The Importance

of APIs for Perfect

Healthcare

Orion Health White Paper

Fiora Au
Product Director APIs
022018
Introduction to data and capabilities. APIs can make
perfect care possible by enabling the best
Healthcare has lagged behind other industries solutions to be built for every healthcare
in terms of technological advancement. But scenario. They open the way for collaboration
that is about to change. Many factors are between healthcare organizations and
driving change and the need for healthcare players from outside of healthcare to develop
organizations to share information: consumers innovative applications to serve any and
are demanding access to their own health every healthcare niche. It is through APIs
information; burgeoning health costs are that we can unlock the massive potential
driving incentives to integrate care across of aggregated and shared healthcare data
different healthcare organizations; and and better health and wellness across
technological advancements in web and mobile communities. It is through APIs that we can
applications are opening up opportunities. capitalize on sharing new technology, such
as artificial intelligence, data visualization,
To date, healthcare organizations have proximity technologies, optical character
struggled with interoperability; health recognition technology…the list goes on. APIs
information often ends up in silos – trapped in open an entire new world for healthcare and
the EMR of a primary care physician, GP, or its technological advancement.
hospital. This means that patients have been
treated episodically, receiving advice and The current state of
prescriptions from medical professionals who interoperability
may not have access to that patient’s complete
medical record. How can individuals receive Interoperability is an opaque word. Officially
perfect healthcare if the professionals treating defined, interoperability is the ability of
them only see part of the picture? Without different information technology systems
clinical data outlining medical history, claims and software applications to communicate,
data to marry up medical interventions with exchange data, and use the information
insurance claims made, medication adherence that has been exchanged1. Simply put,
information, genetic profile, family history, and interoperability is the ability to share
data about social circumstance (whether they information across multiple technologies.
are employed or otherwise; have family
support or not), it’s virtually impossible for a And it’s crucial in healthcare. Health
medical professional to be certain that they information is, for the most part, trapped
are choosing the right prevention or treatment in siloed systems. Think about every time
plan for that individual. Moreover, the traditional you visit your GP or PCP and he/she records
complexity and expense of healthcare notes into their own EMR. Where does that
integrations have limited the number and types information go? The answer is nowhere,
of applications available to healthcare providers unless it is transcribed into a referral (usually
and patients. Given these constraints, it’s still done on paper) and sent to a specialist.
virtually impossible to deliver perfect care. And even then it’s only partial information that
is included – not the entire medical record.
Open APIs (Application Programming So what happens if you go out of state and
Interfaces) have been embraced by many visit a different GP or PCP, or get sent to the
industries as the way to provide easy access emergency department of your local hospital?

1
http://www.himss.org/
library/interoperability-stan-
dards/what-is-interoperability

Orion Health White Paper Importance of APIs for Perfect Healthcare 2

What information is readily accessible for To get these different systems talking to
practitioners there to understand you, your each other – exchanging data – context is
conditions, your medical or family history? critical. Without the correct context, medical
professionals can overlook information.
Currently, this is extremely limited. There is
no “shared care record.” Information about Today most data sharing is based on sharing
you, and me, exists in multiple EMRs so no some data fields with contextual integration
one has the complete picture of our health or sharing view-only document summaries.
upon which to make treatment decisions or Industry standards have been developed to
implement preventative courses of action. make data sharing less clumsy but a non-
uniform approach to the application of these
Around the world, clinicians and managers standards remains a hurdle for interoperability.
in medical organizations – healthcare There are myriad standards too, including
providers and health insurers – are fighting RxNorm, SNOMED, HL7, FHIR, DICOM, LOINC,
to achieve plug-and-play interoperability by and IHE2. HL7 is constantly updating and
unifying organizations to bring about change. releasing new iterations of its standards, which
Healthcare is out of step with other industries: has increased standards heterogeneity. But
we can access our money from ATM machines standards must continue to evolve as the
anywhere in the world; we can send text practice of medicine evolves – so there is a
messages to any mobile network; and we tension between driving adoption of standards
can use applications to service myriad needs and ensuring they are constantly up to date.
(whether dietary, fitness or entertainment)
on our smart phones. But they’re still keeping To explain this, an analogy from outside
paper notes in most hospitals. technology is useful – the standardization
of track gauges on North American
That’s why things must change. Today’s railways. Railways were built using differing
lack of interoperability compromises patient engineering traditions which resulted in
safety; impacts care quality and outcomes and different widths between the inside faces of
ultimately wastes billions of dollars every year. a pair of rails (gauge). But growing demand
for interregional traffic and increasing
But it’s complex. A clinical record can contain cooperation among different railway
more than 100,000 different data fields and companies yielded incentives to resolve
elements including numeric data, structured this diversity and the adoption of a standard
text, unstructured text, and scanned files and gauge – being 4 feet to 8.5 inches – as the
images. Often EMRs have also been tinkered continental standard3. Needless to say, the
with by internal IT departments to evolve adoption of a standard gauge served the
software products to a specific organization’s needs and wants of customers – being the
needs – which means different data fields ability to travel between regions without
have been defined that aren’t necessarily the having to get on and off multiple trains, and
same as what a comparable EMR has. proved commercially beneficial for operators
– people travelled more, further and spent
more money doing so.

