Tag Archives: Office of the National Coordinator

Healthcare Leader Should Embrace APIs

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? 




U.S. funds Health IT Comptency Exams

As the U.S  engages in major effort to drive adoption and meaningful use of electronic health records, a shortage of Health IT professionals threatens to impede progress.   Indeed, the U.S. Bureau of Labour Statistics predicts a possible shortage of approximately 50,000 qualified Health IT professionals.

To combat this problem, the American Health Information Management Association (AHIMA) has launched the HIT Pro™ exams which, according to AHIMA, are designed to “assess basic competency of individuals who are seeking to demonstrate proficiency in certain health IT workforce roles integral to the implementation and management of electronic health information.”   These exams consist of 125 multiple choice questions and are expected to take three hours to complete.

The HIT Pro™ exams offer individuals who have taken a short-duration, non-degree health IT workforce development program or who have acquired relevant, on-the-job experience the means to demonstrate their health IT competency.   At this time, exams have been developed for six distinct competency profiles:

  • Clinician/Practitioner Consultant
  • Implementation Manager
  • Implementation Support Specialist
  • Practice Workflow & Information Management Redesign Specialist
  • Technical/Software Support Staff
  • Trainer

For a limited time, there is no cost to U.S. citizens to write one of the HIT Pro™ exams.   The cost is covered through funding from the U.S. Department of Health and Human Services (HHS). This program illustrates yet another way that the U.S. government is moving forward aggressively to deploy electronic health records across the continuum of care.  When potential roadblocks such as a potential shortage of qualified Health IT professionals is identified, it seems that program is quickly developed to address the problem in the most practical way possible.


ONC Musings on Engaging their Stakeholders

The Office of the National Coordinator for Health IT in the US (more commonly known as the ONC) continues to amaze me with their willingness to listen to and react to what they are hear from their stakeholders.  In a recent post on HealthITBuzz, the ONC blog, Jodi G. Daniel, Director of the Office of Policy and Planning, shares her thoughts on what the ONC has learned from the input they have received to date.  Highlights include:

  • “We should take greater advantage of social networking tools (and this means much more than blogging) when bringing our policy conversations outside of the walls of HHS.”
  • “We have been reconsidering the label “consumer” and thinking about using “individual” instead. Calling people consumers implies that they are necessarily consuming something, whereas an individual may not need to consume anything (health care or otherwise) to manage his/her health more effectively.”
  • “It is not just about changing the behavior of consumers. Health IT offers a tremendous opportunity to change the health care system to become more “consumer-centered.”
  • “In order to include consumers in the health IT policymaking process, we cannot expect them to come to Washington or to find this blog online (although the ones that do are amazing!). To truly be representative, we must go to consumers’ conversations.”
  • “Data liquidity, including consumer access to their health information, is the first step to fostering innovation. Innovation is not just about technology; there is also a real need for innovation on implementation, replicating successes, and using data in advanced ways. But it is the industry that will be leading any such innovation, not the government.”

Engaging the community using social media is a scary prospect for many healthcare organizations.  Fortunately, there are some good role models to emulate and many great resources from which to draw ideas and lessons learned.




ONC Seeks Input on Consumer eHealth Strategy

A recent post on the ONC blog seeks  input on their strategic goal to “Empower Consumers to Better Manage Their Health through Health IT”. Specifically, the ONC asks for input on two questions:

  • First, do you agree with the four objectives listed below?
  • Second, what specific activities would you like to see the federal government take on? See the bullet points below each objective for some starting ideas of possible activities.

The ONC’s strategic objectives for Consumer eHealth include:

  • Objective A. Engage consumers in federal health IT policy and programs
  • Objective B. Accelerate consumer access to electronic health information
  • Objective C. Foster innovation in consumer health IT
  • Objective D. Drive consumer-provider electronic communications



Dr. David Blumenthal, head of the U.S. Health and Human Services Office of the National Coordinator (ONC) for Health Information Technology recently committed to making the process for developing eHealth policy in the US more open and transparent:


According to Dr. Blumenthal, “Beginning January 1, we’ll implement a new policy that will open up workgroup meetings to the public unless a closed meeting is clearly in the public interest“.  Do we need a similar policy in Canada?  Are there discussions going on behind closed doors that people are interested in hearing?