API Adoption Slow, Widespread FHIR Uptake Expected by 2024

Only 24 percent of healthcare companies currently utilize application programming interfaces (APIs) at scale, according to data from the Engine Group commissioned by Change Healthcare.

Despite low utilization, the research revealed most healthcare stakeholders predict Fast Healthcare Interoperability Resources (FHIR) APIs will become widespread by 2024.

More than 50 percent of providers if 400 surveyed stakeholders said they are consuming and producing APIs at scale. Payers lag behind, with 43 percent saying they consume and 37 percent build APIs. However, 67 percent of providers and 61 percent of payers expect their respective organizations to utilize APIs at scale by 2023.

Furthermore, over half of the organizations and more than two-thirds of providers expect “fully mature” API use as consumers. All three stakeholder groups also expect APIs to “become the glue that binds healthcare together,” the study authors wrote.

Almost 75 percent of respondents expect to reach full or nearly full maturity as API producers by 2023.

“I don’t think until six months ago I understood what scale would look like … Now we have some sense that scale will mean sharing anything with anybody using API,” said an anonymous hospital executive during qualitative follow-up. “Whereas an application here, a use case there – I wouldn’t say that’s scale. Scale is on demand, everything, anything, in the thousands.”

Sixty percent of payers, 45 percent of health IT vendors, and 40 percent of providers said APIs improve productivity and reduce burnout. The majority of providers, health IT vendors, and payers also noted that APIs boost solution quality and patient data access.

“They’re core to the way we do business,” explained an anonymous healthcare tech executive. “It’s a critical enabler. There is no Google without the internet. For us, APIs play a very similar role.”

Currently, providers are leveraging APIs in tactical ways, such as collecting payments and eligibility verification. On the other hand, payers are strategically utilizing APIs to gain valuable insight and build engagement.

Provider respondents said security and costs are the two major API adoption barriers. Meanwhile, payers pointed at technical infrastructure, privacy, and a lack of standards as critical adoption challenges.

Healthcare organization respondents said they are surprised by the amount of skill it takes for API adoption. Thirty-five percent of payers said knowledge is a significant API adoption barrier, while 29 percent of provider organizations agreed.

Looking forward, the respondents had mixed reactions about FHIR’s maturity. But the majority of respondents said providers and developers would adopt FHIR over other standards, such as HL7 and electronic data interchange (EDI).

“It’s a ‘standardized’ way of allowing very local control of massive amounts of information … In healthcare, that is really important, because that local control can translate to consent and privacy control … It allows for information to be generated at a population level that is otherwise impossible to generate… You’re better representing the population … which means that you’re getting better answers that are more diverse and more representative,” concluded an anonymous healthcare executive.

Healthcare organizations will soon be beholden to more API use per the ONC final rule. Part of the rule calls on medical providers and health IT developers to encourage patient data access using third-party apps and APIs.

ONC initially proposed to adopt the HL7 FHIR standard as a foundational standard and requested comment on four options to determine the best version of FHIR to adopt. Finally, ONC adopted FHIR Release 4.

Although APIs are becoming more prevalent in healthcare, the industry is inconsistent with its adoption. The 2015 edition health IT certification criteria updates and the new standardized API functionality dates are now required by December 31, 2022.