Public Apis: The Ultimate Silvery Bomb

Congratulations! We receive got a novel buzzword trending inwards wellness attention information technology - Public APIs.  You tin give the sack tell world APIs everywhere you lot used to tell interoperability. You tin give the sack too supercede the real unprofessional “EHRs can’t speak to each other” amongst “EHRs lack world APIs”. People volition nod inwards solemn agreement, in addition to you lot volition audio real informed in addition to upwardly to engagement on the latest developments, but only inwards instance you lot come across the quintessential tiddler inquiring nearly the king’s rather scant wardrobe, hither is a picayune background information.

(Very) Brief Introduction to Public APIs

API stands for application programming interface. Yes, interface, similar the ones you lot receive got amongst your claims clearinghouse or your lab service provider or pharmacies. There are several ways to course of education APIs, but for our discussion, nosotros only involve to reckon 2 types of APIs: information APIs in addition to services APIs. Data APIs are the simplest, in addition to acquire something similar this: software H5N1 sends a asking for information to software B, in addition to software B sends dorsum the required information. Another way is for software H5N1 to post unsolicited, but previously agreed upon, information to software B, which volition in addition to thus post dorsum a brief give thank you lot you annotation to software A.

For this telephone commutation to piece of work well, both software H5N1 in addition to software B involve to concur on a communication protocol in addition to both should percentage a mutual understanding of the data. This mutual understanding of information is called a standard. Standards commonly emerge from non-profit organizations dedicated to defining such standards, thus for example, your claims interface uses something called ANSI X12 every bit its telephone commutation standard, your lab interface uses the HL7 criterion in addition to your chemist's interface uses something called NCPDP Script. Turns out you’ve been using APIs all along…

Service APIs are less mutual inwards wellness care, although if you lot human face at the large picture, you lot could tell that claims clearinghouses, labs in addition to electronic prescribing are all actually services. H5N1 elementary instance of a pure service API, where software H5N1 invokes a slice of code executed yesteryear software B, is a warfarin dosing calculator. Here software H5N1 sends a few agreed upon parameters (i.e. demographics, diagnosis, medications, INR, genomics, etc.) to software B. Software B performs a highly specialized calculation using those parameters in addition to sends the lawsuit dorsum to software A.

APIs are deemed to live on public, or open, if the specifications are publicly available on the Internet for anyone to use. Health attention APIs are non commonly public, in addition to formal trace of piece of work organisation relationships involve to live on established earlier whatever 1 software developer tin give the sack work another’s APIs. Google Maps APIs, for example, are said to live on public, in addition to thus are MapQuest APIs. Note however, that although both serve basically the same purpose, they are non identical or interchangeable, in addition to they are non validated or certified yesteryear a world agency. Both Google in addition to MapQuest set out APIs to their mapping software, because it makes trace of piece of work organisation feel for Google in addition to MapQuest to practise so.

Why Now?

JASON (as inwards Jason in addition to the Argonauts) “is an independent scientific advisory grouping that provides consulting services to the U.S. authorities on matters of defense strength scientific discipline in addition to technology”. JASON was established inwards 1960 in addition to it “has conducted studies nether contract to the Department of Defense (frequently DARPA in addition to the U.S. Navy), the Department of Energy, the U.S. Intelligence Community, in addition to the FBI. Approximately one-half of the resulting JASON reports are unclassified.” The latest unclassified JASON report, A Robust Health Data Infrastructure, was commissioned yesteryear the Department of Health in addition to Human Services (HHS) “to address the nationally meaning challenge of developing comprehensive clinical datasets, collected inwards existent basis environments in addition to accessible inwards existent time, to back upwardly clinical interrogation in addition to to address world wellness concerns. These datasets could live on used to guide clinical research, heighten medical decision-making, in addition to reply rapidly to world wellness challenges.”

The identity of JASON grouping members is secret, but rumor has it that these are some of the best in addition to brightest scientists inwards the Earth in addition to receive got over the years included several Nobel Prize winners. Although nosotros don’t know who JASON is (or are, or notwithstanding 1 refers to an anonymously unaccountable grouping of advisers), nosotros should annotation that JASON was introduced to the bailiwick yesteryear xviii goodness briefers (8 from interrogation in addition to academia, 2 from Microsoft, 2 from IBM, 1 videogames developer, 1 from HIMSS, 1 from Deloitte, 1 from Kaiser, 1 from the White House in addition to 1 from NQF). These representatives of medicine inwards America guided JASON to useful materials nearly information engineering scientific discipline inwards wellness care, in addition to actively participated inwards subsequent JASON discussions.

