Healthcare is witnessing a transformative shift with the advent of Application Programming Interfaces (APIs) in data exchange. Despite initial hurdles, APIs promise immense potential in various healthcare realms. Six primary use cases have emerged: patient and provider-facing APIs, administrative streamlining, population health enhancement, public health data exchange, and social services integration. These APIs facilitate patient data access, address EHR deficiencies, optimize administrative processes, improve population health initiatives, expedite public health data reporting, and integrate clinical and social services data. Overcoming challenges such as cost, trust barriers, and data standardization is imperative for harnessing the full capability of APIs in revolutionizing healthcare data exchange.
In today’s healthcare landscape, integrating Application Programming Interfaces (APIs) marks a paradigm shift in data exchange methodologies. While industries like travel and finance have long embraced APIs, healthcare has been slower to adopt them due to multifaceted challenges. Nevertheless, APIs hold transformative potential across various healthcare sectors. This exploration highlights six pivotal use cases: patient and provider-facing APIs, administrative optimization, population health initiatives, public health data exchange, and integration of clinical and social services data. Understanding and overcoming obstacles is crucial to fully leveraging APIs for enhancing healthcare data interoperability.
Despite these hurdles, APIs linking to certified Electronic Health Record (EHR) systems are gradually gaining traction, primarily driven by federal regulations like the ONC 21st Century Cures Act Final Rule of 2020. This regulation builds upon earlier initiatives, aiming to augment patient access to health data via standardized API adoption.
A comprehensive 2022 study published in JAMIA Open identified six principal use case categories for APIs in healthcare: patient-facing, provider-facing, administrative, population health, public health, and social services.
Patient-Facing APIs
APIs facilitate patient access to personal health records, aligning with the CMS Interoperability and Patient Access final rule. This legislation aims to empower Medicaid beneficiaries by enabling portable access to health information and payer data. Since the rule’s enforcement began in July 2021, there has been significant growth in API adoption for patient data access.
Provider-Facing APIs
APIs offer a cost-effective solution to address gaps in EHR functionalities, particularly in pediatric care. They allow for the integration of specialized clinical support solutions into multiple EHRs and settings, bypassing the need for substantial investments from vendors.
Administrative APIs
APIs streamline data exchange between healthcare providers and payers for administrative functions, such as prior authorization. This automation enhances efficiency in the prior authorization process, reducing delays in patient care.
Population Health APIs
APIs contribute to population health and value-based care by enabling the exchange of claims data between payers and providers. However, barriers include a lack of trust between providers and payers and challenges in patient attribution systems.
Public Health APIs
Amid the COVID-19 pandemic, APIs have proven instrumental in exchanging public health data for case reporting. For instance, CDC integrated APIs from several jurisdictions to update COVID-19 case and death data, significantly improving data accuracy and processing time.
Social Services APIs
APIs are crucial in integrating clinical and social services data to address social determinants of health (SDOH). However, challenges include the lack of advanced IT infrastructure in social service organizations and limited knowledge of health data standards like FHIR.
The integration of Application Programming Interfaces (APIs) in healthcare data exchange presents a promising yet challenging landscape. Despite obstacles such as high costs, trust issues, and data standardization, APIs offer transformative possibilities across diverse healthcare domains. The identified six key use cases demonstrate the potential for patient empowerment, addressing EHR deficiencies, streamlining administrative processes, improving population and public health endeavors, and integrating clinical and social services data. Overcoming these challenges through policy initiatives and collaborative efforts is vital to harnessing the full scope of APIs, ensuring a revolutionized and interoperable healthcare ecosystem.
