Not long ago, I had some mystery knee pain. After ignoring it for a little too long, I visited my chiropractor who sent me to an imaging specialist for an MRI.
I needed to get my records moved from the imaging company to my primary care doctor so they could refer me to an orthopedic specialist. Because they had no way to make this happen electronically, I had to personally drive to the doctor’s office, walk in (during Covid times), get a paper form, and hand it back so they could request my scans.
Sound familiar?
APIs can build better patient experiences and improve health outcomes
We know that APIs – Application Programming Interfaces, the digital building blocks that expose data points for modern applications – can be used to build solutions that measurably improve patient outcomes.
Take the stubborn and expensive problem of medication nonadherence, for example. One regional hospital in Mississippi leveraged price transparency APIs to get more congestive heart failure patients to fill their prescriptions – building a tool that allowed prescribers and patients to see prescription drug costs and discuss options at the point of care.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Price transparency and other FHIR APIs were mandated by CMS and have had a bumpy rollout, but it is thrilling to see that we have a problem in healthcare we can actually solve by creating more complete and coherent systems.
And yet, a recent sobering survey found 61 percent of respondents didn’t access healthcare in the past year because using an online self-scheduling system was too complicated. Why aren’t we making better use of APIs to improve our experiences?
Healthcare’s adoption of APIs has been disjointed
As an industry, healthcare has fragmented its approach to modernization and API enablement, and the result is a lack of synergy.
Two factors have contributed to this: a narrow focus on compliance and an over-dependence on commercial off-the-shelf technology (COTS). In the 2000s, CIOs decided that developing their own applications was inefficient, so they started buying different solutions and ended up with a set of application silos.
Beginning in 2009, when the ONC required electronic clinical records as part of the HITECH Act and patient portals became more common in the U.S., it became clear that clinical records were originally built just for clinicians; they weren’t designed to provide patient experiences. That’s how we ended up with patient portals built from a clinical perspective that don’t actually help a patient do the things a patient needs to do, like schedule appointments or transfer records.
So, healthcare organizations bought more vendor tools to help patients communicate with their doctor’s office, fill out health history forms, or look up coverage and payment information.
But with this approach, data doesn’t flow across these “islands of automation.” By contrast, using the FHIR APIs mandated by the Interoperability Rule allows health providers to leverage discrete data points – reusable building blocks – to compose interoperable solutions.
A more composable data ecosystem would have allowed me, with my aching knee, to quickly transfer my MRI and get the orthopedic appointment I need, and perhaps schedule and coordinate some telemedicine calls as well.
Don’t underestimate the power of experience
Contrast that to another recent personal experience: in the middle of hurricane Nicole, my power went out. I picked up my phone to google Florida Power & Light. I was immediately prompted to go the mobile experience, where a button allowed me to report an outage and the site recognized my phone number and address, sending me updates as the situation changed.
Patients get great customer experiences elsewhere, and now they expect them in healthcare too. We would do well to draw lessons from the business world’s obsession with customer experience. Gartner’s Customer Experience Research Team argues, “Instead of exceeding customer expectations in the hope to mitigate customer loyalty loss, organizations must reduce the effort customers need to put in to solve their problems quickly and easily.”
A useful API doesn’t just update something in a database or fetch something from it: it orchestrates information that flows across multiple applications and causes work to be done – approvals, changes activated in other applications – to put together an experience or a completed piece of work, like refilling a prescription.
People need to be able to complete a task in one sitting. And beyond failing to provide helpful patient experiences, this lack of synergy in healthcare and these growing data silos will eventually result in additional security weaknesses and higher costs for the industry in the long run.
The need for a Chief Patient Experience Officer
Large healthcare systems have begun naming Chief Data Officers to manage the massive task of digitizing patient records and other clinical processes. They embraced data lakes and data scientists and realized that we needed to treat data as an asset. But we still have a people gap.
Healthcare organizations need more than just a data officer; they need a Chief Patient Experience Officer that’s empowered to cross the application silos and pull together solutions that solve patient experience processes.
The FHIR APIs mandated by CMS are only one data format, designed for the fast exchange of electronic health records. But as I mentioned earlier, electronic healthcare data was primarily designed for clinical purposes. There’s a larger category of APIs that will help us provide a simpler, more integrated process: experience APIs.
An experience API is a consumer-centric API (typically a set of APIs bundled together for providing a service) in accordance with a user experience or business capability. Essentially, it takes back-end data points and puts them together so a consumer – or patient – can complete a logical action on the front end.
Experience APIs aren’t just a convenience. Delivering a better, more cohesive digital experience means we can offer higher-quality care to more people; they’re especially beneficial for vulnerable populations, for whom making multiple follow-up calls is a serious access barrier.
Many organizations are still struggling with the mandate for good faith estimates or advanced explanation of benefits and hoping for delays in upcoming rules. But those elements are experience APIs too: they will orchestrate a series of information, request-response, and decisions across many different clinical providers and health plans.
Better digital experiences will also allow us to stem rising healthcare costs, as healthcare organizations are able to focus on delivering care rather than chasing people down for information, payment, or appointments. What’s more, research shows improved experience could help organizations grow their customer base.
We’re not there yet, but the promise of experience APIs holds hope that in the future, a patient can quickly find out what it would cost to repair a torn meniscus, with the information they need to choose a provider, schedule, and adapt accordingly. (Thankfully, I did finally get the care I needed from an orthopedic specialist.)
To achieve this, we need to go beyond just laying a FHIR API on top of a record: we need to consider the whole picture and process from an experience perspective. It’s time to take experience seriously and address it at the C-level.
Photo: Axway
