The Cures Act Final Rule includes regulatory requirements to implement secure, standards-based application programming interfaces (APIs). To support the acceleration of API adoption in health care, ONC has published a series of perspective reports that focus on key stakeholders and their views on APIs.

Accelerating APIs for Scientific Discovery: Provider Perspectives Brief  [PDF – 740 KB] is now available. This fourth and final report explored provider perspectives on API-based data sharing in a rapidly evolving electronic health data ecosystem. Provider organizations are often the primary stewards of a patient’s medical history, and data captured in electronic health records (EHRs) influence a provider’s workflow and clinical decisions. As a result, it is imperative that we understand providers’ perspectives as we build towards an interoperable health care system.

It is imperative that we understand providers’ perspectives as we build towards an interoperable health care system.

The proliferation of health apps has enhanced the ability of patients, providers, and researchers to access EHR data to improve patient care and overall health and wellness. Health IT developers are adopting APIs and other technologies that enable secure data exchange between disparate systems and health apps. Standards-based APIs provide patients the ability to access their electronic health information (EHI) and share it with apps of their choice.

In this report, ONC sought to understand providers’ perspectives on how APIs can support the access, exchange, and use of EHI by conducting interviews with a diverse group of provider organizations in the fall of 2021. Discussion participants included a regional health system; a community hospital; an inpatient rehab, home health, and hospice system; a federally-qualified health center; and five academic medical centers.

These discussions focused on providers’ experiences working with different health IT developers, implementing standards-based APIs for different use cases, resource requirements, timelines, and how this all aligns with their organization’s strategic objectives. We gained a better understanding of the challenges and opportunities each organization faces in implementing APIs and apps. Understanding how these provider organizations view and use health IT solutions and products will help other health IT stakeholders (e.g., health IT developers, app developers, government) advance the interoperability of EHRs and health IT products in a coordinated effort.

The Provider Perspective

Generally, providers indicated enthusiasm and support for using apps to extend EHR functionality using standardized HL7^® FHIR^® APIs and FHIR Bulk Data APIs. They reported that they would benefit from additional guidance regarding the Cures Act Final Rule provisions. In parallel to this project, ONC has published multiple resources and policy guidance on information blocking, API privacy and security, and additional educational resources to facilitate the use of APIs and apps. Providers also expressed that to date many organizations have limited technical resources or experience implementing APIs and apps, and that they rely on their health IT developers to provide implementation assistance for new functionalities. However, they look forward to the promise APIs hold for promoting interoperability, access to EHI, and health data exchange.

What We Learned

In describing their motivations and experiences managing APIs and apps, providers indicated that APIs can support access, exchange, and use of EHI by extending the functionality of their EHRs. For instance, APIs can enable providers to use structured data elements in the EHR for clinical decision support, such as for calculating cardiovascular disease risk. Other findings included:

• Clinical, administrative, and research use cases may benefit from the adoption of APIs and apps that provide additional data sets from external sources such as remote monitoring devices.
• Interest in having patient-generated health data (PGHD) from devices written back to and/or incorporated into the EHR’s workflow to improve clinical decision making and provide additional analytics capabilities to providers.
• Governance processes require a formal implementation strategy, specialized knowledge, and dedicated resources. Provider organizations often lack internal resources to implement, manage, and maintain APIs and apps.
• Provider organizations are aware that they will need to develop new capabilities in the areas of API management and governance or seek outside expertise from third-parties (such as data integrators) to assist with API management, implementation of API functionality, and other interoperability initiatives.
• Privacy and security concerns remain a barrier to the adoption of APIs and health apps and provider organizations noted that consumer education and support was critical.

Learn More About This Project

To learn more about this project and other perspectives on APIs and apps visit the following ONC resources:

Accelerating APIs for Scientific Discovery: Main ONC homepage for the Accelerating APIs for Scientific Discovery project that includes links to project activities aimed at increasing use of APIs and healthcare apps by consumers, researchers, and providers.

Accelerating APIs for Scientific Discovery: Consumer Perspectives: First in the “Accelerating APIs” report series provides the perspectives of consumers and patient advocacy organizations and the need for health care apps to support accurate, timely, detailed and interoperable health information.

Accelerating APIs for Scientific Discovery: Researcher Perspectives: Second in the “Accelerating APIs” report series provides the perspectives of researchers including biomedical and clinical informaticists, academic researchers, and pharmaceutical companies and their need for data housed within electronic health records and other data sources that can be accessed through APIs.

Accelerating APIs for Scientific Discovery App Developer and Data Integrator Perspectives: Third in the “Accelerating APIs” report series reports the perspectives of app developers and data integrators including third-party app developers, data aggregators, data integrators, and data standards implementers, and their experiences of building health IT tools with APIs that need EHR data that are often housed in siloed, disparate systems.