- Interoperability remains one of the biggest challenges facing healthcare organizations today. Despite the advancements providers are making through digital transformation and (application programming interfaces (APIs), many clinicians and patients are still unable to successfully exchange EHR data.
ONC is continuing to work with stakeholders and federal agencies to address the shortcomings of interoperability by inserting APIs for clinicians and patients to access data, as well as creating a trusted framework, according to National Coordinator Don Rucker MD in a recent ONC blog.
“Our primary focus is to accelerate individuals’ ability to access and send their health information via their smartphones or other electronic devices, so they can shop for and coordinate care,” said Rucker. “This is an important piece of delivering value throughout our health care system: As Secretary Azar has said, ‘To bring down costs and increase quality, we have to put patients in charge of their own data.’”
APIs are key to giving patients secure and reliable access to their own health data.
An API is an interface that allows unrelated software programs to communicate with one another. APIs act as bridges between two applications, allowing data to flow regardless of how each application was originally designed.
For applications that function by pulling a constant stream of data from one or more sources, an API is especially important to decrease development time, save storage space on endpoint devices, and overcome any differences in the standards or programming languages used to create the data that lives at either end of the bridge.
In order for APIs to be truly successful for interoperability, they need to be “standardized, transparent, and pro-competitive,” says Rucker. This calls for open APIs.
Open APIs have encouraged competition, which has allowed many industries to develop more advanced APIs faster.
By making API source code accessible in healthcare, developers from different organizations can collaborate by working with the same source code, and resharing their version of the API back with the community.
“The modern internet app economy thrives on an open API software environment,” Rucker explained. “Part of the healthcare API evolution is incorporating many of the current protocols from leading standards development organizations with the newer FHIR (Fast Healthcare Interoperability Resources) web developer-friendly way of representing clinical data.”
“Currently, we work off a narrow worldview of interoperability where the task is to move one patient’s medical record from one doctor or hospital to another,” he continued. “Central to a value-based health system is expanding the ability to find and move data for more than one patient at a time. Modern networks should offer a vastly richer set of data movements and activities.”
APIs are key to providers finding ways to move data efficiently and securely while cutting back costs. Transferring health data at a large scale will help with other data intensive programs too, such as transferring analytics data for population health.
A trusted framework is also on ONC’s interoperability to do list. Different health systems can build exchange frameworks for their health system or community, but that framework can be limited to that community.
Current frameworks offer little connectivity because of variations between one framework and another. Patients who change health systems may have trouble accessing their EHRs. This calls for a trusted exchange framework and common agreement.
“The Cures Act calls on ONC to develop or support a trusted exchange framework and common agreement to address policies and practices between health information networks,” said Rucker. “The final Trusted Exchange Framework will set common principles, terms, and conditions that facilitate trust between disparate health information networks.”
“It will seek to scale interoperability nationwide and enable participating networks to work together to provide an on-ramp to electronic health information regardless of what health IT developer a provider uses, health information exchange or network a provider contracts with, or how far across the country the patients’ medical records are located.”
Developing standards for APIs and frameworks are key to achieving nationwide interoperability. Using open source development, ONC hopes to accelerate the processes of achieving a standard to make interoperability challenges a thing of the past.