What’s the status of the biggest API in healthcare?

D. Levin Brown, MD/MPH student at Chapel Hill and Harvard

As interoperability, APIs, and FHIR become ubiquitous in healthcare conversations, we wanted to give you an updated guide to what you should know about the issues—and have your experiences heard to shape the policies affecting the space.

The rush of positive attention around interoperability has led HHS to launch grants for FHIR. The dollar amounts are fairly small relative to the rigorous application process, it’s a fantastic sign that the ONC is getting serious about practical interoperability solutions. What’s more, major enterprise vendors have been making some progress as well, for example, Epic announced it will have modules for implementation starting with their 2015 edition.

However, many hospitals are not willing to bear the cost of a major version update from any vendor too often, and many EMR vendors are only beginning to work with FHIR, as it will be a real technical challenge to support large parts of the spec. After three years of work, FHIR hit 1.0 status last fall, and HL7 (the non-profit that manages FHIR) deserves an enormous amount of credit for continuing to advance a spec that developers are excited about. But all the talk doesn’t matter much if nobody’s using it in the real world—which is why Rock Health wants to hear from you about how entrepreneurs can be best served by these standards. To better understand how interoperability standards are affecting various healthcare stakeholders, we reached out to gather their thoughts on the state of FHIR.

The first call was to Duke’s head of Mobile Technology Strategy, Dr. Ricky Bloomfield. Ricky is not only a double-boarded physician, but an iOS developer who’s helped lead Duke’s efforts to implement FHIR well ahead of the market. Noting that, “use of a standard API like FHIR decouples the innovator from the health system or EMR vendor in a way that benefits both”, he was very positive on their early collaborative efforts and excited about the applications they’ve been able to build on their own. Of course not every hospital or clinic is Duke—a leading AMC with enormous resources and it’s own physician-programmer who built popular applications as side projects. Without in-house or consultancy expertise to implement FHIR on their own, much of the market will rely on the major EMR vendors supporting the spec for a long time to come. And what about the startups?

Rachel Katz, CEO at YC-backed care-quality startup Able Health had this to say, “We’ve implemented an instance of our product using FHIR to access granular clinical data to an extent impossible using legacy standards. More vendor support would allow us all to put our energy toward other goals: streamlining workflows, engaging patients, and improving care.”

To that end, Athenahealth has been one of the leading EMR vendors in developing and facilitating API access to its systems, but only recently began focusing on FHIR. Athena’s head of API development, Chip Ach, had a pragmatic take on the issue: “FHIR has great solutions for certain things but the process is going so slow; we need to just pick some parts of the spec, say that’s good enough, and get moving on it.” Coming from someone who’s in charge of implementing production APIs in healthcare, maybe this indicates that the ONC should commit to near term progress. Could some deadlines help?

For a multi-vendor perspective, we talked to Jitin Asnaani, Executive Director of the interoperability consortium Commonwell Health Alliance. Jitin had similar thoughts on the pace of implementation, but an overall positive attitude indicating, “our EMR and other IT vendor stakeholders have enormous incentives to make this happen, and many of our new constituents are excited about using FHIR soon.”

So, there you go—hospitals, startups, EMR vendors and industry organizations all foresee wider implementation of FHIR, but apparently pretty slowly, in bits and pieces, or requiring DIY expertise. However, you—the reader, patient, builder, and entrepreneur—are the ultimate judge here, and we want to share your expertise with the ONC.

Stay tuned here for a second update on some promising efforts around the bend from leaders in the industry that may help point the way forward.

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