As Proposed APIs Rollback Nears, Caution and Commentary Needed – Now

If you care about APIs – and you should – then you may want to weigh in on a little-known, fast-approaching proposed rules change that could have a sweeping impact on healthcare. Deadline for comment to the Centers for Medicare and Medicaid Services (CMS) Calendar Year 2018 Updates to the Quality Payment Program is 5 p.m. this coming Monday, August 21.

CMS ranks the change as “economically significant,” and indeed it is. Intended to help solo and small practices, the unintended consequences may affect patients as well as healthcare IT vendors large and small, from EMRs to digital health applications to device manufacturers.

When Congress passed the Medicare Access and CHIP Reauthorization Act of 2015, it set certain technology adoption standards and deadlines for clinicians. These standards could be rolled back in the proposed 491-page CY 2018 Updates to the Quality Payment Program – which would allow clinicians to have a choice to use the 2014 or 2015 standards.

Something that might get overlooked because of the document’s length is a fairly significant ripple effect. CMS is basically saying not enough people are going to be able to adopt 2015-certified EHR technology in time. Therefore, “clinicians may use EHR technology certified to either the 2014 or 2015 Edition certification criteria, or a combination of the two.” This change would stay in effect through all of 2018.

This dials back the prior requirement that clinicians allow applications of a patient’s choosing to use an open-spec Application Program Interface (API) built into their EHR, so patients can manage information themselves.

APIs are phenomenally important to healthcare, and their future even more so, as observed by the Harvard Business Review. If the CMS proposal is finalized, a clinician will be neither required nor encouraged to allow APIs to work – that is, if a physician’s API has even been shipped by the developer. According to the government’s Certified Health IT Product List, many developers are lagging. As of today, only 14 vendors are certified for at least one of the 2015 API criteria.

One result will be patients going back to pen and paper, faxing in forms to get their healthcare data.

And how many innovative IT vendors could this affect and in what fashion? The Department of Health and Human Services’ 2015 definition for what clinical information exchange must be made available via APIs is intentionally vague: “We do not seek to define the types of health information that could be accepted as we believe this should be as broad as possible.” It includes, but is not limited to, “health information from devices or applications.”

All this raises several  concerns:

• A rules change will create further confusion in healthcare, not only among clinicians, but also among vendors who may be treading water while debate over the Affordable Care Act continues.

• To encourage adoption of 2015-edition products, the proposal states, “we are proposing to offer a bonus of 10 percentage points under the advancing care information performance category” to eligible clinicians. I think that’s great. But what about clinicians who for whatever reason are unable to upgrade? We need to find out why those clinicians are not making progress, and figure out how we can help them and their patients. Accepting yesterday’s technology simply kicks the adoption can down the road. We’re treating symptoms of adoption illness, not the root causes.

• In this atmosphere of Affordable Care Act uncertainty, relaxing requirements will stifle innovation tied to clinical data and its use cases. Why should gutsy start-ups form, and why should established companies continue to innovate in this area as they develop new solutions and evolve existing ones? In relating its concern over slow adoption, the document refers to “conservative readiness estimates,” without naming them or their sources. As shown on the Certified Health IT Product List, the problem may not be with clinicians but with their vendors, who are for whatever reason unable to ship updated solutions. (Incidentally, a friend tells me that he suspects they have lobbyists.)

• By letting those vendors off the hook, it disadvantages all the vendors who have been working hard, who have been hiring, training, investing – and responsibly meeting deadlines.

The Bottom Line on APIs

Up-to-date solutions, obviously, better prevent errors and save more time for clinicians – time they can use to spend with patients. And that’s my major concern:

I think patients should be able to access their medical records in the way most useful to them. Sometimes that will be through the patient portal that an EHR vendor supplies. Other times it’s going to be via other tools that work better for them.

It goes along with a traditional conservative philosophy. If we want to control spending and make the market more efficient, then we need to enable patients to be portable, to move between competing service providers, to shop using readily available information, and be able to access their information so they can take greater responsibility for their care. And that’s what APIs are all about.

Learn more and provide your comments to the Centers for Medicare and Medicaid Services. Deadline is 5 p.m. on August 21st. (CMS does not specify time zones.)