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Instead of a Weapon For Health Care Improvement, Monitoring Becomes Another Battleground

Posted on September 3, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

If you wax enthusiastic about “patient engagement,” or work with health and fitness devices, or want to derive useful data from patient monitoring in the field, or–basically–read this blog for any reason at all, you should check out a recent study in the Journal of Medical Internet Research. It warns about psychological and logistical factors that trip us up when we try to get patients to monitor their vital signs.

The paper has a catchier title than most: “You Get Reminded You’re a Sick Person”: Personal Data Tracking and Patients With Multiple Chronic Conditions (citation: J Med Internet Res 2015;17(8):e202). The paper summarizes results of a qualitative study, focused not on the purposes or benefits of monitoring, but on how patients react to it. The messages from the patients cited are pretty eye-opening.

Doctors and public health officials know very well that most people with chronic conditions suffer from more than one. Just thinking about their meds, visits to the clinic, bills to pay, and the ways the conditions constrain their lives is more than enough effort for most of the patients. And yet on top of that we pile glucose readings, weighings, diet logs, and other measures with joyful assurances that they will lead to improvement in the patients’ lives.

Monitoring can be depressing. You can glibly say that denial and avoidance is worse in the long run, but people need to get on with their lives in the face of debilitating conditions. So it’s not surprising that many patients wait until an acute phase of an illness (feeling faint, for instance) before they use the monitoring devices.

We like to think of data as empowering, and sometimes go even further to say that it introduces objectivity into a field like health that is fraught with wrong impressions. But monitoring does not allow patients to put emotional distance between their egos and their medical problems. Quite the opposite–monitoring raises moral issues that turn patients off. They can easily feel shame or guilt for departing from their diet and exercise regimes. Because the link between behavior and vital signs is often unclear, patients have all the more reason to get frustrated and abandon monitoring.

Data can also get between the patient and doctor, whittling away the trust and empathy that’s so necessary for clinical improvement. Patients get annoyed seeing doctors putting so much stress on the numbers, and perhaps not paying attention to extenuating circumstances or important non-quantitative information reported by the patient.

Still, the study reported successes too. Some patients seem to get into the spirit of living deliberately and taking control of their devices to achieve positive change. It’s not clear from the study what makes these patients succeed.

The authors recommend that we find ways technologies can reduce burdens on patients, not increase them. (Would be nice if technologies acted the same way on clinicians, although this goes unmentioned by the authors). The paper doesn’t offer ways to achieve this desirable outcome, except to automate data capture more effectively. We can imagine some other ways as well.

Perhaps patients could be asked to treat monitoring as a personal research project. How does my glucose go up or down during the hours after a certain kind of meal? Does pulse change after exercise? If you engage patients’ curiosity, they may turn into Quantified Selfers.

Regular messaging has also been shown improve compliance–for instance, in one study about medication adherence and another about appointment scheduling. Messaging should be done intelligently and be tailored to the patient. It may convey the clinician’s concern to the patient reward her for sticking to a monitoring regimen.

The health care field is crying out for more data. To get meaningful data–and meaningful results in health care–it must have more meaning for patients. This is perhaps the leading user experience (UX) challenge in health care.

Total Cost of Ownership (TCO) of EHR

Posted on September 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After teaching a two day EHR workshop in Dubai, I was particularly interested when I came across this whitepaper called Health Care IT: The Real (and Hidden) Costs of Ownership. I’d just talked for 2 days about the costs and benefits of EHR and so I was interested to see how this whitepaper aligned with what I’d been saying. Most of it aligned really well with what I’d taught them which was quite comforting.

However, there was one section of the whitepaper that was particularly interesting and I don’t think I covered it quite enough in my EHR workshop. This section covered what it called the “Opportunity Costs Not Accounted for in Current TCO Models.” Here’s what they think aren’t accounted for:

Standardization of Workflows
Increased efficiency, quality, fewer interruptions and distractions, better care coordination among providers.

Agility
Ability to quickly scale HCIT up or down as the organization evolves. Responsiveness to changes in reimbursement models, reporting and clinical requirements, and other regulations.

