The transition to electronic health records (EHRs) gave rise to the promise that a clinician, anywhere and at any time, could access a patient’s full, accurate medical history. EHR systems are now used in almost every U.S. hospital and physician’s office, and they have done much to improve patient care. But complete digital medical records remain elusive because these various systems often can’t “talk” to each other and reliably exchange data.
This lack of interoperability can put patients at risk. We know, for example, that communication gaps among EHR systems have led to delays in treatment and duplication of tests, compromising medical care and increasing costs.
A recent draft rule from the Office of the National Coordinator for Health Information Technology (ONC)—the federal agency that oversees EHRs—takes aim at these shortcomings, following through on a bipartisan mandate that Congress gave the agency in a 2016 law, the 21st Century Cures Act (Cures). ONC’s proposal would significantly strengthen criteria for EHR interoperability and—together with existing regulations from the Centers for Medicare and Medicaid Services—establish powerful incentives to meet the requirements. If the ONC rule is finalized as written, hospitals and medical practices would effectively have two years to deploy systems that are better able to exchange patient data—or risk running afoul of Medicare’s payment policies.
ONC’s rule would adopt a technology already used in other industries to address interoperability challenges: application programming interfaces, or APIs. These tools allow services such as travel and personal finance websites, and smartphone applications, to organize and display information from multiple sources. They also have the potential to sync data across EHR systems and feed this information into apps that let patients share their medical records with caregivers or alert clinicians to best practices for a treatment decision.
APIs are already making some EHR data accessible to patients, but ONC proposes two vital steps to boost their benefits. First, EHR systems would have to allow access to data using APIs built with a common, industry-established standard known as Fast Healthcare Interoperability Resources, or FHIR. By one estimate, more than 80 percent of hospitals and about two-thirds of clinicians already use FHIR.
But FHIR alone isn’t sufficient because it permits EHR manufacturers to choose which data formats to provide in response to an API request for information. This multiplicity of options can stifle interoperability by forcing app makers to design products that accommodate countless variations of data and formats. In response, the rule would limit the choices in FHIR by requiring EHR developers to use API implementation guidelines from the Argonaut Project, a collaboration among technology developers and health care providers. Combining FHIR and the Argonaut guidelines for standard APIs would ensure that these tools can be used to easily and securely request data from other EHR systems and get consistent, predictable responses.
Second, ONC‘s rule would mandate that APIs provide access to a wider range of health record information, including clinical notes in which doctors often describe nuances in a patient’s medical condition and treatment plan. Doctors need these details to make better decisions, and research shows that reading these notes also helps many patients understand and follow through with treatment.
These provisions would significantly improve the effectiveness of APIs, but they shouldn’t be ONC‘s last word on the tools. To meet Congress’ requirement that APIs make available “all data elements” in EHRs, ONC should continue in follow-up rulemaking to expand the types of patient data that must be transferable with standard API technology.
ONC’s proposed requirements, as well as the implementation timeline for Medicare providers, deserve support. Finalizing these rules would launch a new era in interoperability, one powered by standardized APIs that allow health care providers to leverage the same internet-based tools that fuel innovation in other industries. The sooner this transformation begins, the sooner clinicians and patients will benefit.
Ben Moscovitch directs The Pew Charitable Trusts’ health information technology initiative.