Information technology has allowed much of our economy to automate processes. We have seen transformations of the airline, banking, brokerage, entertainment, lodging, music, printing, publishing, shipping and taxi industries through the availability of massive volumes of real-time price and service data. Across America, consumer-facing retail service continues to shift to a virtual environment.
Healthcare is the exception. Many health information technology (health IT) products initially focused on billing. The misalignment between billing support and the sense that these tools do not materially automate clinician work to build in efficiencies or improve workflows adds to an overall frustration with the increasing amount of time providers spend at their screens.
Automation is hard because it tends to require interfaces of various types – both to other machines (Internet of Things) and to humans. Often automation proposals involve solutions that focus on highly structured data. But, someone or something has to put energy (physician salary, for example) into organizing much of this information, assuming it is even knowable. The underlying disease or patient behavior (e.g., smoking) is also often not knowable. And, automation relying on machine to machine interfaces regularly runs into a lack of application programming interfaces (APIs) supporting complex clinical data flows.
The 21st Century Cures Act (Cures Act) presented an opportunity to transform American medicine through effective use of health IT. In Title IV, Congress defined, prohibited and penalized the practice of information blocking by various stakeholders, effectively outlawing the practice of information blocking and advancing patients’ access to their health information and to competing providers of coordinated patient care. The Cures Act looked to facilitate communication between the diverse patchworks of healthcare providers and between providers and their patients. Finally, the Cures Act required the electronic players in this space to provide open APIs that can be used “without special effort on the part of the user.” These APIs are standardized software services that can allow patients to use and direct innovative “apps” to get the health information they need to shop for and obtain care.
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These provisions which fundamentally improve the electronic sharing of health information are to be encouraged by payment regulations and the enforcement activities of the federal government. The Cures Act provisions on data exchange will support the growth of new business models (think of services like rideshares). With “open” APIs, the app economy can start thinking more holistically about healthcare (and not just monitoring health markers). APIs – and the reduced potential of information blocking – will help to foster new business models and tools that could expand efficiency and automation across all aspects of healthcare. But to do that, APIs must be standardized, transparent, and pro-competitive. APIs cannot be available in some uniquely proprietary way.
With an eye to the future of artificial intelligence and machine learning, as well as the promise of value-based healthcare, ONC’s approach to addressing interoperability is to help make all clinical data, including free text data, liquid and accessible. By unlocking information systems to third-party developers and researchers in a secure and responsible manner, innovative entrepreneurs can design apps, tools and platforms that will reduce unnecessary tasks (e.g., billing documentation and data entry) and allow clinicians to put their time and energy into delivering high-quality patient care. I encourage you to be part of this ongoing conversation and healthcare transformation to ensure that we promote APIs in ways that will positively transform health care.
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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