Compliance
Having the right reporting, data, and workflows in place to meet new mandates (e.g., Meaningful Use Stage 1 and Stage 2, ICD-10)

Integration
Ability to build effective, low-cost connections to clinical trading partners, labs, pharmacies, and other
third parties to exchange information; and to build and connect with mobile health applications

Adoption
With as much as 70 percent of health care providers dissatisfied with their EHR product, having a system that will encourage rapid adoption and provider satisfaction

I’d certainly covered some of these items tangentially, but it was interesting to frame many of these things as part of the total cost of ownership of an EHR. One thing I did hammer home in my EHR workshop was that you won’t be able to be a next generation healthcare IT company without an EHR. Many of the next innovations in healthcare are going to require an organization have an EHR. If you don’t have one, you won’t be able to benefit from these innovations. I’m not sure how you calculate that in your EHR ROI, but it’s going to be very valuable.

Algorithmizing Humans and Humanizing Algorithms

Posted on September 1, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While I think this is an extraordinary play on words, I don’t think either is a bad thing. In fact, I think both are good things. I don’t believe like some people that robots and AI are going to take over the world. I do think that robots and AI will become quite amazing and in some ways they already have.

Humans have flaws and algorithms have flaws. That’s just the nature of life.

The more I learn and talk about the future of EHR, the more excited I get about the power of technology to make healthcare better. My only sadness is that we haven’t gotten their faster. I want my vision of a smart EHR to become a reality everywhere. The technology is there. We just need to capitalize on it. I’m hopeful that we’ll do so in the next 5 years.

Awesome #HIT99 Profile Site

Posted on August 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Communities are amazing and that’s especially true of the healthcare social media community. For those who didn’t see it, we recently held the #HIT99 to recognize and thank those people who’ve been active in the healthcare social media community. You can see the official #HIT99 rankings listed here along with a number of other lists to help you find some interesting healthcare people on social media.

Steve Sisko (@shimcode) did all the massive work associated with collecting the nominations for the #HIT99 and he published the raw data for anyone to use. We both hoped that people would use that data to do cool things for the community. Luckily Don Lee (@dflee30) did just that when he created the #HIT99 List site. Here’s a description of how the #HIT99 site came to be:

A few weeks ago on the #HITSM chat a bunch of people were talking about how it would be nice to have a central blog site for the HIT99 list. I suggested a relatively easy way to do it. Rather than being the “here’s how we should do this” guy who then does nothing, I went ahead and built it. My goal is to provide an MVP that solves just the original problem – create a central place for the HIT99ers to tell us some more about what they do and more importantly, why they do it.

I love what he’s started, because it’s always fun to learn something more about the people behind the list. He’s started collecting people’s profiles (including mine) and he has details for how to update your profile if you’re on the list and haven’t sent over your info yet. Let’s all support Don and get our profiles updated.

Consumers Take Risk Trading Health Data For Health Insurance Discounts

Posted on August 28, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

When Progressive Insurance began giving car owners the option of having their driving tracked in exchange for potential auto insurance discounts, nobody seemed to raise a fuss. After all, the program was voluntary, and nobody wants to pay more than they have to for coverage.

Do the same principles apply to healthcare? We may find out. According to a study by digital health research firm Parks Associates, at least some users are willing to make the same tradeoff. HIT Consultant reports that nearly half (42%) of digital pedometer users would be willing to share their personal data in exchange for a health insurance discount.

Consumer willingness to trade data for discounts varied by device, but didn’t fall to zero. For example, 35% of smart watch owners would trade their health data for health insurance discounts, while 26% of those with sleep-quality monitors would do so.

While the HIT Consultant story doesn’t dig into the profile of users who were prepared to sell their personal health data today — which is how I’d describe a data-for-discount scheme — I’d submit that they are, in short, pretty sharp.

Why do I say this? Because as things stand, at least, health insurers would get less than they were paying for unless the discount was paltry. (As the linked blog item notes, upstart health insurer Oscar Insurance already gives away free Misfit wearables. To date, though, it’s not clear from the write-up whether Oscar can quantify what benefit it gets from the giveaway.)

As wearables and health apps mature, however, consumers may end up compromising themselves if they give up personal health data freely. After all, if health insurance begins to look like car insurance, health plans could push up premiums every time they make a health “mistake” (such as overeating at a birthday dinner or staying up all night watching old movies). Moreoever, as such data gets absorbed into EMRs, then cross-linked with claims, health plans’ ability to punish you with actuarial tables could skyrocket.

