How APIs Are Powering Digital Transformation in Healthcare

The ability to manage APIs in such a way as to protect sensitive personal information is central to today's healthcare providers, so a basic understanding of what these superbly adaptable tools have to offer is important.For some time, healthcare productivity has lagged behind other sectors. In response to the consumerization of healthcare and outcome-based reimbursement systems, many organizations are now beginning to think in customer-centric terms. Existing business models in healthcare delivery and insurance are being disrupted by agile, cutting-edge public and private APIs. Here's what you need to know about this transformation.

Understanding APIs

APIs (Application Programming Interfaces) are the essential technology underlying digital transformation, but it's only recently that this acronym has made it out of the IT department and into common circulation. "The number of open (i.e. publicly accessible) APIs has grown from nearly zero a decade ago to over 13,000 in 2014 and is projected to more than double to 30,000 by 2016," according to startup specialist Zak Schwarzman. Schwarzman quotes a definitive declaration by Chet Kapoor, CEO of Apigee: "APIs are the nervous system of our new digital world."The ability to manage APIs in such a way as to protect sensitive personal information is central to today's healthcare providers, so a basic understanding of what these superbly adaptable tools have to offer is important. When your APIs are properly managed, providing security and scalability, it frees your organization to fully participate in the digital transformation in healthcare.

Unique Challenges in Digital Healthcare

The growth of APIs stems from an elementary need: Your patients/consumers want control of their data, and health-related information remains difficult to encapsulate and share. This need for privacy reduces the opportunities available for health providers to use aggregated data to improve patients' health. Security concerns, as well as the size and fragmentation of the healthcare industry, all combine to give rise to an exceptional need within that industry for vertical APIs. The way the industry is meeting these challenges is explored below.

Internal and Industry Digital Transformation

Chet Kapoor defines "becoming digital" as "creating value by delivering digital experiences." API technology is at the heart of becoming digital, and a good API acts like a magic key. You are creating an actual architectural framework for sharing information in a safe, manageable way. At the same time, you are gathering a network of patients and providers into a community and turning your healthcare website into a powerful platform.

Collaboration Between all Members of the Health Care Team

Digital tools based on APIs increase the opportunity for collaboration within the healthcare provider ecosystem. New data-sharing streams improve patient health through care coordination and referrals. Furthermore, technology enables payors and providers to work together on new initiatives that can hold down costs. One such example is the rapidly growing field of medical wearables that monitor the well-being of patients with chronic conditions. This real-time connectivity allows patients to enjoy greater independence while reducing expenses for every party involved. The growing field of telemedicine is another example, because it increases access to direct care while reducing the need for in-person appointments. These technologies, based on API architecture, create a new science of triage. The proliferation of remote access options allows for the patients with greatest need to be seen, while others have their worries relieved without having to go through the inconvenience of coming in for an examination.

Data Mining and Advanced Analytics

Digital transformation within healthcare focuses on who has access to data and how that access is managed. New digital tools create numerous authorization gateways, including one-time permission, real-time authorization and more. Control of data becomes simple, and providers are assured of remaining in compliance with increasingly stringent regulations regarding protection of sensitive data. Digital medical records are more easily and securely retrieved than any paper-based system, and they can be instantly transferred across any distance as needed.With advanced analytics, it's also possible to leverage internal data to make better informed business decisions. Data mining and analysis allow management of the health of entire populations, and payors are able to tailor their products to the needs of specific demographic sectors and areas. Payors can help providers develop sophisticated applications to manage the health of their patient population. The complex functions of data-sharing that are necessary between payors and providers are streamlined while being simultaneously made more secure. Value-based payment systems can be developed in response to the broad community information that the new data science provides.

Greater Access and Greater Security, Simultaneously

An example of the importance of public APIs can be seen in the federal government's development of the Federal Data Services Hub. Implemented as part of the Affordable Care Act, the Hub is a platform that allows disparate IT systems from state and local agencies to exchange patient information securely. This information concerns eligibility for various public and private programs, as well as related verification and enrollment data. The Hub itself does not store data, but its public APIs allow numerous agencies to share sensitive information securely in real time. As more agencies connect through the Hub, patient's' needs are served by having their benefit information immediately available where it is needed.

Flexibility Leads to New Projects

Digital tools make it easier for all members of the healthcare system to increase efficiency through automation. When information doesn't have to pass through the hands of as many individuals, the agility of the entire system is enhanced. Digital assets can be reused by a range of stakeholders, reducing development costs for new projects and initiatives. If a small-scale project turns out to be highly beneficial, the ready access to centralized data makes it easily scalable to a larger group. The potential monetization of data (while still abiding by regulatory constraints) invites the participation of new technology startups in the field, and a win-win loop of innovation is begun.

Consumer Experience Transformation

The consumer experience is the place to begin when you're first planning to tap the power of APIs. You must consider what you need in terms of user interface and user experience and then build your API and your application to meet the need you have defined.

Digital Tools Bring Empowerment

Transforming the digital experience enables the patient/consumer to feel empowered. They have the ability to make better informed healthcare choices through digital tools that enable them to select the lowest-cost, most appropriate healthcare option. They are able to compare the characteristics of all available plans and determine which one is most appropriate for their personal situation. Through personalized data, patients are also provided access to the facilities that are closest to them and have the technology to offer the precise procedures that the patient needs. In addition, patients are now able to manage their appointment scheduling and the status of their claims and remaining deductibles, annual copays and premiums. This type of enhanced choice is a necessary part of helping healthcare consumers control out-of-pocket costs.The transformation offered by API technology also provides patients with streamlined access to their own medical histories, which takes the highly personal issue of one's health out of the sealed-off realm of the professional and puts it into the hands of the individual patient. This simple change is profoundly empowering. At the same time, the security of new cloud-based storage systems meets the most stringent standards, providing patients with reassurance that their personal health histories are not being freely dropped into the wilds of the internet.

Empowerment Leads to Engagement

Instead of being moved around like a passive chess piece between providers and insurers, today's patient/consumer is engaged in making active choices. Technology brings the patient back into the picture as an empowered agent, and as a result, the patient experiences greater satisfaction with the services provided. The greater connectivity, aggregation and control of personal health data brings benefits throughout the healthcare environment. For those patients who are not in a condition to make choices about their care or about insurers, the increased coordination between providers and payors enables the patient to be directed automatically to the most appropriate, effective and affordable care option. The end-to-end care experience is integrated by partnerships throughout the delivery system.

Innovation Is Nurtured

The sheer volume of data exchanges, charts, tools, survey results and interactive databases available to the public through the U.S. government's Health Services Research Information Central website speaks for itself. This growing treasure house of real-time information that researchers can draw upon means that each individual project no longer has to start from scratch when it's seeking specific data. The potential for innovation offered by this open access to data is unprecedented in human history.The outcome of API-based innovation will also facilitate the integration between individual electronic health records and the growing Internet of Things (IoT), and the result will be that patient "records" are no longer historical -- but are instead a real-time reflection of an individual patient's status. Building on this information, technology will inevitably lead to predictive health analysis, with the benefit of real-time recommendation and advice for patients. The IoT will become the Internet of Devices, as APIs allow mobile apps to interface more fully with more and more physical instruments, tools and devices.APIs are already beginning to deeply transform the entire healthcare ecosystem. The relationship between providers and patients is evolving from a more "paternalistic" relationship, where a provider tells the patient what to do, to a patient-centric system, where providers make data-informed recommendations that the patient validates, using multiple services enabled by the data he or she has aggregated. It will be exciting to watch and participate in this revolution.