US Agency Taps APIs To Drive Digital Medical Records Transformation

The U.S. is launching rules to drive digital transformation through open application programming interfaces (APIs), a move that could fuel new digital medical services and applications, Venture Beat reported on Thursday (July 1).

Using APIs, the healthcare community could make medical records available to medical providers and insurers while also improving coordination among patients and making the data searchable.

The effort is spearheaded by the U.S. Centers for Medicare and Medicaid Services (CMS), which has said it would drop payments for non-compliance. The agency is tasked with handling all federal insurance payments to health care providers, according to the article.

API innovation has lagged for healthcare providers, but the goal for the past 10 years or so has been to bring medical records into the digital mainstream. A stumbling block to integration has been the healthcare industry’s reliance on the 1960s Electronic Data Interchange (EDI) standard, Venture Beat reported.

APIs enable digital communication between applications. People using a smartphone to check the weather or send an instant message use APIs without being aware of what is happening in the background, according to published reports.

The current system used by the healthcare industry often takes a number of days for a hospital to get insurance authorization, Ruby Raley, vice president of healthcare and life sciences at Axway, an API tools provider, told VentureBeat. The new APIs are intended to offer real-time information.

New rules are set to take effect over the next two years. These rules include a rule regarding data exchange between payers as well as the No Surprises Act, which will handle inquiries regarding unanticipated medical bills. Another rule regarding prior authorization is in the works to address authorization processes, and a Transparency in Coverage rule will make pricing transparent to patients.

The notion of connected healthcare was accelerated by the COVID-19 pandemic, with telemedicine becoming a mainstay as people locked down. Telehealth usage increased by 154 percent during the pandemic, and now 41 states are looking into new regulations to maintain the connected version of healthcare.

Healthcare algorithms have been in the works since May via a collaboration between Google and HCA Healthcare. The goal is to advance HCA’s digital transformation.

Just before the pandemic took hold, the federal government was working to standardize legislation surrounding access to digital healthcare records.