In fact, if consumers permit health plans to keep too close a watch on them, it could give the health plans the ability to effectively engage in post-contract medical underwriting. This is an unwelcome prospect which could lead to court battles given the ACA’s ban on such activities.

Also, once health plans have the personal data, it’s not clear what they would do with it. I am not a lawyer, but it seems to me that health plans would have significant legal latitude in using freely given data, and might even be seen to sell that data in the aggregate to pharmas. Or they might pass it to their parent company’s life or auto divisions, which could potentially use the data to make coverage decisions.

Ultimately, I’d argue that unless the laws are changed to protect consumers who do so, selling personal health data to get lower insurance premiums is a very risky decision. The short-term benefit is unlikely to be enough to offset very real long-term consequences. Once you’ve compromised your privacy, you seldom get it back.

Wearables Data May Prevent Health Plan Denials

Posted on August 27, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This story begins, as many do, with a real-world experience. Our health plan just refused to pay for a sleep study for my husband, who suffers from severe sleep apnea, despite his being quite symptomatic. We’re following up with the Virginia Department of Insurance and fully expect to win the day, though we remain baffled as to how they could make such a decision. While beginning the complaint process, a thought occurred to me.

What if wearables were able to detect wakefulness and sleepiness, and my husband was being tracked 24 hours a day?  If so, assuming he was wearing one, wouldn’t it be harder for a health plan to deny him the test he needed? After all, it wouldn’t be the word of one doctor versus the word of another, it would be a raft of data plus his sleep doctor’s opinion going up against the health plan’s physician reviewer.

Now, I realize this is a big leap in several ways.

For one thing, today doctors are very skeptical about the value generated by patient-controlled smartphone apps and wearables. According to a recent survey by market research firm MedPanel, in fact, only 15% of doctors surveyed see wearables of health apps as tools patients can use to get better. Until more physicians get on board, it seems unlikely that device makers will take this market seriously and nudge it into full clinical respectability.

Also, data generated by apps and wearables is seldom organized in a form that can be accessed easily by clinicians, much less uploaded to EMRs or shared with health insurers. Tools like Apple HealthKit, which can move such data into EMRs, should address this issue over time, but at present a lack of wearable/app data interoperability is a major stumbling block to leveraging that data.

And then there’s the tech issues. In the world I’m envisioning, wearables and health apps would merge with remote monitoring technologies, with the data they generate becoming as important to doctors as it is to patients. But neither smartphone apps nor wearables are equipped for this task as things stand.

And finally, even if you have what passes for proof, sometimes health plans don’t care how right you are. (That, of course, is a story for another day!)

Ultimately, though, new data generates new ways of doing business. I believe that when doctors fully adapt to using wearable and app data in clinical practice, it will change the dynamics of their relationship with health plans. While sleep tracking may not be available in the near future, other types of sophisticated sensor-based monitoring are just about to emerge, and their impact could be explosive.

True, there’s no guarantee that health insurers will change their ways. But my guess is that if doctors have more data to back up their requests, health plans won’t be able to tune it out completely, even if their tactics issuing denials aren’t transformed. Moreover, as wearables and apps get FDA approval, they’ll have an even harder time ignoring the data they generate.

With any luck, a greater use of up-to-the-minute patient monitoring data will benefit every stakeholder in the healthcare system, including insurers. After all, not to be cliched about it, but knowledge is power. I choose to believe that if wearables and apps data are put into play, that power will be put to good use.

Outsourced Medical Billing #KareoChat on Twitter

Posted on August 26, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On Thursday, August 27th at 9 AM PT (Noon ET), I’ll be hosting the #KareoChat where we’ll be discussing the good and bad of outsourced medical billing. You can follow along tomorrow on Twitter by watching the #KareoChat hashtag or by checking out my tweets on @ehrandhit.
Outsourced Medical Billing Twitter Chat
Here are the questions we’ll be discussing in tomorrow’s Twitter chat:

  1. Why are many practices choosing outsourced billing over in house?
  2. What are the disadvantages of outsourced billing?
  3. How will ACOs and value based reimbursement work with an outsourced billing company?
  4. How do you select a high quality outside billing company? What differentiates these companies?
  5. Does your outsourced billing company need to have tight integration with your EHR? Why or why not?
  6. What are the pros and cons of outsourcing your billing to your EHR vendor?