2
Interoperability 2015: KLAS 3
The Journal of Economic
History, December 2000, Vol-
ume 60, Number 4, p.933

Orion Health White Paper Importance of APIs for Perfect Healthcare 3

The same is true in healthcare, except that we application. But until recently, APIs have been
are talking about streamlining the exchange of glaringly absent in healthcare.
data about people, rather than people per se.
interoperability is crucial to deliver the business In the past, in the absence of reusable and
capabilities that we need in healthcare – well understood connectivity protocols,
inside and outside healthcare organizations authentication frameworks, data models
– such as an electronic shared care record, and the design patterns that APIs provide,
automatic alerts and notifications by text, developers had to reinvent the wheel and
seamlessly transferring information between repeat work for each new integration. The
and within care settings, delivering remote knowledge, time and effort required to do this
care, analysing data for population health created high barriers, meaning healthcare
management, and resource optimization. integration became a specialist and expensive
field. The complexities and costs involved in
The part APIs have to play any subsequent upgrades meant that legacy
systems hung around until well past their
APIs are programming routines or protocols prime, and the industry as a whole could not
that allow software applications to share easily and cost effectively adopt technology
data, invoke business logic or perform an innovations.
action (such as send a notification, map data,
calculate and return a risk score, and start Yet now APIs are favored as a way to
a workflow). They are ubiquitous in most standardize the way applications can access
aspects of modern day life. Large consumer data. In part this has been driven by EMR
brands Amazon, Twitter, Facebook and vendors pushing the ability to connect
Google all have substantial APIs that enable standalone EMRs, but also by collaborations
developers to access information so they such as HL7 FHIR. The time and cost involved
can build new applications or businesses. in sharing data through APIs is much less than
Facebook’s APIs allow developers to traditional systems.
incorporate Facebook functionality into
their own apps (often used for sign-on) and So what are the benefits of APIs? And how will
the YouTube API lets developers integrate they empower niche services in healthcare?
YouTube videos into their websites or APIs will do this by enabling connectivity and
applications. Transport disruptor Uber expansion, and driving innovation.
has launched two key APIs to create new
value for their services – UberRUSH which
i. Connectivity
facilitates same-day delivery for businesses
and RideRequests which facilitates the use of
Healthcare data is vast and expanding.
Uber rides through third party apps4.
From clinical to claims to labs to radiology to
social and behavioural, there are myriad data
APIs originally emerged in software as a great
types that all help to make up the complete
way for companies and vendors to share the
patient record. Not to mention quantified-self
functionality they’ve built in their proprietary
data – the numerous sources of consumer
application with a wider set of developers.
contributed data now available through
They enable the abstraction of data, without
wearables, smartphones, and the burgeoning
giving away how that data is released –
number of connected devices in the Internet
thereby protecting the source code of the
of Things. Access to this data is crucial.

