The Executive Suite: Why innovation with FHIR APIs strengthen our healthcare ecosystem

Whether we realize it or not, every day we're benefiting from application programming interfaces (APIs). If you're paying with PayPal, logging into Facebook, or making vacation plans on one of the popular travel booking websites, it’s an API that makes these actions possible. APIs are a hallmark of the consumer experience, enabling safe and secure data sharing and supporting functionality between devices, applications, and people.

By enabling interoperability, APIs power so many aspects of our economy. Yet compared to other industries and sectors, healthcare lags behind in adopting or implementing technology or new capabilities that can further assist in improving workflows and outcomes. Strapped with legacy systems and proprietary technology, information sharing in the healthcare space is difficult. Legacy systems result in unnecessary roadblocks for providers that can benefit from sharing patient records to deliver the best care for patients. And while patients want greater access to and control over their own health data, that has been inexplicably difficult to achieve.

With the introduction of Fast Healthcare Interoperability Resources (FHIR), however, this is all changing. As this API standard is more broadly adopted, we can expect a significant impact on the healthcare ecosystem. FHIR will deliver greater consistency for structuring medical data and supporting new, innovative applications to enhance collaboration and care. And, in the era of growing healthcare consumerism, FHIR APIs also give patients more convenient access to their health information from any device, at any time.

More Patient Data Provides Greater Healthcare Opportunities

Today, there is a staggering amount of data being generated about our health from apps that monitor your activity and sleep to the DNA test you received for Christmas. In addition to the typical clinical data, such as test results and imaging, patients are asking their doctors to consider patient-generated health data from wearables and remote monitors when making treatment decisions and recommendations, which have become even more commonplace during the COVID-19 pandemic.

In fact, estimates show that healthcare accounts for about 30% of the world's data volume. By 2025, the compound annual growth rate of data for healthcare is expected to reach 36%, growing more than three times faster than any other sector, including media and entertainment, financial services and manufacturing.

This data has great value. By having a full picture of a patient’s data—collected both in the office and generated during their daily lives—providers can tailor and optimize care for each individual. However, the proprietary or product-specific solutions employed by each provider, hospital, and health system have long stood in the way of effective healthcare data utilization.

Congress sought to change this with the 21st Century Cures Act, which is intended to accelerate medical product development and bring new innovations and advances to patients who need them. Enabling support for FHIR APIs was the first step toward this vision, as it creates a standard nomenclature for the data elements and a standard API for exchanging data. Substitutable Medical Applications and Reusable Technologies (SMART) on FHIR improves that functionality by ensuring that any app can easily integrate into the user experience of any EHR system, portal, Health Information Exchange or other health IT system. SMART on FHIR addresses the issue of secure authentication between systems (such as single sign on) and allows providers to access third-party applications inside of their EHR user experience.

Though there has been progress in deepening interoperability in healthcare, adoption of FHIR-enabled applications by healthcare providers or patients is still in nascent stages. The bulk of FHIR adoption is being done by larger, more advanced health systems, which are leveraging the APIs for patient-record exchange, clinician-enabling tools, and patient-facing solutions, according to a CHIME/KLAS Research report. In fact, about one-quarter of organizations surveyed noted that they have gone live with FHIR APIs and are able to rate their satisfaction, whereas nearly 40% said that they could rate their satisfaction on implemented FHIR APIs.Notably, 40% of respondents said they weren't attempting to use them at all.

The initial use cases for APIs tend to center around patient access and clinical decision support. APIs for other use cases, such as data exchange among healthcare providers treating the same patient, are not yet as prevalent. One reason could be that vendors still vary significantly on the data elements they permit for FHIR APIs and standardization of patient-centered healthcare data mandated by U.S. Core Data for Interoperability (USCDI). Other factors holding back use of APIs for provider information sharing include terms of use agreements governing relationships between providers, EHR vendors, and third-party application developers and the terms and conditions, which didn't include details, such as costs.

Real-Life Applications: FHIR-based platforms for providers and patients

Despite the lack of widespread use and initial early lack of consensus on a FHIR standard, there have been promising applications of FHIR APIs. For example, Georgia-based Emory Healthcare now offers an orthopedic surgery app that enables providers to document procedure details and track outcomes with integration to surgical and clinical schedules. Through the app, patients can self-report post-operative details, such as nausea, pain, medication usage, and physical therapy outcomes, while doctors can search by patient, procedure or multiple patient characteristics to find patients with similar cases to compare therapy regimens.

Emory is also using a FHIR app to manage deep brain stimulation (DBS) procedures for Parkinson’s disease and other neurologic conditions. DBS is a long, multi-step process that’s often frustrating and confusing for patients, inefficient for providers and administrative staff. Much like tracking the items you order from Amazon, the app keeps patients and providers on the same page and offers transparency in the complex pre-and post-surgical process. The DBS app allows patients to view appointments and communicate with their clinical care team, while providers can use the app to enroll patients in the program, send reminders and configure their treatment journey -- all from within their existing EHR experience.

These types of applications are just the start of game-changing offerings in healthcare. Our industry is on the cusp of significant innovation unleashed by FHIR that will enable EHR vendors, app developers and providers to truly improve care and the patient experience. As the industry moves forward, we must ensure all information – from data generated by consumers using at home devices and patient-reported outcomes, to details in EHRs and third-party data – is included and adoption is encouraged amongst providers of all sizes and types. By effectively supporting widespread interoperability and data exchange, FHIR APIs have the power to fundamentally reinvent the healthcare ecosystem.