Proposed rules from HHS open door to healthcare API economy
With the federal government’s call for adoption of standardized application programming interfaces, the industry could be poised to move towards a healthcare API economy.
An ecosystem of third party API-enabled apps, running on smartphones and other mobile devices, is envisioned by the Department of Health and Human Services as dramatically increasing consumer access to their electronic health records and other healthcare data.
“Although the app universe now has over 2 million products, it is nevertheless very difficult to get your personal medical data on your phone—but this is about to change,” according to National Coordinator for Health IT Don Rucker, MD.
On Monday, the Office of the National Coordinator for HIT released a proposed rule—for the first time—requiring HL7’s Fast Healthcare Interoperability Resources as the standard to which developers must certify their APIs.
In addition, the Centers for Medicare and Medicaid Services on Monday made public its own proposed rule requiring that all health plans doing business in Medicare, Medicaid and through the federal exchanges share claims and other health information with patients electronically via an API by 2020.
“The foundation of our API economy is trust and standards—it was with that in mind that we started working on FHIR to bring the web economy to healthcare,” observed Graham Grieve, HL7’s FHIR product director, who spoke Thursday at the HIMSS19 conference in Orlando.
FHIR, which is based on modern internet conventions, has been widely embraced by app developers, health IT vendors and providers to help solve the interoperability challenges confronting the healthcare industry. In addition, large consumer tech companies such as Apple and Microsoft are supporting FHIR and implementing it into their products to bring the API economy to healthcare.
Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, says he “really likes the addition of the FHIR API as a requirement—a lot of people have already gone that way, and having it become part of regulation will help to move quicker to implement it and put more resources behind it.”
“It’s generated incredible interest and involvement across the industry, and the reason is really simple—because it enables an API economy,” said Grieve. “APIs drive costs down. This is fundamentally an economic driver. By leveraging the web, we have stable and robust information handling techniques, and wide availability of developers and libraries.
“Most importantly, the web has shown how to build communities—and the web economy builds on communities as much as on technologies,” added Grieve. “But, in spite of all those things, healthcare has remained hard.”
However, with ONC’s proposed rule, he contends that the industry is “now at an inflection point in the entrenchment process.”
Last month, HL7 announced the publication of FHIR Release 4, the normative version of the emerging interoperability standard. However, in its proposed rule, ONC wants to make FHIR Release 2 a requirement. Although the agency required FHIR Release 2, ONC has asked for public comment on their proposed rule, and Grieve predicts it “will get a lot of strong comments on that.”
Nonetheless, Huff says “it wouldn’t be a bad thing to have experience with FHIR Release 4 before it becomes regulation.” He adds that one of the challenges with standards is “you need some way to elegantly move from version to version” and “being able to move seamlessly from version to version without causing a lot of challenges for implementers.”
Rasu Shrestha, MD, chief strategy officer at Atrium Health, is leading the Department of Veterans Affairs’ Open API Pledge initiative, which calls on providers to support current and future versions of FHIR. As part of the effort, provider organizations are voluntarily collaborating with the VA to map health data to industry standards.
“The economic drivers that got us providers to where we are today was driven primarily by the fact that there were these proprietary standards that vendors really were pushing forward,” said Shrestha during a panel session at HIMSS19.
However, Janet Campbell, vice president of patient experience and research and development relations at Epic, pointed out that her company was a founding member of the Argonaut Project, an industry-wide effort to accelerate the development and adoption of FHIR.
“As much as this might be a surprise to people, both we and Cerner—and all the other major vendors out there—really do care a lot about standards-based development,” commented Campbell. “It’s why we’ve been participating in organizations like HL7 for so long.”
Still, Shrestha believes that healthcare market conditions are ripe for change and that a “coalition of the willing” is pushing for open standard APIs.
Jocelyn Keegan, project manager for the Da Vinci Project, a payer-provider led initiative to leverage FHIR to exchange critical data required for value-based care delivery, sees healthcare insurers starting to adopt the standard.
“If you think about our market in general, there are always folks that are the advancers doing the new technology—the latest things,” said Keegan. “On the provider-provider and provider-patient side, they are a year or two ahead. But, I’m still gobsmacked at the force with which the payer community has joined Da Vinci and been joining HL7 over the last eight to nine months.”
According to Shrestha, the promise of the API economy is for healthcare to finally catch up with other industries in focusing on the “experiential layer” of providing care—in the same way that consumer apps enable easy online banking, shopping, and travel services, among others.
“In our proposed rule, we propose to adopt FHIR as the standard to which developers must certify their APIs and propose language to support an ecosystem for the secure flow of information,” according to ONC’s Rucker. “We believe this approach could lead to industry standard interfaces—interfaces where app developers can develop effective apps that use API technology without special effort to access a patient’s data.”
“If you create a single language and create convergence in the community around the single API, then there’s all sorts of ways to leverage that,” concluded Grieve. “If you get everybody in this one place, then you get benefits, often in multiple directions.”