Why ‘the year of the API’ will pose big challenges for providers

Every year, there’s some theme that emerges from the HIMSS annual conference, some technology that gets the lion’s share of the buzz and attention.

Many times, it’s the magic panacea that will just solve everything. It’s the technology that’s ascending on the Gartner hype cycle receiving all the…well, hype.

Last year, it was blockchain technology. The year before, it was artificial intelligence. It’s the magic hammer that will solve every problem—at least all those problems that look like nails. And those annual buzzwords often can involve expensive investment in new technology for providers. Jumping on the hype train usually means having to make a big outlay and take a big risk.

So it was interesting this morning to hear the perspective of John Halamka, MD, CIO at Beth Israel Deaconess Medical Center in Boston. During a short interview, he offered his take on the biggest buzz for HIMSS19—he sees 2019 as the year of the API.

A defining moment for him was the announcement of the proposed rule from the Center for Medicare and Medicaid Services, in which the agency wants to require that, by 2020, all health plans doing business in Medicare, Medicaid and through the federal exchanges share claims and other health information with patients electronically through an application programming interface.

The move is significant because federal policy typically leads where the bulk of the industry will go in the next few years.

Application programming interfaces aren’t bank-busting technologies. But just because they are not expensive to implement doesn’t mean that they will be implemented easily. APIs are the foundation for truly disruptive changes in healthcare.

Information ownership is at stake here. And multiple movements and trends are in place that seek to put the consumer in charge of their own information. Halamka noted that consumers want more responsibility for their electronic data, deciding who gets to see what and managing its distribution.

The big change for healthcare organizations involves losing further control of their medical information. That’s already happening from an operations perspective, as more organizations see value to moving data, applications and more to cloud environments. The requirement of operating an on-premises data center thus may lessen, but so, too, does providers’ hands-on control over their own information technology. And for some HIT executives, that’s their “safe spot,” their background expertise that they’ve built up over the course of their careers.

Now, widespread use of APIs raises the likelihood that healthcare organizations will lose more control over patient data. This can be a significant philosophical and strategic challenge, more than a technical one.

I was talking to an executive of a pediatric hospital this morning, and he described this foundational challenge as follows. A typical doctor, 50 years ago, would write notes on his patients just for his own personal purposes, so that he had background on patients’ past medical conditions, which would help jog his memory and aid his treatment. Those notes were his own personal property.

Then, notes were linked to billing, because the clinical documentation became crucial to the coding and billing that enabled a healthcare organization to effectively get paid for delivering services. Those notes were no longer “owned’ by the doctor, but became the property of the larger billing organization.

In past years, healthcare organizations have merged and become larger, and they’ve digitized their records, but the perception continues that they own the data. Like a miser, they may share a few tuppence with outside entities—only enough to meet business purposes—but they still strongly hold an ownership view of their data.

Now, the ownership model for data is being stood on end. Consumers will be given more control and authority over their medical information, and which providers will have access to it.

The pediatric hospital executive suggested the extent of this disruption with this example—say a young patient treated for a chronic condition over the years at a pediatric facility turns 18, and he tells it that, because he’s no longer a minor, he no longer would give the facility permission to access his information.

Given this, there are many implications for care continuity, research and business models, but it’s evident that healthcare organizations will need to devise ways to both share information broadly and make the intellectual shift to a world in which they are losing control of their data.