Federal advisory committees endorse task force recommendation for public API

The Health IT Policy Committee and the Standards Committee formally approved a set of recommendations from the JASON Task Force that calls for the establishment of an orchestrated architecture based on public APIs as the foundation of interoperability.

During the Oct. 15 joint meeting, the task force shared its conclusions that current interoperability approaches are functionally limited and need to be supplemented and gradually replaced with more comprehensive API-based models.

“The idea doesn’t mean that current approaches are barren or without use, but they have limited functionality,” said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and Jason Task Force co-chair. A public API “is an improvement over what we have today. It's a transition. We want to begin this transition.”

Meaningful Use should be leveraged as a starting point to this transition, he said.

Tripathi and the other task force co-chair David McCallie, MD, vice president of medical informatics and director of the Cerner Medical Informatics Institute, laid out and received approval for the following six recommendations:

1. The Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) should act with urgency to use HITECH to motivate industry-wide API-based capabilities. “This is the most important recommendation,” Tripathi said. Meaningful Use should shift focus to interoperability. “Overly broad and complex requirements slow progress on all fronts,” he said. The committees voted to remove some of the language of this recommendation that says the agencies should consider delaying or staggering Stage 3 incentives to accommodate development of the API.

1. A market-based exchange architecture should be defined by industry and government to meet the nation’s current and future interoperability needs based on the following key concepts: coordinated architecture; data sharing arrangements; public API; and core data services. The architecture should not be a single, top-down architecture and should leverage and build upon existing networks, according to the speakers.

1. The nationwide exchange network should be based on a coordinated architecture that "loosely couples" market-based data sharing networks.

1. The “public API" should enable data- and document-level access to clinical and financial systems in accordance with internet-style interoperability design principles and patterns. The coordinated architecture and data-sharing networks create an ecosystem to facilitate use of the public API. “It’s the only industry-wide lever we have in a widely fragmented country. We should use HITECH to motivate industry-wide API abilities,” said McCallie.

1. Core data services and profiles should define the minimal data and document types supported by all public APIs. HITECH should focus initially on clinician-to-clinician exchange and consumer access use cases. “It’s a key idea,” said McCallie of core data profiles, which tightly specify data elements and formats. “It’s more powerful, but less complicated.”

1. Federal government should take the following steps to motivate adoption of public APIs: transparency; guidance; organization; incentive alignment; federal operational alignment; DSN bridging standards; and nationwide shared services. The task force added that the government may choose to consider direct regulation of DSNs in the event that the market does not develop coordination mechanisms.

Some members questioned the feasibility of a public API, and whether including such requirements in Stage 3 would work. Entrepreneur Paul Egerman noted that while people were excited about Direct, “it hasn’t been a smashing success. We run a similar risk with this.”

Christine Bechtel, president of the Bechtel Health Advisory Group, said she generally supported the recommendations but would not agree to any language pushing for a delay in Meaningful Use Stage 3. The committee thus voted to remove related language from recommendation one.

Senior Vice President and Chief Technology Officer Jeremy Delinsky weighed in on the impact the recommendations. “I think what you’re proposing is a profound change to the provider experience. It would fundamentally change what data looks like to the provider,” he said. “I think the API approach would offer a more real-time way to incorporate outside data in a much more usable way.”

Andrew Wiesenthal, MD, of Deloitte, commented that if the Department of Veterans Affairs and the Department of Defense include such requirements in their procurements, “that would make the market.” If ONC and CMS miss that opportunity, “it would be an enormous loss. Because whatever market they make, they’ll do it in 12 to 18 months.”

The committees will draft a formal letter to the ONC and CMS endorsing these recommendations.