The integration of application programming interfaces (APIs) in electronic health records (EHRs) is on the rise, with 73% of digital health companies leveraging standards-based APIs. ONC’s survey, conducted in collaboration with industry partners, highlights the widespread adoption of the FHIR standard and the proactive stance of EHR companies in making APIs available to third-party users. The study underscores the challenges faced, including barriers to adoption and the need for policy interventions to promote interoperability. ONC’s efforts, as reflected in the Health IT Interoperability (HTI-1) rule, aim to streamline API usage and ensure compliance with information-blocking regulations, ultimately advancing healthcare delivery.
In the ever-evolving landscape of healthcare technology, the adoption of application programming interfaces (APIs) has become increasingly prevalent. According to a recent survey conducted by the Office of the National Coordinator for Health Information Technology (ONC), a staggering 73% of digital health companies are now leveraging standards-based APIs to enhance the functionality of electronic health records (EHRs), with the majority embracing the Fast Healthcare Interoperability Resources (FHIR) standard.
Collaborating with the University of California San Francisco, the California Health Care Foundation, and ScaleHealth, ONC embarked on a comprehensive study to explore API integrations, identify barriers encountered during the integration process, and assess relevant policy efforts in this domain.
The significance of this trend cannot be overstated. The findings of the survey, published in the Journal of the American Medical Informatics Association (JAMIA), underscore not only the widespread adoption of the FHIR standard but also the proactive approach taken by EHR companies in implementing standards-based APIs. Remarkably, these APIs were made available to third-party users well ahead of the December 31, 2022, deadline mandated by HL7 for the utilization of FHIR standards in certified APIs.
Wes Barker, Catherine Strawley, and Benjamin Rosner, authors of the ONC study, emphasized the significance of these results, noting that they validate the concerns expressed by stakeholders, particularly app developers and digital health companies. These concerns revolve around the limitations of current certified APIs and the barriers to entry such as exorbitant fees, inadequate clinical testing data, and insufficient data elements of interest or value.
Furthermore, the study revealed that approximately 57% of respondents employed a combination of standards-based and proprietary APIs for EHR integration, with 24% evenly distributing their usage between both types of APIs. This hybrid approach underscores the complexities involved in integrating various systems within the healthcare ecosystem.
Addressing these challenges, ONC’s Health IT Buzz blog highlighted the initiatives undertaken to alleviate barriers to API adoption. The recently finalized Health IT Interoperability (HTI-1) rule aims to streamline the use of APIs by standardizing requirements for publishing electronic FHIR endpoints and endorsing the United States Core Data for Interoperability (USCDI) version 3.0. These efforts are pivotal in facilitating nationwide interoperability and ensuring compliance with information-blocking regulations.
Notably, the HTI-1 rule mandates the exclusive use of USCDI version 3.0 within the Certification Program, effective January 1, 2026. As part of its ongoing commitment to enhancing interoperability standards, ONC is currently soliciting feedback on Draft USCDI Version 5, underscoring its dedication to staying abreast of technological advancements and evolving industry needs.
The implications of these standards extend beyond technical requirements, as noncompliance with information-blocking rules can have severe financial repercussions for healthcare providers. The 21st Century Cures Act, which enshrined secure, programmatic access to patients’ electronic health information, underscores the imperative of information sharing in modern healthcare delivery.
Micky Tripathi, National Coordinator for Health IT, and Jonathan Blum, CMS Principal Deputy Administrator, emphasized the expectation of information sharing in a recent article discussing disincentives for noncompliant healthcare providers. They underscored the importance of adherence to regulations in promoting transparency and fostering patient-centered care.
In reflecting on the survey findings, Barker, Strawley, and Rosner expressed ONC’s commitment to leveraging insights from studies to refine health IT policies and better serve the needs of the healthcare community. These collaborative efforts are essential in driving innovation, enhancing interoperability, and ultimately improving patient outcomes in an increasingly digitized healthcare landscape.
As the healthcare industry continues to navigate the complexities of digital transformation, the integration of application programming interfaces (APIs) emerges as a critical enabler of interoperability and innovation. ONC’s survey findings underscore the widespread adoption of standards-based APIs among digital health companies, signaling a shift towards a more interconnected healthcare ecosystem. However, challenges such as high fees and limited clinical testing data persist, necessitating policy interventions to promote API adoption and ensure compliance with information-blocking regulations. By addressing these barriers and fostering collaboration among stakeholders, ONC is poised to drive positive change and propel the healthcare industry toward a future characterized by seamless data exchange and improved patient outcomes.
