Application Programming Interfaces (APIs) are revolutionizing healthcare data exchange by enabling seamless, secure, and efficient sharing of data among payors, providers, and patients. With the passage of the CMS Interoperability and Patient Access Final Rule, the healthcare industry is about to be positioned for a massive shift toward API-based data exchange. The rule aims to promote interoperability between different healthcare systems and payors by allowing patients and members to access their health data more efficiently and making it easier for providers to share information.
The rule also requires healthcare organizations to use APIs to make data available to patients and third-party apps. By implementing these requirements, the CMS hopes to improve patient’s overall quality of care and increase transparency in the healthcare system. However, implementing an API strategy can be complex and requires careful planning and execution. Consider this 5-step playbook as a beginning guide to help healthcare and health plan organizations develop an API strategy.
Step 1: Assess Your Needs and Goals
The first step in developing an API strategy is to assess your organization’s strategic and operational needs and goals. It will be critical to identify the types of data that need to be shared internally and externally and to understand your IT infrastructure’s current and future capabilities.
Key questions to ask:
- What business goals and objectives can be achieved by implementing API technology in our organization? How can current and existing data-sharing technologies coexist or support other data-sharing platforms utilized through the organization?
- How can API technology help streamline healthcare data exchange processes and improve interoperability with other systems and providers?
- What are the potential risks and challenges associated with implementing API technology, and how can we mitigate these risks to ensure a successful integration?
Step 2: Determine API Use Cases
Once you have identified your organization’s needs and goals, the next step is determining the specific use cases for APIs. These use cases include identifying the types of data that need to be shared and the stakeholders involved, such as patients, healthcare providers, health plans, and even local state HIEs. It will be critical to consider any potential benefits and challenges of each use case in the more significant consideration of technical and regulatory requirements.
Key questions to ask:
- What specific business and clinical processes within our organization can benefit from API integration?
- How can organizations ensure the security and privacy of patient data when utilizing APIs for healthcare data exchange?
- How can API usage help improve patient outcomes, quality, patient-member engagement, risk, and overall healthcare coordination and care delivery?
Step 3: Choose the Right API Technology
The next step in developing an API strategy is to choose the right technology. Organizations must carefully assess and select an appropriate data-sharing API-based platform. Most organizations already utilize interoperability solutions. Bridging the gap between short-term data-sharing needs and longer-term API-based requirements might cause many organizations to have a multi-model data-sharing approach.
Key questions to ask:
- What are the API platform technology’s key technical features and capabilities, and how do they align with our organization’s current and future needs?
- How well does the API platform integrate with an organization’s existing IT infrastructure and applications, and what customization and configuration are required to achieve seamless integration?
- What security and data protection level does the API platform offer, and how does it address our organization’s regulatory compliance requirements?
Step 4: Develop an API Governance Framework
An effective API strategy requires a well-defined governance framework. Governance structures should include policies and procedures for API development, testing, deployment, and maintenance. Establishing guidelines for data sharing, such as data ownership, consent, and data use agreements, will also become critical to outline. It’s important to determine how API data quality and integration fits into their existing data and analytics governance structures and functions. Finally, organizations will need to consider measuring the effectiveness of their API strategies, such as by tracking API usage, user satisfaction, and even data quality.
Questions to ask:
- What are the current governing policies and procedures for managing APIs?
- How can organizations ensure that our API governance framework is aligned with current or future data governance structures and functions?
- How can organizations establish clear roles and responsibilities for API governance, including who will monitor and enforce compliance with API policies?
Step 5: Build a Collaborative Ecosystem
Organizations will need to determine how to maximize the benefits of APIs within their internal and external data-sharing platform ecosystems. Building and fostering strategic data-sharing partnerships with other healthcare organizations, technology vendors, and state and regional data-sharing partners will become redefined and advance in new and innovative ways. Organizations should also consider incentivizing stakeholders to utilize APIs, preparing for the impacts and new cost models of API-based healthcare ecosystems, and offering value-added services and fostering a culture of innovation and continuous improvement.
Questions to ask:
- How can organizations foster strategic data-sharing partnerships with other healthcare organizations, technology vendors, and state and regional data-sharing partners to maximize the benefits of APIs?
- What new incentives and payment models might emerge across key stakeholders to encourage them to utilize APIs? How can we prepare for the impacts and new cost models of API-based healthcare ecosystems?
- How can organizations create a culture of innovation and continuous improvement within our organization to adapt to the changes in the collaborative API-based healthcare ecosystem?
The use of APIs in healthcare will improve data sharing and interoperability. However, implementing an API strategy requires careful planning and execution. Historically, healthcare has underinvested in API-based platforms as a key component of its overall infrastructure. This trend needs to change.
By following some of the suggestions from this playbook, organizations can develop a successful API strategy that aligns with their needs and goals. The CMS Interoperability and Patient Access Rule is paving the way for API-based healthcare. We are all on the cusp of a game-changing transformation in the healthcare industry.
This piece was written by Jeffrey Brown, Chief Information & Digital Officer at Martin’s Point Health Care. To view the original post on LinkedIn, click here.