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Will FHIR, APIs Help or Hinder Health Information Exchanges?

Open APIs such as FHIR can help resolve a health IT interoperability, but they could further challenge the viability of standalone health information exchanges.

By Kyle Murphy, PhD

- Application programming interfaces, such as the much-discussed Fast Healthcare Interoperability Resources, have the potential to increase the fluidity and sharing of health data currently stored away in health IT systems.

Use of FHIR by health information exchanges

But will increased API use prove beneficial to some stakeholders and come at the expense of others, namely health information exchanges?

Recent research has already pointed to extant and emergent challenges facing these mediators of health data exchange.

In an interview with HealthITInteroperability.com earlier this week, University of Michigan professor and researcher Julia Adler-Milstein, PhD, spoke at length about how a lack of provider and payer buy-in and increased EHR vendor presence in health information exchange were threatening the sustainability and viability of independent HIEs. She also touched upon API use as a means of health information organizations (HIOs) to demonstrate their ability to drive innovation in care coordination and delivery.

"Nothing would prevent an HIE from using APIs to help improve what they're trying to do, too. My hope is independent HIEs will it as an opportunity. That was certainly the vision of the JASON report and the response, for instance — that API use to could help standalone HIEs and also increase the competition so to speak because everyone will have these available to them," said Adler-Milstein.

"The vision of APIs is that they will open up the market to allow smaller software vendors to come in and build creative solutions for interoperability and other domains," she continued. "The sense is we're not moving fast enough and APIs are a key enabler that will allow data to be extracted from systems more easily and do a whole range of things with that information."

According to the JASON report on developing a robust health data infrastructure, health information exchanges and EHR vendors "are currently woefully inadequate in what they provide to health care professionals" and both have the ability to leverage open APIs to meet the current and future needs of the healthcare industry.

Adler-Milstein noted a particular advantage for independent HIES based on their experience with data governance and stakeholder engagement:

Are APIs going to be a game changer in and of themselves and will they make information easier to move? From a technical perspective, the answer is clearly yes. But you still then need that governance framework around the data sharing and that in some ways has always been the stickier piece. Whoever is most effective at figuring out which stakeholders are going to be willing to come together and share information, those are going to be the ones who are most successful. Independent HIES have been in that business for a long time. They've had to be negotiating data use agreements and getting stakeholders to cooperate around data sharing, so maybe they have a leg up in that sense of taking best advantage of these APIs.

One particular API is FHIR which both the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have request public feedback on as part of the proposed rule for MACRA implementation and final rule for health IT certification, respectively.

While Adler-Milstein sees promise in FHIR-enabled applications and services, she cautioned against treating the health IT specification and API as the panacea for achieving widespread interoperability.

"FHIR seems like a key enabler, but it's not the silver bullet that's going to solve interoperability," she concluded.

Dig Deeper:

A FHIR Future Burns Brightly for Population Health Management
Updating Progress of FHIR, C-CDA Health IT Standards at ONC

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