of analytics. You can stand up whatever APIs you want, as long as you've been smart about defining security and observability and governance.
Kyle Murphy, PhD:
How do you build those kind of partnerships, those collaborations? Obviously you're talking about API, so the technology is there, but I imagine you're talking about those larger forces at play. How do you bring the right people to the table? I mean, you were a national coordinator, you were coordinating folks....
Don Rucker, MD:
Yeah, yeah, yeah. Yeah.
Kyle Murphy, PhD:
So I'm curious, how does that happen to really push things forward?
Don Rucker, MD:
Yeah, we're very lucky to have a number of consortia that really work on this and that have done really extraordinary work. Weavy for a long time has done extraordinary work. HL7 has been the absolute champion in all of these things at every stage of the way, V2, V3. Now with FHIR, HL7 is doing some great stuff with the FHIR accelerators, Da Vinci and FAST, most notably for true economic impact. The CARIN Alliance has done great stuff in exposing some of things like eligibility as a sort of financial resource to be a measure value coverage. And so there's some just great groups that are doing a lot of work.
And for the audience, you have access to that work through implementation guides.
Kyle Murphy, PhD:
Yes.
Don Rucker, MD:
And now, you read HL7 implementation guide and you might think this is better than Ambien. I'm not endorsing Ambien. I don't take Ambien. I know people who have. But the reality is there's extraordinary wisdom on how to think about healthcare. So you don't have to worry if you're not the engineer on is it a one-to-one field or one-to-many field. But you should absolutely read through "what are the fields? How do I put a query together, right?" You're a data analyst. This is a great checklist on "how do I do a query? Have I factored in all the things?" I mean, this is paint by numbers.
And so the first blush, very dry. Second blush, oh my God, this is valuable. So for folks in the audience, just Google HL7 FHIR implementation guide. You can do CDex, PDex Da Vinci, whatever, they're a lot of them.
Kyle Murphy, PhD:
They're all out there. And then last question is what are your advice for health IT professionals in terms of... I would say, you want to work with developers, you want to bring more people into this space, because coming full circle, consumer side we have all these apps and it's all these brilliant minds that you can finally get to tap into things. I think you already shouted out HL7, but how should they think about working with API's, working with data going forward?
Don Rucker, MD:
And there's some political controversy. I think there's some steps backward, frankly, like TEFCA going back into 1990s, document things and trying to graft FHIR onto API's that don't really work and a great expense. But the entire internet, every app on your phone is using a RESTful API. That is the modern standard. It has enabled essentially the entire smartphone economy. And what RESTful, representational state transfer, is just saying, I'm not going to make a big glob of data and what to do with the data. I'm just going to have data. I'm going to get it and put it, it's a little thing in the URL on your browser if you look for a second before they repaint it--you just have to pay attention-- and that's what drives the world.
So I think if you're smart as a product manager, as an executive, as a tech person, you'll look at your data from the lens of RESTful. And of course then JSON, JavaScript Object Notation, on which FHIR is based. It's just the FHIR version of JSON, and those things go together. The pea and the pod type of thing. The benefit is really when they're together, that's of course the challenge for TEFCA, so to get the guilds to do brokering. First, they tried the old stuff and now they're trying to graft it. But if you don't have the right API, you're missing the modernity of it. And that's essentially what the difference is between the 1990s internet and the 2020 internet are these highly powerful atomic APIs. And so whatever your corner of the healthcare world is, you should be thinking atomic RESTful transactions, how would they change my business, my corner of the sandbox.
Kyle Murphy, PhD:
Excellent. Well, thank you, Don, for checking in with us.
Don Rucker, MD:
Yeah. Thanks.
Kyle Murphy, PhD:
We really appreciate it.
Don Rucker, MD:
Yeah, no, our pleasure.
Kyle Murphy, PhD:
Wish you a good conference. Hope you enjoy yourself. Thank you.
Kelsey Waddill:
Listeners, thank you for joining us on Healthcare Strategies' Industry Perspectives. When you get a chance, subscribe to our channels on Spotify and Apple and leave us a review to let us know what you think of this new series. More Industry Perspectives are on the way, so stay tuned.