4
developer.uber.com

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In healthcare, information has historically new functionalities to build bridges across
been exchanged through discharge systems and provide increased data access
summaries and continuity of care documents. to help patients have unprecedented access
Some of these are distributed in XML formats to their own health records, empowering
that allow a program to extract a particular individuals to make key health decisions6.
piece of data (such as a specific lab result),
but are much more complicated than modern
ii. Expansion
RESTful and SOAP APIs.
APIs can grow the healthcare ecosystem by
APIs can solve connectivity between systems allowing applications to share data with any
by clearly defining transmission and security other system and to leverage each other’s
rules. A set of common and open APIs will capabilities.
enable information to flow across systems
and to be accessed across geographies. Not only do APIs present the opportunity
In a healthcare world where APIs are for internal innovation – where providers
commonplace, clinicians and patients can build their own custom user interfaces
themselves can have easy access to data, no for specific needs – but they enable third
matter where it is stored. Although concerns parties to access information and capabilities
over privacy and security are ongoing barriers for specific purposes. This means that
to technological change in healthcare, APIs information stored in an EHR is utilised for a
are a way to agree and honor authentication more tailored application – either that serves
protocols and ensure control over who sees a patient’s purpose or empowers clinicians.
what information.
There are also benefits in expanding access to
In the United States, the Health Information healthcare data to other healthcare verticals –
Technology for Economic and Clinical Health such as researchers, pharma companies and
(HITECH) Act 2009 instituted financial medical device organizations. Researchers
incentives to adopt certified EHR technology can engage in “citizen science” by accessing
systems, including requirements that specific anonymized information from thousands of
providers “meaningfully use” these systems. individuals and analysing it to identify trends;
As a result of this program, 97% of reported better understand causes of conditions and
hospitals had certified EHR technology outcomes of treatments; and asses asset
in 2014, up from 72% in 20115. Meeting utilization and costs. Pharma companies
meaningful use requirements affects the can access the same information to assist
reimbursement providers receive from the with the development of clinical trials, to
Centers for Medicare & Medicaid Services. better understand the reported side effects
One of the objectives of meaningful use is a and effectiveness of specific treatments
requirement that healthcare providers enable and drugs, and to monitor adherence to
their patients to view, download and transmit then action plans to minimize wastage.
their health data to a third party. Meaningful Similarly, medical device companies can use
use stage 3 criteria – which are optional in aggregated information to develop products
2017 and mandatory in 2018 – require the that serve a specific patient/consumer need.
use of APIs that enable the development of

5
https://www.healthit. 6
https://www.cms.gov/News-
gov/sites/default/files/da- room/MediaReleaseData-
ta-brief/2014HospitalAdop- base/Fact-sheets/2015-Fact-
tionDataBrief.pdf sheets-items/2015-10-06-2.
html

Orion Health White Paper Importance of APIs for Perfect Healthcare 5

But possibly the most important and side effects felt. This information stayed in
beneficial expansion enabled by APIs is ink and was only shared with her treatment
involving patients and their family in their nurse when she went into the cancer centre.
own care. Through APIs, healthcare can It was not transcribed or shared in real-time
become something that is part of everyday at any point. She took this book (and a huge
life, versus isolated, episodic visits to the wad of other papers, files and notes) to each
doctor or hospital. APIs enable expansion appointment with her different specialists in
outside of the traditional boundaries of a bag and had to go over everything, sifting
healthcare, giving access to data from other through papers, each visit. Fortunately, she
life spheres such as finance, education, had a family member caring for her who
hospitality, social services, social media and helped her navigate her bag of notes and
retail, all of which contribute important clues her medication requirements (not easy for a
to an individual’s health profile. For example, sober person, let alone someone ingesting
connecting the home and devices through morphine and other medications).
the Internet of Things – where air quality,
weight and amount of sleep are all data points Imagine if my friend had had access to an app
included in an individual’s healthcare record; where she could have received notifications
integrating healthcare information with an and alerts to remind her to take which
individual’s social media feed; understanding medication at which time; where she could
an individual’s financial circumstances; have logged how she was feeling each day
connecting educational and fitness and any unusual symptoms; where she could
applications; and giving individuals access have securely communicated with her circle of
to their own medical record, will revolutionize care to ask questions without having to phone
the way we perceive healthcare and how the and leave messages and wait for hours for
healthcare industry operates. a response; where she could have indicated
that she was feeling slightly drowsier than
For example, a friend of mine was recently usual one day; where an alert in real-time to
undergoing aggressive radiotherapy and her oncologist might have led to a phone call
chemotherapy for a malignant (but curable) and assessment that might have prevented
tumour and had to chronicle every day in her dying, within a matter of hours at home,
a paper folder (her “little green book”). In from an acute pneumonia.
this book she recorded how she was feeling,
numerous quantities of medication taken, and

Chronically ill
Low proportion of population
ill but high proportion of
healthcare costs

The Will
Will People with risk factors
indicating they will
develop chronic conditions

