What part do Open APIs play in improving interoperability?

April 17, 2018 Dr. Dave Dembo

A data platform with Open APIs that can break down health information silos, this is the Holy Grail of healthcare interoperability - one patient, one record; primary to tertiary interoperability. 

Yesterday I attended the Wild Health Summit and heard from excellent speakers on their quest for interoperability in the Australian healthcare sector. Healthcare connectivity is not just an Australian issue but a global issue for all healthcare providers. Where a patient’s medical information should be able to move seamlessly across organizational, state and national boundaries.

What is interoperability and why is it so hard to provide efficient connectivity?
Interoperability is the ability for different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. So why is it not possible for a patient’s medical record to be readily accessible?

Unfortunately, a patient’s medical record is most often captured in unreachable data storage systems. If a patient visits their PCP, they document notes about the appointment into their own Electronic Medical Records (EMRs). For the most part, this information remains in the EMR, unless a partial piece of medical information is included in a referral and sent to a specialist. 

What happens when a patient is in a serious car crash or has a life-threatening medical emergency? And they are taken to the emergency department of the local hospital. What medical information is readily available to the emergency clinicians? The care team requires an understanding of the patients underlying medical conditions and family history. 

With most patient records being stored in silos, there is no “shared care record.” Information exists about individual patients in multiple EMRs, so no one has the complete picture. Not only does the absence of context create clinical risk, but it also creates sluggishness in health systems as each member of a patient’s care team tries to assemble their own view of the patient’s issues. 

Healthcare is lacking behind other industries, there is the ability to send text messages to any mobile network and use applications to service multiple needs on our smartphones. But it is difficult to provide an emergency clinician with a complete patient medical record. Healthcare organizations globally want to achieve plug-and-play interoperability, by unifying all healthcare organizations to bring about change. The current lack of interoperability compromises patient safety, impacts care quality and patient outcomes.

Providing a complete patient medical record is difficult. A clinical record can contain over 100,000 different data fields which include numeric data, structured text, unstructured text, and scanned files and images. The key is to get these different systems to be able to talk to each other and exchange data. Currently, most data sharing is based on sharing data fields with contextual integration or sharing view-only document summaries. Industry standards have been developed to make data sharing less arduous and provide a non-uniform approach to the application of these standards, this remains a hurdle for interoperability. There is a myriad of standards, including HL7®, FHIR®, DICOM, and IHE. HL7 is constantly updating and releasing new iterations of its standards, which has increased standards heterogeneity. But standards must continue to evolve as the practice of medicine evolves – so there is a tension between driving adoption of standards and ensuring they are constantly up to date. 

Interoperability is imperative to deliver the capabilities that are needed in healthcare – such as an electronic shared care record, automatic alerts, and notifications, seamlessly transferring information between and within care settings, delivering remote care, analyzing data for population health management, and resource optimization. 

What part do Open APIs play in improving interoperability?
Application Programming Interfaces (APIs) allow software applications to share data, invoke business logic or perform an action (such as send a notification, map data and start a workflow). They are everywhere in most aspects of modern day life. Large consumer brands Amazon, Twitter, Facebook and Google all have substantial APIs that enable developers to access information, so they can build new applications. They enable the access to data, without giving away how that data is released – thereby protecting the source code of the application. 

APIs provide reusable and well-understood connectivity protocols, authentication frameworks, data models and the design patterns, historically developers had to reinvent the wheel and repeat work for each new integration to achieve this connectivity. The knowledge, time and effort required to do this, created obstacles, so healthcare integration became a specialist and expensive field. This meant complexities and costs were involved in any upgrades, so legacy systems remained well past their best. 

The preferred way to standardize the way applications can access data is through APIs. This has been steered by EMR vendors pushing the ability to connect standalone EMRs and by associations such as HL7 FHIR. The time and cost involved in sharing data through APIs is substantially less than traditional systems, this will benefit the healthcare sector and empower services, by enabling connectivity and expansion. 

APIs open up a healthcare platform to external applications, allowing data to be shared across different care settings. Orion Health Amadeus is not only a platform with a global footprint, but it also comes with Open APIs that are based on industry-leading open standards such as OAuth2, FHIR, and OpenID Connect. This makes it easier for developers to build their app once and deploy it against a large number of vendor platforms that also support those open standards.
 
In the latest chapter in our Open API story, the Orion Health Developer Portal now makes it possible for developers to experiment with health APIs and innovate on our platform. Ultimately, it is a digital playground to explore new ideas and discover new ways of making sense of the vast amount of data available.  
 
The Developer Portal will provide all the information that a developer would need to integrate their existing app or build a new app using the open standards that we support. The documentation in the Developer Portal is loaded with examples that can be run against our sandbox, allowing anyone interested in the APIs to see how they work and what they can do.

With these resources, developers have access to everything they need to improve interoperability in the healthcare sector, break down health information silos, and build valuable solutions that truly serve the delivery of excellent healthcare for every individual. And in doing so, the Holy Grail of one patient, one record; primary to tertiary interoperability could be realized. Where a patient’s medical record can move seamlessly across organizational, state and national boundaries.

To learn more about Open APIs, click here.

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