What Do APIs Mean for Health Interoperability, Data Exchange?

Patient Access to Data

The CMS Interoperability and Patient Access final rule requires payers and providers to remove the industry siloes that prevent seamless patient data exchange across the care continuum. To comply with the rule, most provider organizations are implementing APIs.

Washington and Michigan selected a secure API to grant members access to personal health data, thus fulfilling the CMS interoperability rule.

The CMS Final rule 9115-F requirements aim to empower Medicaid beneficiaries to make informed decisions related to their health and healthcare by ensuring portable access to personal health information and payer data.

Member data access must also follow the HL7 FHIR standard for the electronic exchange of healthcare information.

To fulfill these requirements, Washington and Michigan selected an interoperability solution from CNSI which provides members access to their personal health data through a secure API.

"Implementation of these rules is a natural evolution of all the hard work we have put into building out our MMIS system (CHAMPS) and statewide HIE infrastructure over the past 10 plus years,” Jason Werner, manager of the Medicaid EHR Incentive Program at State of Michigan, said in a press release at the time of the announcement.

“Medicaid beneficiaries are the real winners in all this as they will have access to their healthinformation when they need it most and in a way they can best use it,” Werner continued.

The interoperability tool is set to provide patients with data regarding care encounters and claims, as well as a provider directory.

Christine Nolan, Washington Health Care Authority’s deputy chief information officer of Medicaid services, noted that this new integration will boost care coordination among the state’s Medicaid population.

"Washington is pleased to be able to give our clients access to their own health care data and allow them to share it with their care team to improve the coordination of their care," said Nolan. "This new development will enable the ProviderOne system to comply with CMS' patient access interoperability rules, furthering our vision of a healthier Washington."

CDS Tool Implementation

APIs and web services can help optimize EHRs for pediatric use, according to a recent policy statement published in Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

Currently, many EHR systems lack pediatric features such as growth charts, anthropometric percentiles, weight-based dosing, and well-child visit and immunization schedule tracking.  

It can also be challenging for EHR vendors to stay up-to-date with clinical content, as agencies continuously put out new pediatric policies and guidelines. For instance, in August of 2017, AAP made significant changes to high blood pressure screening and management guidelines.

Implementing such changes directly in the EHR requires functionality development investment. Often, vendors will leverage content development tools to integrate pediatric functionalities into the EHR, but each individual customer must pay for the service.

APIs and web services may be a more cost-efficient route to EHR optimization, AAP suggested, as these technologies provide clinical decision support solutions that can be shared across multiple EHRs and settings.

“Because Web services are smaller, more specialized software modules compared with EHRs, they have the advantage that they are easier to develop, test, and augment in a more rapid development cycle and do not have to rely on vendors to prioritize functions for development,” the report authors wrote.

The report called for developers to rigorously test the accuracy of their tools to ensure that the service functions properly and records the data used to generate calculations or guide clinical decision support. 

Provider-to-Provider Patient Data Exchange

CMS’ conditions of Medicaid/Medicare participation rule requires hospitals to direct message the individual’s care team regarding patient events such as emergency room visits or admittance and discharge from the hospital.

“The idea is that the message is generated automatically by the EHR when one of these conditions are met,” Jordan Tannenbaum, vice president, CIO, and CMIO at Saint Peter's Healthcare System, told EHRIntelligence in a June 2021 interview. “The result of this is better follow-up, less readmissions, and overall better care because it's supposed to follow up after a hospital encounter.”

In addition to the clinical quality improvements the rule seeks, these conditions of participation have some money tied to them. Healthcare organizations that fail to deliver on these requirements could get booted from Medicare and Medicaid altogether, which is a pretty big stick that can motivate adherence considering the broad population of Medicare and Medicaid beneficiaries.

Healthcare organizations can take several approaches to adhere to the new conditions of participation for Medicaid and Medicare.

Foremost, provider organizations can enable the EHR to send messages directly to patients’ care team, or they can send the information through a health information exchange, Tannenbaum added. Alternatively, organizations can adopt APIs to adhere to the final rule.

Saint Peter’s Healthcare System chose to integrate CarePort, an API powered by WellSky. Tannenbaum said Saint Peter’s already had the API in place in its post-acute facilities, making the integration intuitive and seamless for the organization.

When a qualifying patient event occurs, such as a hospital admission or discharge, the API takes the HL7 message live out of the EHR and forwards it to the direct addresses for post-acute care providers listed on the patient’s record, Tannenbaum explained.

“The API has the benefit of having a lot of information about those direct addresses for all the different post-acute care positions and providers,” Tannenbaum added. “They have a record of who has seen this patient outside that we don't know.”

This ensures that the correct people receive the direct message regarding a patient’s medical events, promoting care coordination through appropriate follow-up.

As the digital health transformation progresses, APIs could help the healthcare industry fulfill various interoperability use cases.