Standards-based application programming interfaces, the way that computers “talk” to each other, are the technological enablers that will ensure consumer access to electronic health information.

That’s the vision of National Coordinator for Health IT Don Rucker, MD, who sees APIs as driving consumer empowerment in healthcare by enabling patients to share their data with third party API-based apps.

“That fundamental realignment based on APIs has transformed our financial, travel and entertainment industries,” said Rucker on Wednesday at ONC’s Interoperability Forum in Washington, who described the app economy. “We think this is happening in healthcare.”



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In particular, Rucker contends that the consumer app economy in healthcare will “hold us as providers accountable for levels of service and innovation that we haven’t had” in the past. “All of this brave new world is predicated, frankly, on the right of the patient to get their data about their body,” according to Rucker. “We have not had that right.”

Despite the individual right to access health information about themselves established by HIPAA, patients often lack access to their own data, which hinders their ability to manage their healthcare and shop for medical services at lower prices, Rucker pointed out.

However, he noted that ONC has issued a proposed rule requiring providers to offer patients’ access to their electronic health information through secure APIs.

“We are very serious collectively—you’ve seen the CMS rule as well—in getting the American public to have the benefits of interoperability on their smartphone,” Rucker added. “You will have the right to select an app and—using the OAuth 2.0 security protocol—bring it to a provider (FHIR) end point and download your data. It’s important to understand what that means. It means you have to choose the app. You have to bring the app (to the provider).”

As the healthcare industry joins America’s app economy, Rucker contends that most patients will be as protective of their medical data as they are of their banking information. Still, ONC is warning about the inherent risks of sharing data with third party API-based apps that may put health information at risk from inappropriate secondary uses and disclosures.

“We’re working with a number of folks on better ways of doing consent,” Rucker added. “There’s a very complicated, delicate balancing act on how do we protect the consumers’ right of access with protections around privacy.”

While Rucker acknowledged that provider adoption of electronic health records was “a bit of a tortured past” for the industry, he observed that EHRs are “pretty much everywhere now,” and a “global wave of computer science that is transforming every industry will increasingly transform healthcare.”

Rucker made the case that “you can’t have modern computing, AI and machine learning without big data, and so far, we haven’t had the infrastructure to do that.”

At the same time, Rucker said EHRs must be transformed into “more powerful, understandable and actionable” platforms that get away from their limited origins as mere “billing tools” and embrace automation, while pointing out that healthcare is the only industry in which computers have actually resulted in “more work for ourselves” and inefficiency.

“We are in extremely exciting times in healthcare—I have to say it’s disappointed me a little that it’s taken so long,” he concluded. “I do believe that exponential growth is finally coming. Good things happen to those who wait. I think we have extraordinary abilities and opportunities to make healthcare efficient.”