Abstract
BackgroundHealth systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions.ObjectiveThis study sought to ascertain health systems’ understanding, strategies, governance, and organizational infrastructure around patient-facing APIs, as well as their business drivers and barriers, to facilitate national learning, policy, and progress toward adoption.MethodsWe performed a content analysis of semistructured interviews with a convenience sample of 10 health systems known to be leading adopters of health technology, having either implemented or planning to implement patient-facing APIs.ResultsOf the 10 health systems, eight had operational patient-facing APIs, with organizational strategy driven most by federal policy, the emergence of Health Records on iPhone, and feelings of ethical obligation. The two priority use cases identified were enablement of a patient’s longitudinal health record and digital interactions with the health system. The themes most frequently cited as barriers to the increased use of patient-facing APIs were security concerns, an immature app ecosystem that does not currently offer superior functionality compared with widely adopted electronic health record (EHR)–tethered portals, a lack of business drivers, EHR vendor hesitation toward data sharing, and immature technology and standards.ConclusionsOur findings reveal heterogeneity in health system understanding and approaches to the implementation and use of patient-facing APIs. Ongoing study, targeted policy interventions, and sharing of best practices appear necessary to achieve successful national implementation.
Highlights
An array of federal policy efforts seeks to create a more patient-centered, consumer-empowered health care system by improving patients’ access to their electronic health information (EHI) [1,2]
We created a convenience sample of health systems known to be early adopters of health technology, including health systems engaged in the Health Records on iPhone patient-facing application programming interface chief information officers (CIOs) (API) pilot and others known to be the users of API technology, and selecting for regional variation by ensuring at least one health system per census region (Northeast, West, Midwest, and South)
APIs can be used by patients, providers, payers, third-party apps, and others, we used “patient-facing APIs” to describe use cases where patients are the actors requesting EHI via the API, or directing third-party apps to access the information on their behalf
Summary
Background An array of federal policy efforts seeks to create a more patient-centered, consumer-empowered health care system by improving patients’ access to their electronic health information (EHI) [1,2]. 1 (page number not for citation purposes) care system has digitized health data significantly, with 96% of hospitals and 78% of physician offices using certified electronic health record (EHR) technology [4]. Beginning January 1, 2019, with stage 3 of the federal Medicare and Medicaid EHR Incentive Programs ( known as the Promoting Interoperability Program) and bolstered by provisions of the 21st Century Cures Act, health systems must give patients electronic access to their EHI via patient-facing application programming interfaces (APIs), “without special effort” [1,7]. Health systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions
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