The Well
Well Healthy individuals

FIGURE 1: Population and Sickness

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It is not just possible – but definite – that • Provide real-time advice for patients
applications that access health data and struggling with a specific and rare skin
enable the sharing of this data across an disorder;
entire circle of care and multidisciplinary care • Triage patients before they arrive at their
team will improve healthcare outcomes and GP’s or PCP’s office;
patient experiences.
• Are aimed at visually impaired people by
utilising voice control;
Applications that further challenge and
encourage well consumers to change their • Target people living in rural settings
behaviour, through encouraging better diets who are exposed to very different
and increased activity – will also assist in environmental factors than city dwellers;
delivering better healthcare outcomes. They • Are designed for gym junkies who have
will encourage the “Will” section of society a greater interest in capturing all their
reflected in the diagram to undertake activity and contributing it to their health
preventative action and reduce the likelihood of record;
them developing an expensive chronic condition.
• Are aimed at frequent travellers who might
suffer from jet lag-related sleep disorders;
iii. Innovation or
• Target mental health disorders where
Perfect healthcare means catering for someone’s unusual behaviour on social
the many permutations of an individual’s media sends an alert to a carer to check in
circumstances, health, expectations and with them.
experiences. But to date, the expense of
creating health applications often force The possibilities are endless.
solutions to be generic to achieve wide but
shallow coverage, and slow the uptake of Not only will APIs fast-track interoperability
new technologies. APIs can bring the level of across healthcare organizations, but they
innovation we’ve witnessed in other industries will enable intelligent and adaptive apps
– like banking, travel and entertainment – to that connect healthcare providers, health
healthcare. People currently working outside insurers, and other related parties with
of healthcare will be motivated to bring patients in new ways. This is more than
their skills, expertise and experience to the creating mobile applications. It’s about
sector if given secure access to clinical and harnessing and connecting a spectrum of
other data in a cost effective way, creating specialist capabilities such as risk prediction
technologically advanced tools of huge value algorithms, data visualization engines,
that serve not only the masses, but select payment providers, workflow engines, and
groups as well. proximity technologies – and more.

Imagine applications designed especially for Opening access to data is a tailwind for
certain conditions and user groups, which innovation, enabling infinite possibilities. No
cater for their specific needs. For example, one organization or individual can foresee all
applications that: the needs that healthcare of the future will
surface, so we need to set in place systems
• Capture blood pressure for a specific that are flexible and adaptable, ones that can
cohort of diabetic patients; grow as healthcare technology becomes more
sophisticated and consumer expectations
increase.

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The barriers to APIs • Workflow and Culture
Healthcare providers fear a deluge of
As fantastic as APIs are, and as exciting as data when APIs are implemented that
the future of healthcare is that they promise allow patient-generated data to enter the
to unlock, there are barriers to adopting APIs system.
that need to be mitigated. An article in the
Harvard Business Review7 identified four At Orion Health, we have spent a lot of
main challenges to the adoption of APIs: time addressing the above challenges and
are investing in Open APIs as a central
• Financial
tenet of our interoperability and platform
Enterprise software is a significant
strategies. We have evolved our culture
investment for any healthcare
and ethos towards API-led design where
organization. Financial incentives for
our own applications use our APIs to work
information exchange will support the
together and leverage our Amadeus data
case for implementing APIs. These
platform. We are embracing FHIR® (Fast
already exist in many parts of the world
Healthcare Interoperability Resources), the
(in the US, Medicare’s new merit-based
leading open industry standard, to ensure
incentive payment system (MIPS); in the
true interoperability within and across
UK (reimbursement schemes and free
organizations. We are leveraging our track
computers helped to drive EHR adoption
record in securely handling private health
years ago) but the promise of improved
information and continue to invest in robust
outcomes and increased efficiency alone
security and privacy protocols. And, of
are financial incentives.
critical importance, we are engaging with
• Privacy and Security customers (providers, payers and pharma),
Exchanging data raises concerns users (clinicians, care coordinators and
about privacy and security, especially administrators), and developers to ensure
in healthcare where Personal Health that our API platform is fit for purpose and
Information is so sensitive. There are commercially viable for adoption.
standards for the secure exchange of data
– adopted by other industries – such as
OAuth2.0 and Open ID Connect, which
can be used to authenticate and authorize
access via APIs.
• Standards
As referred to previously, a lack of
consistent application of standards means
that integrating with EHRs can still be
costly. Consistent standards are needed
to give developers and small start-ups
confidence that they won’t start working
on accessing healthcare data, only to
find that the resources required are cost
prohibitive.

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Conclusion
To build a healthcare ecosystem that truly
serves the delivery of perfect healthcare
for every individual, challenges around
interoperability and APIs must be
tackled head on. Open APIs can, and will,
revolutionize healthcare delivery through
empowering patients and enabling cross
community collaboration between traditional
healthcare providers as well as new players.

FIGURE 2: Data Processing Pipeline

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