Six Interoperability Use Cases for APIs in Health Data Exchange

Patient-Facing APIs

APIs make it easier for patients to access personal health records. In fact, most healthcare organizations have implemented APIs to comply with the CMS Interoperability and Patient Access final rule, which requires payers and providers to support patient access to health data using the HL7 FHIR standard.

The legislation aims to empower Medicaid beneficiaries to make informed decisions related to their health through portable access to personal health information and payer data.

Since enforcement of the final rule began on July 1, 2021, API adoption for patient data access has grown. A September 2023 ONC data brief found that two in three hospitals reported using a FHIR API to enable patient access to data through apps in 2022, representing a year-over-year increase of 12 percentage points.

Provider-Facing APIs

APIs can be a cost-effective way to extend an EHR platform's core capabilities, according to a policy statement published in Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

Many EHRs lack pediatric features such as growth charts, anthropometric percentiles, weight-based dosing, and tracking for well-child visits and immunization schedules. Implementing such changes directly in the EHR requires substantial investment from vendors.

Often, vendors will leverage content development tools to integrate pediatric functionalities into the EHR, but each customer must pay for the service.

APIs and web services may be a more cost-efficient route to EHR optimization, AAP suggested, as these technologies provide clinical decision support solutions that can be shared across multiple EHRs and settings.

"Because Web services are smaller, more specialized software modules compared with EHRs, they have the advantage that they are easier to develop, test, and augment in a more rapid development cycle and do not have to rely on vendors to prioritize functions for development," the policy statement authors wrote.

Administrative

APIs can also support data exchange between healthcare providers and payers for administrative purposes, such as prior authorization.

Prior authorization is a utilization management strategy that payers use to ensure patients access the most cost-effective medication available for their clinical needs.

When a drug has prior authorization requirements, clinicians must submit certain documents to the payer for permission to prescribe the drug. However, the traditional prior authorization process is time-consuming and can lead to patient care delays.

APIs could streamline the data sharing experience for stakeholders. A payer would provide the data requirements via an API, and the healthcare provider then sends those required data elements back to the payer. Then, the health plan returns a response, all using APIs.

In the Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule, CMS proposes to require impacted payers to build and maintain a FHIR API that would automate the prior authorization process.

Population Health

In the 2022 study published in JAMIA, subject matter experts described the use of APIs for population health and value-based care.

For example, payers can use APIs to send claims data to providers in bulk, and providers can make APIs available to improve the accuracy and lower the cost of chart abstraction processes, the study noted.

Similarly, the Health Level Seven International (HL7) FHIR Accelerator DaVinci includes several API use cases for value-based care, including provider-to-payer data exchange for quality measures and exchanging information to identify patients who are part of a risk contract.

The study noted one important barrier to the adoption of APIs for population health is a lack of trust between providers and payers.

One subject matter expert noted that providers need to change their trust model and "unleash clinical data to the payer in order to make their value-based contract actually work."

Payers must also ensure that the data they send providers are limited to patients attributed to those providers, which can be challenging with less-established patient attribution systems.

Public Health

The COVID-19 pandemic highlighted the value of APIs for public health data exchange and case reporting between different organizations.

For instance, CDC created a system to track COVID-19 aggregate case and death data, known as aggregate case and death surveillance (ACS). Public health jurisdictions (PHJ) such as laboratories, healthcare providers, long-term care, correctional facilities, and contract tracers reported COVID-19 case and death data to the ACS platform.

Initially, CDC created the system to monitor the cumulative and daily number of COVID-19 cases and deaths recorded by the submission date.

As PHJs revised the historical COVID-19 case and death data with updates, CDC came up with a streamlined process to update the records for improved accuracy.

Starting in March 2022, CDC integrated APIs from three jurisdictions — California, Florida, and Tennessee — to automatically pull current and historical COVID-19 case and death data.

The use of APIs improved data quality and required less human intervention, reducing the overall processing time from nearly 30 minutes to less than five minutes.

Social Services

Experts also noted the use of APIs for interoperability of clinical and social services data to address social determinants of health (SDOH).

The study noted how APIs could improve interactions between EHRs and social service organizations by identifying and documenting SDOH and streamlining referrals to address social needs such as food insecurity and housing.

However, a major challenge to advancing this API use case is a lack of advanced IT infrastructure in social service organizations. Unlike hospital systems, social service organizations have not had access to federal incentives like Promoting Interoperability for digital health adoption.

"Social service technical resources may also lack knowledge of health data standards like FHIR, further increasing the cost and complexity of implementation," the study pointed out.

While challenges exist for API adoption across healthcare, policy efforts to increase adoption could help drive valuable use cases and enhance health data exchange across the care continuum.

The study authors emphasized that researchers must seek to understand the particular barriers to each use case and how to overcome them to create value.