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APIs may be the cornerstone of a digital transformation strategy, but the health care industry has not really benefited from widespread API adoption because of concerns over interoperability, patient data exchange, and infrastructure challenges, according to a new study.

While 9 in 10 health care executives said APIs were important or mission-critical, only 24% of leading organizations currently use APIs, according to the study from Change Healthcare and Engine Group. One reason many health care organizations are not using APIs may be because the main driver for adoption has been regulatory compliance, Change Healthcare VP Gautam Shah told VentureBeat. In contrast, the primary driver in other industries was improving business processes and customer experience.

Digital transformation in health care focuses on better patient care, differentiated patient and provider experiences, and increased efficiency. For health care organizations to see the kind of success enjoyed by industries such as banking, fintech, and retail, they need to address differences in API usage, misaligned priorities, and a skills gap.

Navigating API challenges

Health care providers (hospitals, health systems, and facilities) and payers (insurance companies, government programs) are not currently aligned on their priorities. Providers want to ensure the security of the data and its appropriate use, so security (52%) and cost (47%) are their biggest barriers to adoption. Payers want to get and operate on health care data in the fastest and most efficient manner possible, but they are hampered by a lack of high-performance technology infrastructure and standards. Payers in the study were concerned about technical infrastructure (45%), privacy (43%), and lack of industry standards (43%).

There is also a disconnect between how providers and payers use APIs. Providers use APIs tactically, for eligibility verification and collecting payments. Payers are more strategic, using APIs for insights and engagements.

The health care industry is undergoing a third wave of digital transformation, driven in part by changes mandated by the American Restoration and Recovery Act (2014), the 21st Century Cures Act (2016), and the Interoperability and Patient Access Rule (2020). Providers and payers need to implement electronic health record systems, improve data portability and interoperability, and enhance the use of data to make the cost and quality of care more visible and transparent.

Making, supporting, and operating these technologies and models requires new or specialized skillsets. There is a steep learning curve because of the unique challenges associated with health care data and operations. There is also a skills gap, and 35% of payers and 29% of providers in the study said knowledge of how to create or use APIs was a barrier to adoption.

New medical app opportunities

As the industry consolidates around data interoperability, enhanced patient experiences, and operation experiences, there will be a shift to value-based care, increased consumerization, and adoption of digital technologies in health care, Shah said. New Fast Healthcare Interoperability Resources (FHIR) requirements take effect in July.

Providers need to increase their adoption and use of FHIR APIs to power their digital and virtual patient experiences. Payer organizations will need to adopt FHIR APIs to enable greater data portability and transparency for their members. Digital Health companies will need to move quickly to embrace FHIR APIs to enable a wide range of applications, from wellness initiatives to chronic disease management, in order to meet patient and member expectations for richer applications driven by their data.

Shah predicted, “Over the next two years, as APIs become more prevalent, as their usage matures, and as the data becomes more liquid, we stand to see real change and tangible benefit to patient care, patient and provider experience, payer operations, and ultimately to a health care system that we, our families and community, interact with daily.”

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