Our trendy lives are powered by APIs — software program instruments that permit completely different techniques to speak to one another — and so they’re so embedded in our routines that we hardly ever take into consideration them. We examine our financial institution balances, flight occasions, music queues, and climate forecasts in actual time, all from our telephones. Behind the scenes, numerous software program applications and servers work collectively through the web to fetch the knowledge we want and ship it immediately. These interactions sometimes depend on RESTful APIs (a typical net service design type) and transmit information utilizing JSON, a light-weight format for structuring info.
Healthcare, nevertheless — arguably probably the most very important (pun supposed) of all industries — doesn’t operate with the identical real-time, seamless performance. Whereas there are items in place — corresponding to APIs that pull lab and imaging outcomes into EHRs, claims processing pipelines for monetary information, and customized APIs that allow cardiac and very important signal monitoring in hardwired intensive care environments — we’re lacking wealthy integration between our private well being (which we will more and more monitor ourselves, due to the quantified self-movement) and supplier techniques that may digitally monitor and reply to that information on a steady foundation.
Most of us may use just a little extra assist with regards to managing our well being. One instance of extra superior, API-enabled care is the mixing of steady glucose displays, insulin pumps, and, at occasions, the EHR for sufferers with insulin-dependent diabetes. Different continual circumstances corresponding to weight problems, hypertension, coronary artery illness, bronchial asthma, COPD, despair, and vascular illness may all profit from APIs that allow seamless information sharing between people and sensible servers.
So, why hasn’t this type of seamless, API-powered expertise prolonged extra broadly throughout the US healthcare system? It’s not a query of technical functionality. The difficulty is that our healthcare infrastructure continues to be based mostly on “bricks and mortar” / in-person visits and procedures. Your entire enterprise mannequin incentivizes providers delivered inside the partitions of clinics and hospitals, not the sort of steady digital care that APIs make potential.
Whereas value-based care is commonly championed as the long run, it stays largely theoretical. And futures don’t include billing codes. René Descartes famously stated, “Cogito, ergo sum” — I feel, subsequently I’m. In American healthcare, it could be extra correct to say, “CPTo, ergo sum” — I code, subsequently I’m. (Your mileage on translation might range.)
Extra importantly, our digital anchor level in healthcare is the EHR, a device function constructed for documentation, not automation. When one thinks of the necessity to monitor “state” in laptop science phrases, that’s just about precisely the kind of computation wanted to know and reply to a affected person’s well being standing in real-time. Arguably, the complete cloud computing world is about bringing such subtle computing on to APIs — an API-first technique.
Finally, to unlock the advantages that APIs have introduced to each different business, we’ll must rethink the motivation construction that governs how care is delivered and paid for. Proper now, many well being techniques and EHR distributors function like monolithic fortresses the place connectivity with the surface world is feared as a door for “affected person leakage.” However, APIs shouldn’t be seen as a risk to healthcare supply, they need to be seen as a gateway to delivering smarter, extra responsive care. We must always rethink APIs. Healthcare wouldn’t be the primary business to have its “brick and mortar” existence upended by rivals offering a special mixture of digital providers.
What would possibly an API-first world appear like for suppliers and payers? Image every affected person with a computational mannequin of their well being the place every treatable parameter (like weight, blood stress, coronary heart charge, train, irritation, and blood chemistry) serves each as a marker for analysis and as a possibility for therapy. Many of those metrics, and the continual circumstances related to them, might be monitored and managed through smartphones and linked gadgets.
Whereas this may occasionally sound futuristic, it’s price noting that almost all giant on-line retailers use the identical sort of method to interacting with their prospects. The HL7 FHIR scientific information transmission normal lastly permits us to have a uniform, computable format for representing medical information, making this type of clever information change potential at scale.
There are additionally near-term alternatives for APIs to enhance care, particularly in acute settings the place prices and stakes are excessive. That is the place the cash is being spent proper now. Consider a affected person with congestive coronary heart failure, on dialysis, or present process chemotherapy. These are folks whose circumstances might be monitored and managed extra successfully in between visits, avoiding expensive ER visits or hospitalizations.
Payers, too, have entry to a lot of the identical affected person information (or may receive it through FHIR APIs) and are more and more incentivized to behave on it, particularly those that are working beneath capitated threat fashions. The brand new HHS and CMS management has already stated a number of occasions that they are going to be transferring to extra digital fashions of care — and APIs are on the coronary heart of that. As healthcare strikes towards trendy tech stacks and smarter infrastructure, care administration is poised to look very completely different.
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