New research from a survey of digital well being corporations exhibits that almost all corporations (73%) use standards-based utility programming interfaces (APIs) when integrating with digital well being data (EHRs) (Determine 1). In 2020, ONC finalized its Cures Act Final Rule, which codified using the Well being Stage 7® (HL7®) Quick Healthcare Interoperability Assets® (FHIR®) customary for “licensed APIs” that may allow safe, programmatic entry to a affected person’s digital well being data (EHI). These licensed APIs standardize information connectivity and format necessities in order that third-party functions, like smartphone apps, can anticipate the identical performance and affected person information when connecting to any EHR with a licensed API.
Determine 1: Digital well being firm use of APIs and the FHIR customary
Notes: N = 141.
The Cures Act Closing Rule required builders of those licensed APIs to undertake the FHIR customary and respective implementation guides by December 31, 2022. The survey data, collected previous to the December 2022 deadline, present that not solely do most digital well being corporations who combine their apps or software program with EHRs use the FHIR customary as a part of their merchandise, but additionally that corporations who join with a number of EHRs use these standards-based APIs at greater charges. About 3 in 4 corporations with apps built-in with a couple of EHR reported in depth use of the FHIR customary, in comparison with simply 1 in 4 corporations with apps built-in with one EHR.
What the Information Inform Us
The info not solely present excessive ranges of adoption of the FHIR customary amongst these healthcare know-how corporations, but additionally exhibit that EHR corporations carried out these standards-based APIs and made the know-how out there to third-party customers properly earlier than the deadline for the certification requirement. Different research has shown that FHIR adoption amongst EHRs, particularly market main EHRs, was frequent earlier than and after the finalization of the Cures Act Closing Rule, however this new information reveals the broad use of the know-how among the many supposed customers – third-party utility and software program builders. A session at ONC’s Tech Forum, the place our examine was introduced, expounds on this level.
Regardless of the early success in implementation and use of those FHIR-based APIs, a big portion of corporations proceed to make use of different API sorts. As proven in Determine 1, 57% of corporations reported utilizing proprietary APIs alongside standards-based APIs, and 11% reported utilizing proprietary APIs with out using standards-based APIs. Firms might use APIs of various sorts as a consequence of persisting challenges with API implementation in addition to restricted FHIR help for specific use circumstances. About half of digital well being firm survey respondents reported excessive charges, 4 in 10 reported the shortage of life like scientific testing information, and one other 4 in 10 reported information components of little curiosity or worth as substantial boundaries to the use and broader utility of the APIs. The outcomes validate different considerations raised by health IT community members, particularly app builders and different digital well being corporations, concerning the restricted scope of the present licensed APIs and boundaries to entry like charges, information entry, and developer help, that have an effect on realization of APIs “with out particular effort” as referred to as for within the twenty first Century Cures Act.
Reaching APIs “With out Particular Effort”
ONC initiatives like Lantern and Inferno attempt to enhance the sources and information out there to digital well being corporations. ONC’s information blocking laws reinforce and help a affected person’s capability to entry their EHI, together with by means of an app of their alternative. Moreover, sure necessities in ONC’s latest HTI-1 final rule goal to resolve some persistent boundaries by lowering the hassle to make use of these APIs. Particularly, the ultimate rule revises and standardizes necessities for licensed API builders to publish digital FHIR endpoints and adopts the USA Core Information for Interoperability (USCDI) model 3, which expands the present set of standardized information components out there by means of licensed APIs. These updates make it simpler for app builders to attach their customers to their information and expands the info set EHRs are required to supply by means of their licensed APIs.
Research like this allow ONC and its companions to higher perceive the wants of the neighborhood and consider the implementation of well being IT insurance policies. Nonetheless, no examine is complete sufficient to grasp the experiences of all neighborhood members. In case you expertise a priority or problem utilizing licensed well being IT, particularly in case you are a third-party developer or affected person attempting to interoperate your app with an EHR, chances are you’ll submit your concern to ONC’s Health IT Feedback portal. All considerations are fastidiously reviewed and regarded by ONC to tell and enhance its insurance policies and packages.
Please read the open access article to study extra about digital well being firm experiences utilizing EHR APIs.
Thanks to our companions on the California Well being Care Basis and ScaleHealth and co-authors on the College of California at San Francisco.
