Digital disruption, in any industry, comes in waves. While other industries have benefitted from modern technology, healthcare has some catching up to do.

Consider, for example, application programming interfaces or APIs. Today, consumer technology runs on modern APIs. We have all heard that APIs have a big part to play in the health IT interoperability, and with phrases such as “Blue Button 2.0” and “21st Century Cures Act,” it’s time we saw what the story is behind APIs and what is the best way forward.

The importance of APIs in healthcare and the challenges associated with them

Application Programming Interface (API) is redefining accessibility of data in the healthcare ecosystem. Such APIs enable systematic data exchange and flow across fragmented operations in the healthcare scenario. They are helping in safe and protected data reciprocity between the right parties, not only ensuring relevant clinical information at the point of care but also unified data to the beneficiaries for informed planning.

However, due to the lack of technical standards and the use of multiple technologies, there is an emerging need for service-customized APIs. A system with multiple APIs can take long durations to provide readable integrated data. Management of APIs with system upgradation and replacement is yet another challenge.

Nevertheless, APIs are helping to create the fluidity between EHRs, claims data, and other relevant information throughout healthcare operations, inching closer to value-based care and economic health planning.

What is Blue Button 2.0?

Launched with a focus on patient-data-accessibility, Blue Button has already been helping millions of Medicare beneficiaries to access their electronic health records and make informed decisions.

However, EHRs scattered across platforms and formats, like puzzle pieces of healthcare jigsaw, continue to be a challenge for the care ecosystem. Not only is scattered data a worry for the patients, but it is also a difficult challenge for ACOs and provider networks.

These data challenges for the healthcare triangle are expected to minimize with the increasing payer-provider interoperability. Blue Button 2.0 uses FHIR (Fast Healthcare Interoperability Resources) standards to avail translated claims data to Medicare beneficiaries. It also uses OAuth 2.0 for beneficiary consent.

With Blue Button, interoperability and authorization come handy to patients. With Blue Button 2.0 API, patients can share their entire claims and healthcare data with trusted parties or applications. It surely has brought about a wave of freedom around healthcare choices.

With the increasing White House focus on interoperability, resulting in initiatives like MyHealthEData and the Blue Button 2.0 Initiative, emphasize on the nation’s expanding calls for value-based care.

With the latest indication by CMS towards mandating Medicare Advantage plan sponsors to adopt data-sharing platforms that can be linked with Blue Button 2.0 from the beginning of the year 2020, we take a step closer to health data portability for all.

“By encouraging plans to adopt data release platforms that meet or exceed @CMSGov’s #BlueButton 2.0 capability, enrollees in #Medicare Advantage plans will be able to connect their claims data to the apps, services, & programs they trust.”

Seema Verma, CMS Administrator

How is Blue Button 2.0 different from Blue Button?

 Blue Button was launched in 2010 with features to download and print patient data. Blue Button 2.0 has a much wider impact potential with an additional facility of uploading data on trusted applications. Patients can be more responsible for their healthcare planning, forwarding their data to credible sources like health apps, claim apps, among others, to best utilize their financial resources.

 What can healthcare achieve with its crucial data via Blue Button 2.0?

Since its prolonged encouragement for involved parties to adopt Blue Button friendly data platforms, CMS has considered mandating the thought, due to a small volunteered uptake by the providers and insurance executives. Around the same agenda, CMS is proactively engaged with developers to bring adaptability to the forefront. Developers once leveraging the Blue Button API will add value to not only patients, but also providers, payers, and researchers, among others, to streamline care information and provide insights to improve health outcomes.

With this mandate, interoperability will majorly increase for the benefit of all the parties actively occupied in providing value-centric care. In the year 2018, 22 million lives were recorded to be covered through Medicare Advantage, and the number is expected to grow in the coming years. With the considered mandate likely to come out in 2020, it will have the potential to impact and transform the additional lives of more than 6.7% of US citizens.

According to a report by KFF, the share of Medicare beneficiaries in Medicare Advantage plans ranges across states from 1% to over 40%, with more than 41 percent of enrollees in the four states of Florida, Hawaii, Minnesota, and Oregon. The CMS considered mandate is expected to close greater care gaps and transform the care planning. With the maximum Medicare Advantage beneficiaries enrolled in these states, more people will be benefiting from the Blue Button 2.0 API, rippling out enhanced and more economic care planning and delivery.

Blue Button is a consumer-directed exchange, and is escalating the beneficiaries towards greater interoperability and is significantly changing care planning for Medicare patients. With the considered mandate, it can potentially aid all enrollees of Medicare Advantage plans as well. However, the private payers and their insured patients are still out of the API loop.

As per a 2017 report, 50% of the US population is insured under employer-based or other payer models. Approximately, the same patient population is still deprived of data unification benefits. We need an API for the private segment to make healthcare API benefits uniform across the population. Just like Blue Button, InAPI is built on RESTful API and supports high-performance bi-directional workflow interaction between third-party applications and EHRs.

How can APIs be used for data integration and interoperability

APIs are helping glue together the different data formats and allow easy exchange between platforms. Blue Button 2.0 API is a revolution in US healthcare, with data unification across prescribed drugs, primary-care treatments received, costs of care, type of Medicare coverage, and four years of claims data. This extensive data integration through different data formats and sources is empowering patients with their own healthcare data and hence the choice of procedures around it.

A few years down the road, healthcare APIs will be indispensable. APIs will be key in enabling payers and providers to effectively coordinate care at the patient level. Additionally, as interoperability gives way to easy-to-use and easy-to-understand data sets, healthcare organizations will have a new level of insights into the needs of their patients and the blind spots of their networks. This alone will guide healthcare into an era of better, informed decision making.

It holds a bright future for private and other insurers, putting them first and best in providing organized data, and thrusting the network ahead in value-based care.

The road ahead

 Healthcare with APIs, in the long run, will become highly efficient and planned. With patient participation in care planning, we can expect more economic and transparent procedures.

Once APIs expand completely into the healthcare space, and patients across networks are empowered with access to their data, the entire healthcare ecosystem is bound to move towards excellent utilization. APIs are our staircase to the goal of value-based care, with the potential to eliminate existing friction in healthcare cross-source operations, leading to best resource optimization and leading health outcomes.

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Abhinav Shashank is the CEO and co-founder of Innovaccer, a leading San Francisco based healthcare technology company. He built the foundation for Innovaccer’s success as a leader in population health management and machine learning-oriented healthcare solutions recognized by Gartner, KLAS, Forbes, Black Book Market Research, and others. Abhinav’s continued efforts and ambition enabled the company to flourish in health information technology in the U.S. and acquire over 25 healthcare organizations as customers, with more than 25,000 providers using Innovaccer’s solutions daily. His continued work and focused approach have resulted in the latest round of Series C investment led by Dragoneer, Tiger, Steadview Capital and M12, Microsoft’s venture fund. With his vision for seamless care delivery using unified patient records, Abhinav is now leading the team towards $1 billion in savings for U.S. healthcare. Additionally, Abhinav Shashank is an influential thought leader and a renowned author. Abhinav has published over 300 articles for various international media outlets, was bestowed a coveted spot in Forbes “30 Under 30 Asia 2017: Enterprise Tech” and was recognized by Becker's Hospital Review as one of the ‘Top 60 rising leaders in U.S. healthcare under 40’ in 2019.

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