Application Programming Interfaces in Health Care: Findings from a Current-State Sociotechnical Assessment

Abstract

Objective Interest in application programming interfaces (APIs) is increasing as key stakeholders look for technical solutions to interoperability challenges. We explored three thematic areas to assess the current state of API use for data access and exchange in health care: (1) API use cases and standards; (2) challenges and facilitators for read and write capabilities; and (3) outlook for development of write capabilities. Methods We employed four methods: (1) literature review; (2) expert interviews with 13 API stakeholders; (3) review of electronic health record (EHR) app galleries; and (4) a technical expert panel. We used an eight-dimension sociotechnical model to organize our findings. Results The API ecosystem is complicated and cuts across five of the eight sociotechnical model dimensions: (1) app marketplaces support a range of use cases, the majority of which target providers' needs, with far fewer supporting patient access to data; (2) current focus on read APIs with limited use of write APIs; (3) where standards are used, they are largely Fast Healthcare Interoperability Resources (FHIR); (4) FHIR-based APIs support exchange of electronic health information within the common clinical data set; and (5) validating external data and data sources for clinical decision making creates challenges to provider workflows. Conclusion While the use of APIs in health care is increasing rapidly, it is still in the pilot stages. We identified five key issues with implications for the continued advancement of API use: (1) a robust normative FHIR standard; (2) expansion of the common clinical data set to other data elements; (3) enhanced support for write implementation; (4) data provenance rules; and (5) data governance rules. Thus, while APIs are being touted as a solution to interoperability challenges, they remain an emerging technology that is only one piece of a multipronged approach to data access and use.

Human Factors and Organizational Issues Section Synopsis IMIA Yearbook 2021

“…Next, a paper by MacKenna et al [ 10 ] described how a poorly designed medication ordering system resulted in 9.5 million excess cost in one year for ordering more expensive generic medication than was necessary. Finally, a paper by Dullabh et al [ 11 ] used a socio-technical model to structure an analysis of the current state of application programming interfaces in healthcare for providing necessary interoperability and data sharing. Not surprisingly, they found a large amount of potential use cases and existing applications, most of which focused on filling a physician's need, read capabilities were widely provided, but not write, FHIR was the overwhelming standard that is used, and it enabled communication of the common clinical dataset, and validating data from external sources complicated providers’ workflows.…”

A Mobile, Electronic Health Record-Connected Application for Managing Team Workflows in Inpatient Care

“…The user interface connects to its database and to our organization's many other clinical information systems using application program interfaces, HL7 messages, direct database queries, and web services ( Supplementary Appendix S1 , available in the online version). 38 Our decision to build the application alongside (rather than within) the main EHR was largely motivated by our requirement of supporting a mobile, paperless handoff and rounding workflow. This was not possible within our EHR at the time (Allscripts) nor within the EHR our health system planned to implement shortly thereafter (Epic).…”

“…Other identified vulnerabilities included: effective visualizations of laboratory and other structured data, collaborative task management, and transitions of care both within a team (e.g., night coverage) and across teams (e.g., intensive care unit to ward). 29 30 31 Learning from prior examples of institutional systems designed to improve clinicians' interactions with EHR functionalities, 32 33 34 35 36 37 we recognized opportunities to leverage recent advances—mobile technology, facile web application interfaces, and data interoperability 38 —in the creation of a homegrown EHR-adjunct that provides a modern digital experience.…”

Design, Implementation, Utilization, and Sustainability of a Fast Healthcare Interoperability Resources–Based Inpatient Rounding List

“…Specific application programming requirements were determined by the application programming team and previously utilized by other developers. [18][19][20] Requirements include that it generates a short 1-to 2-page list, displays laboratories in the same format as used on paper lists, condenses patient information, is real time and accurate, and is user customizable.…”