Health Providers Support Public APIs to Achieve Interoperability

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Recommendations adopted last week calling on the government to re-align the EHR meaningful use program to expand interoperability are getting kudos from industry stakeholders.

A task force of HIT Policy and Standards Committee members has been analyzing interoperability recommendations from an independent group of scientists called JASON that advises the federal government. The HIT task force agreed with JASON's assessment that lack of an architecture supporting standardized APIs is a major impediment to achieving interoperability. A JASON report released by Health and Human Services in April 2014 recommended the Office of the National Coordinator for HIT define an overarching software architecture for the exchange of health information based on the use of public APIs and open standards, interfaces, and protocols.

Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and co-chair of the JASON Task Force, told the joint HIT committee meeting last week that “current interoperability approaches are functionally limited and need to be supplemented and gradually replaced with more comprehensive API-based models,” and that meaningful use Stage 3 “should be used as a pivot point to initiate this transition.” He argued that Stage 3 and associated certification will be “important drivers in the long transition to a public API-based health information exchange model.”

In response, the College of Healthcare Information Management Executives (CHIME) and Health Level Seven International (HL7) applauded the JASON Task Force recommendations as a “significant step forward in achieving the promise of information technology in healthcare.” Specifically, CHIME and HL7 praised the task force’s support for a foundation of interoperability based on public APIs and advance modern communications standards, such as HL7's Fast Healthcare Interoperability Resources (FHIR).

FHIR has been gaining momentum as an open healthcare data standard. As a result, the JASON Task Force recommended that ONC “mobilize an accelerated standards development process to ready an initial specification of FHIR for certification to support MU Stage 3.” The goal, according to the task force, is to “make such a FHIR specification available to vendors and providers along with other existing functional specifications so as to offer a viable opening to those who would invest in new standards, while at the same time not penalizing those who are already investing in capabilities based on existing standards.”

As the task force points out, current exchange APIs (such as XDS/XCA) allow access to structured and unstructured documents but do not allow direct access to individual data elements, while no widely accepted healthcare industry API provides discrete data-level access to EHR data. FHIR, on the other hand, is “currently the best candidate API approach to data-level and document-level access to healthcare data,” the task force concludes.

Kenneth Mandl, M.D., professor at Harvard Medical School and chair of the informatics program at Boston Children's Hospital, told Health Data Management that the JASON Task Force “really moved the needle in the right direction.” Mandl, who led a four-year, $15 million project funded by ONC to define an API for EHRs, agrees that FHIR is the “way to go.” 

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