Similar to a report set forrard yesteryear the President’s Council of Advisors on Science in addition to Technology (PCAST) 4 years ago, JASON recommends that massive amounts of clinical information live on collected at the indicate of attention inwards a format suitable for extraction in addition to combination amongst non-clinical data, to facilitate large scale “biomedical” research. To that end, HHS should actively engage inwards the creation of a national clinical information telephone commutation architecture, based on nationally enforced standards in addition to world APIs implementing those standards, in addition to it should engage inwards these activities forthwith in addition to amongst the total strength of a authorities agency. All the piece of work done to engagement yesteryear HHS in addition to its diverse initiatives resulted inwards inadequate proliferation of legacy wellness information technology systems, which should live on replaced now, in addition to the aggressive migration path suggested yesteryear JASON begins amongst using those world APIs to extract in addition to reformat clinical information from the vast repositories of legacy systems.

To date, HHS has spent over $25 billion of taxpayer coin on partially reimbursing hospitals in addition to physicians for the purchase of wellness information technology systems. The much larger remaining costs of buying, implementing in addition to using these systems is unknown. According to the CMS data, at that spot are closed to one-half a 1 one m thousand clinicians in addition to almost 5 one m hospitals registered to participate inwards the Meaningful Use program, all using certified EHRs. Practically all these legacy EHRs receive got found ways to routinely telephone commutation billing information, medications information, laboratory in addition to imaging information, in addition to to a greater extent than recently, referral information, immunizations information, generic messaging in addition to a host of other document based notifications. This may live on a slap-up commencement for patient attention delivered yesteryear people who tin give the sack read, but it is totally in addition to completely unacceptable for global biomedical research.

Faced amongst distinguished panels of scientists in addition to engineering scientific discipline experts stating that medical attention is basically a gigantic experimental interrogation project, in addition to a authorities thoroughly convinced that peace, prosperity in addition to goodness wellness are a straight role of the amount of information collected nearly each in addition to unmarried 1 of us, what should nosotros practise next? Should nosotros forthwith commencement ripping in addition to replacing the laid upwardly novel legacy systems inwards work yesteryear 80% to 90% of doctors in addition to hospitals, because to a greater extent than powerful vendors would too similar to laid upwardly coin inwards wellness care? Or should nosotros bring a subtler approach in addition to slap a host of novel regulations on legacy vendors forcing them to construct in addition to keep a world API infrastructure to practise goodness all newcomers? After IBM, Apple, Google, Facebook, Verizon, Salesforce (I tiddler you lot not), in addition to everybody amongst a registered spider web address, bring together the wellness attention feast, you lot should human face to a greater extent than colorful user interfaces, amongst interminable scrolling screens filled amongst extra-large fonts, large apartment smoky colored buttons, eye-popping images in addition to practically no functionality, every bit is stylish inwards consumer websites. Most of this “software” volition live on geared towards your patients, the ultimate generators of marketable biomedical interrogation data. Your electrical flow EHR vendor volition live on exhausting all its resources on creating, maintaining, testing, certifying in addition to publishing to a greater extent than often than non information APIs, but inwards the brusk term too services APIs, to pave the route for giant engineering scientific discipline aggregators in addition to tiny app builders.

If your certified EHR vendor is modest to medium inwards size, human face it to neglect in addition to acquire bankrupt inwards the adjacent few years. If your EHR vendor is large, human face it to live on acquired in addition to decimated yesteryear a global corporation. Barring a miracle, the passive-aggressive grumbling of physicians volition in conclusion subside, in addition to the march to defragmentation of our “broken”, “stove-piped”, “siloed”, “walled-garden” scheme (a.k.a. competitive, free-market, allow the best human being win, type of system), volition move along at a brisk pace.

For amend or worse, nosotros involve to recognize that inwards this Earth wellness attention is a business, a real large in addition to profitable business. Perhaps it shouldn’t be, but it is. Health attention is beingness told hateful solar daytime inwards in addition to hateful solar daytime out that it should larn from other industries. Well then, how would the banking manufacture react to a requirement to create world APIs allowing wholesale extraction of fully identified transactional information of their customers in addition to all the communications conducted or thus such transactions betwixt the banks in addition to their clients? What would live on the response of airlines, motorcar manufacturers, restaurants, or fifty-fifty Google in addition to Apple, if the authorities demanded that they invest inwards infrastructure exclusively intended to aid other companies set them out of business? Take a wild guess...