Originally published in Healthcare Information Management and Communications Canada magazine:
Despite their technical sounding name, Application Programming Interfaces (APIs) are a strategic weapon that can drive innovation, foster interoperability, and unlock the value of existing information systems. Just as leaders in industries as diverse as retail and finance have embraced APIs as a strategic imperative, so too should Healthcare leaders.
Over the summer I had the perfect opportunity to pitch the benefits of APIs to a hospital leadership team and I blew it! I was interviewing to fill a vacancy on the leadership team and had been asked (as had the other candidates) to prepare a presentation on how the organization could optimize use of their recently deployed hospital information system replacement. APIs were part of my response.
While many aspects of my presentation elicited nods and smiles, the mere mention of APIs was met with quizzical looks that quickly morphed into the dreaded “eyes glazed over” expression. I knew that I had failed to clearly explain APIs and why they matter when the CEO asked, “So, what exactly is an API?”
As I am firm believer in the old adage, “if you at first you don’t succeed, try, try again”, I’m taking another run at convincing healthcare leaders to embrace APIs.
The U.S. Office of the National Coordinator for Health Information Technology (ONC) describes APIs as “messengers or translators that work behind the scenes to help software programs communicate with one another.” APIs “describe a specific set of technical instructions that allow one piece of software to interact with another piece of software.”
An October 2015 article in Forbes entitled Why Your CEO And Board Should Be Demanding API Adoption, asserts:
“Given the benefits that companies of all sizes in a diverse collection of industries are getting from APIs, it is clear now that more CEOs and Boards of Directors should be delivering their own version of the Yegge rant.” (Written by Steve Yegge, formerly with Google, the rant includes a leaked communication from Amazon CEO Jeff Bezos in which he demanded that everyone at Amazon implement APIs or be fired).
In a companion article entitled Don’t Get Ubered: APIs Hold Key To Digital Transformation, author Dan Woods argues:
“In a larger sense, APIs are the secret sauce to becoming digital, that is, to transforming business so that innovation can happen at a faster pace, so that barriers to change are reduced, so that many more people can contribute to your company’s success, and so that you can create better products and defend yourself from the competition.”
Robert S. Huckman, faculty chair of the Harvard Business School Health Care Initiative, and Maya Uppaluru, a policy advisor in the Obama administration’s White House Office of Science and Technology Policy, share Dan Wood’s views on the benefits of API. In a December 2015 Harvard Business Review article entitled “The Untapped Potential of Health Care APIs”, they assert:
“If the health care industry followed suit, the impact on the quality and cost of care, the patient’s experience, and innovation could be enormous.”
Many industries have embraced APIs. According ProgrammableWeb, Reference, Financial and Social are the leading users. The health sector, unfortunately, does not make the top ten on the ProgrammableWeb list.
A Commonwealth Fund healthcare policy and practice commentary entitled “Making Health Data Useful to Patients Through Open APIs” puts the current use of APIs by the health into perspective:
“APIs have the potential to remove many barriers to the sharing of health information between providers, patients, and others but they are fairly new to health care.”
The ONC has recognized the transformative potential of APIs and views them as the means to overcome the interoperability challenge that has plagued the health sector. Certification criteria for electronic health record systems include reference to APIs. Since the majority of hospital information systems used in Canadian hospitals are from U.S. vendors, these hospitals can potentially leverage these same APIs.
The Ontario Hospital Information System (HIS) Renewal Secretariat shares the ONC’s views on the transformative potential of APIs and has included API support as a core requirement that must be incorporated into Master Service Agreements and RFPs. Specifically, with respect to Data Access and Portability, the HIS Renewal Provincial Framework (draft) specifies that an HIS must “support access to the hospitals’ data by other health care solutions including through the use of published APIs.”
The Harvard Business Review article that I referenced earlier describes the benefits of APIs for patients, healthcare providers, and researchers. With respect to optimizing use of hospital information systems (the topic I was asked to address in my interview), the article explains:
For providers, who often report difficulty with using EHR technology, APIs represent an opportunity for internal innovation. Open APIs can allow provider systems to build their own custom user interfaces in-house or shop around for a better solution than the interface that comes standard with their EHR system. EHRs could eventually become a platform on top of which other companies could build more tailored applications and improve usability for clinicians.
What are your thoughts on the strategic importance of APIs? Are they strategic a strategic imperative that healthcare leaders, including CEOs, should embrace?