Healthcare APIs – A cure to accessing Healthcare Systems

Healthcare is undergoing significant change at a rapid pace. The need for speed to meet changing requirements and new opportunities can be aided through the use of Web APIs. Let’s take a look at Healthcare and the API Economy, once again using the structure I introduced a few weeks ago (here).   This is still generic and not specific to any single Healthcare Payer. My hope is that these examples provoke thought and help you identify APIs that will benefit your business. Note: this week I am focusing on Payers, I will come back another time and focus on Healthcare Providers.

Mobile App Development – What are the common use cases for Healthcare APIs being used in Mobile App development?

  • General information includes information about the Healthcare Payer and offerings.  API examples here might be: find a doctor in a plan, find specialists, hospitals, and urgent care facilities in a plan, find plan coverage limits and deductibles.
  • Custom information and transactions includes information that is tailored to the specific customer. API examples might include – ID cards, coverage eligibility, claim submission and status, deductible status.
  • Mobile advantages – Customers using an App on the mobile device can use functions of the phone or tablet in conjunction with the APIs provided.  A common example is to use the doctor or facility location list with a mapping API to find which doctor is located closest to their home that is in their plan.

What APIs are available today in Healthcare? Here are just a few samples of public APIs:

  • BlueButton – is a service that allows people in the U.S. to access their own medical records online in order to track their health and check reports for accuracy.
  • RxREVU – is a medication cost savings database. RxREVU offers datasets on prescription medication costs.
  • Kaiser Permanente Interchange – enables internal and external developers to use approved public data from Kaiser Permanente to create individualized health care management apps. Using personalized health information, apps can be customized to cater to patient lifestyle, including nutrition and activity, to support total health.
  • TrueVault – is a Backend-as-a-Service (BaaS) platform designed to provide HIPAA compliant information storage for healthcare applications. Data stored with TrueVault is secured, but still accessible from anywhere the developer needs it.

Besides creating Mobile Apps, there are many other areas where APIs can provide value for Healthcare.

Partnering – APIs help make it easy to do business with you. There are many examples of partner APIs across a variety of different partnership types. Healthcare payers can provide APIs that allow Healthcare providers to check eligibility for services. Pharmaceutical companies can benefit from APIs reaching into healthcare data to determine effectiveness of treatments and possible enhancements. IBM’s Watson APIs can be used in conjunction with healthcare data to improve diagnosis and treatment options. As we move to a distributed healthcare model with physicians working together on tough cases across geographies, APIs can provide necessary access to enable this collaboration.

Public APIs – The same APIs listed under the “general information” section in private APIs above make sense to make public. Find a doctor in a plan, find specialists, hospitals, and urgent care facilities in a plan, find plan coverage limits and deductibles could be useful when comparing healthcare plans during the open enrollment period. Public comparison Apps could make good use of these APIs. Customer specific APIs (e.g. to check claim status) may not make sense in a public API context.

Many healthcare companies are integrating wellness programs into their offerings. For example APIs to allow wellness programs to provide information on client usage of the program might be implemented.

Social / Big Data Analytics –The large amount of data gathered by healthcare payers on treatments and outcomes can be accessed via APIs by providers, researchers, and pharmaceutical companies to improve healthcare as described above. Healthcare companies can also participate in social networking. For example participating in fitness groups or groups focused on medical issues (e.g. cancer patients) can provide value to these groups and direct them to appropriate healthcare offerings.

Device Integration / Wearables – Fitbit or similar wearables can help encourage healthy behavior reducing medical costs. The Fitbit APIs can feed information to the healthcare payer to provide data to ensure the user is meeting wellness program requirements (e.g. for discounts or reimbursement incentives). Medical devices and monitors in hospitals can help ensure patients are given the correct care and medications, avoiding costly errors.

Data Assets – Earlier we discussed analytics that are useful within the healthcare context. The data collected may also be of value to other industries for marketing purposes. For example, life insurance companies may want to target specific customer segments with offers and may pay for access to send offers to your client base.

Connect with me through comments here or via twitter @Arglick to continue the discussion.  You can also read my earlier blogs