Four Ways that API-led Interoperability Will Drive Digital Healthcare Innovation

Via Public API, Centers for Medicare and Medic-aid Services (CMS) aims to address problems highlighted after COVID-19 with CMS-9115-F, a directive that will give patients greater access to their healthcare data. With an implementation deadline of July 1, 2021, the rule will break down barriers across the U.S. healthcare ecosystem, not just empowering patients but also increasing innovation and fostering competition in healthcare delivery.

Patients stand to benefit dramatically from interoperability. In the long run, easy access to their personal health information means payers can make better decisions regarding their care, ultimately leading to healthier populations across the country. There are four ways that the final CMS data interoperability guidelines will digitally transform healthcare delivery now and for years to come.

Enables Better and Faster Decision-Making Across Stakeholders

A large factor in the lack of coordination across stakeholders can be attributed to the healthcare industry’s data silos. Many hospitals and providers are challenged when attempting to provide holistic care to patients because relevant data is stored in different locations, from hospitals to SMART on FHIR apps and healthcare IoT wearables. Regulations such as ONC’s Cures Act Final Rule allow for the secure access and use of electronic health information while the CMS rule puts the patient first by allowing them to use their data in the most optimal manner. All of these rules are designed with the same purpose in mind – for the secure sharing of data between patients, doctors, and healthcare systems.

The challenge is the current lack of an efficient manner for documenting massive amounts of data, which can impede productivity and workflow in an environment where time is of the essence. An integrated healthcare ecosystem that captures analyzes and shares vital information is essential in offering patients the best possible treatment.

Under the CMS rule, payers are required to implement and maintain a secure, standards-based API that allows patients to easily access their claims and view information and costs available through third-party applications of their choice. Moving towards interoperability will create a comprehensive, longitudinal view of a patient’s health history and liberate patient data. As a result, individuals will have a more holistic understanding of their interactions in the healthcare system, enabling better, more informed healthcare decisions.

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Presents Opportunities to Create and Monetize New Business Models

The API-driven interoperability required for this compliance also presents opportunities to create new business models by packaging data and services as API products that can be shared and monetized. The CMS rules require payers to make provider directory information publicly available via a standards-based API. The broad availability of this data stands to encourage innovation by allowing third-party application developers to access information so they can create services that help patients find providers for care and treatment, as well as help clinicians, locate other providers for care coordination.

An API developer portal encourages businesses and app developers to subscribe to, test, and try out APIs. This will be the foundation of healthcare API marketplaces, where companies can productize APIs that comply with the rule as well as other APIs — and monetize some of them.

Strengthens Privacy and Security for Patients

The shift toward public APIs and third-party apps puts the onus on advanced security in an industry where security and privacy are already a core challenge. Patient privacy and security must not be compromised when undertaking data-sharing practices and policies. Healthcare identity systems must be able to handle API security through protocols, such as OpenID Connect, while advanced end-user consent management for apps and data needs to become a core requirement. Failure to do so can impact retention for providers and hospitals should personal health data be subject to breaches.

By promoting interoperability, chief information security officers (CISOs) can better identify users, track access, and more effectively manage access rights. Secure, interoperable systems give a better idea of where critical patient data is located and who can access it. Utilizing multi-factor authentication, data encryption, and proper employee training are necessary tools for preserving confidentiality and compliance and advancing the secure exchange of health data. End users and patients require fine-grained access and control over their data, and they should have the option to manage and revoke consent to specific data elements.

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Streamlines Compliance Within a Highly Regulated Industry

To comply with regulatory requirements, healthcare payers and providers often must overcome obstacles, including aggressive timelines, lack of in-house expertise, or limited budgets. API-led interoperability enables compliance across the healthcare facility, allowing the staff to focus on more pressing concerns such as patient treatment. And with more rules sure to emerge in the future, the new regulatory standards for interoperability will be a useful baseline for health systems to remain compliant.

Teams must identify and validate data sources, integrate with source systems, and expose FHIR resources as APIs to complete the project by deadline day, of which selecting the right technology vendor is critical. API accelerators and connectors built on top of a full API Integration platform allow organizations to connect to heterogeneous data sources. Similarly, identity and access management systems that provide consent management are well suited to handle the rule’s complex consent requirements.

Addressing the CMS Rule and Beyond

Facilitating access to patient data and healthcare information is an effective method for preventing medical errors and improving patient safety and care. Technology selection here is key, affecting time to market and flexibility and providing the features and road map that fit the business’ bigger picture vision. Purpose-built healthcare solutions based on full API-integration platforms enable organizations to participate in the API economy, which is key for healthcare companies looking to build a competitive edge. Platforms should also support flexible deployment models, and CIOs should be able to pick from software as a service (SaaS), Cloud, on-premises, or Hybrid Cloud deployments.

While the finish line to breaking data silos and analyzing clinical data is yet to be crossed, the healthcare industry is moving in the right direction. Healthcare companies that invest resources into a sustainable API ecosystem and platform business model will trigger innovation, drive down costs, and most importantly, provide more precise care to patients.

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