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API adoptions rise as data silos fall


By Joseph Conn
Posted: May 20, 2014 - 3:00 pm ET
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At its Virtual Care Center now under construction in Chesterfield, Mo., the 33-hospital Mercy system plans to operate as many as 75 telehealth programs linking providers with patients in their homes and at remote-care facilities in rural areas. The Internet bandwidth in many rural areas is not high quality.

So Mercy is using so-called application programming interfaces to improve the quality of connections in its 5-year-old home health monitoring program. The APIs help Mercy connect images flowing over Vidyo, its Web-based video service, to both its electronic health record system and to mobile devices.

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“It gives us a high-quality picture over low bandwidth,” said Dr. Tom Hale, Mercy's executive medical director of telehealth services “Their API allows us to have pictures at home over virtually any mobile technology and even a smart TV.”

APIs are sets of requirements that enable one software system to talk to another, most commonly over the Web. They facilitate moving information between software programs. For example, when you use Yelp to find a restaurant, that program can display nearby restaurants on a Google Map. APIs do this by exposing some of a program's internal functions, enabling applications to share data and take actions on one another's behalf without developers sharing their software code.

Advocates foresee APIs becoming ubiquitous in health IT, opening up data in older proprietary EHRs for health information exchange and analysis via Web-based tools, particularly applications running on mobile devices such as smartphones and tablet computers.

Last month, a group of scientists called JASON recommended in a report to the Agency for Healthcare Research and Quality that APIs be mandated for use in the federal EHR incentive-payment program. The group said APIs will help create “a migration pathway from legacy EHR systems” to the interoperable healthcare communications network of the future.

That's how the Veterans Affairs Department is using APIs in connection with its venerable VistA EHR system. APIs will allow the agency to move ahead with a mobile device strategy for veterans.

Kathleen Frisbee, director of the Web and mobile solutions initiative at the Veterans Health Administration, said an API is like a legal contract. “It sits between the user interface that wants something and a database that can provide something,” Frisbee said. “The contract says to the database, 'If the user interface gives you XYX, then the database promises to return ABC.'” APIs give developers speed and flexibility compared with other interfaces, she said.

Last May, the VA launched a pilot project in which it distributed Apple iPad mobile devices to 881 caregivers of seriously injured veterans of recent wars. The iPads were loaded with nine apps—seven of them clinical—connected to VistA via APIs. They include apps that enable the user to see a clinical care summary compiled from the veterans' own EHR, request prescription refills, notify the veterans when they need to take a medication, coach them on post-traumatic stress, and monitor and manage their pain. It also includes an app to help caregivers manage their own stress. Frisbee foresees more than 1 million veterans becoming mobile app uses.

Keith Figlioli, senior vice president of healthcare informatics at group purchaser Premier, said JASON's recommendation for increased use of APIs could prove crucial as the demands on EHR developers skyrocket. “You'll be coming up with (uses) that most people haven't even thought about yet,” he said.

APIs will play a big role in population health management applications, said Jeremy Delinsky, the chief technology officer for Athenahealth, a developer of Web-based EHR and physician practice-management systems. “Our clients are going to ask for more functionality than we could ever churn out,” he said. “As a vendor, you have to swallow your pride and say it's OK, you're going to lose a bit of control.”

Dr. Doug Fridsma, chief science officer and director of the office and science and technology at HHS' Office of the National Coordinator for Health Information Technology, said APIs also may play a role in meaningful use of EHRs. For example, they could be used by small physician practices to get data from hospital EHR systems enabling the doctors to analyze their practice patterns.

Follow Joseph Conn on Twitter: @MHJConn


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