I’m particularly interested in people’s responses to question number 3. I think many in healthcare understand the good and bad of doing the billing in house or outsourcing it. Although, I’m pretty sure I’ll learn even more on the Twitter chat tomorrow. However, how things like ACOs and value based reimbursement will impact an outsourced billing company is still a really important topic of discussion. Will it drive more people towards outsourcing their billing or will it mean more practices bring their billing in house? I’ll be interested to hear people’s thoughts on tomorrow’s Twitter chat or feel free to start the discussion in the comments below.

Periscope and Healthcare – Healthcare Scene “Minute”

Posted on August 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last week I posted a question on EMR and HIPAA: Do You Periscope? I’m sure that many readers had no idea what periscope even is even though there are more than 10 million Periscope accounts created to date. After writing the post, the discussion about Periscope was hopping on Twitter and so I decided that it would be fun to try something new. I call it the Healthcare Scene “Minute”.

What’s the Healthcare Scene “Minute”? Well, I basically hop on Periscope and spend ~1 minute talking about a topic related to healthcare IT. Since doing the Periscope 21 hours ago, I’ve had 24 replay viewers and I had 38 live viewers. Not a bad start. You can view the video on periscope for the next few hours here.

What I realized when I started the Periscope is that many people would love to talk about something more than just the topic I planned to talk about for a minute or 2 (or 3 in the case below). So, for now the Healthcare Scene “Minute” periscopes I do will start with 30 seconds to a minute intro where people get a chance to join live. Then, I’ll talk for a minute on a specific topic. After I finish a quick look into a specific topic, I’ll stay on and answer questions from those who attend for as long as I have time.

In case you missed the live Periscope linked above, here’s a look at the chopped out Healthcare Scene “Minute” video where I talk about Periscope (seemed like an appropriate topic for my first Periscope):

In the Q&A that followed, someone asked an important question, How Can Periscope Be Used in Healthcare? Turns out in my Healthcare Scene minute (which wasn’t much time even at 3 minutes) I mostly talked about Periscope and how it fit in social media and video streaming and not how it applied to Healthcare. So, here’s my in the moment response to how Periscope can be used in healthcare:

I asked on Twitter if I should be consistent in my Periscopes. I decided that I’d be consistently inconsistent. Although, I’m already planning to do the next Healthcare Scene “Minute” today where I’m going to talk about the cost of Epic (Update: Here’s a link to the Periscope stream I did today. I forgot to hit the save button and so it will be gone after 24 hours. Lesson learned!). Hopefully I’ll see you on Periscope.

Accenture: “Zombie” Digital Health Startups Won’t Die In Vain

Posted on August 24, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I don’t know about you, but I’ve been screaming for a while about how VCs are blowing their money on questionable digital health ventures. To my mind, their investment patterns suggest that the smart money really isn’t that smart. I admit that sorting out what works in digital health/mHealth/connected health is very challenging, but it’s far from impossible if you immerse yourself in the industry. And given how much difference carefully-thought out digital health tools can make, it’s exasperating to watch failing digital health startups burn through money.

That being said, maybe all of those dollars won’t be wasted. According to no less an eminence grise than Accenture, failing digital health ventures will feed the stronger ones and make their success more likely. A new report from Accenture predicts that these “zombie” startups — half of which will die within two years, it says — will provide talent and technology to their surviving rivals. (OK, I agree, the zombie image is a bit unsettling, isn’t it?)

To bring us their horror movie metaphor, Accenture analyzed the status of 900 healthcare IT startups, concluding that 51% were likely to collapse within 20 months.  The study looked at ventures cutting across social, mobile, analytics, cloud and sensors technologies, which include wearables, telehealth and remote monitoring.

While most researchers try to predict who the winners will be in a given market, Accenture had a few words to say about the zombie also-rans. And what they found was that the zombies have taken in enough cash to have done some useful things, collecting nearly $4 billion in funding between 2008 and 2013.

The investments are part of an ongoing funding trend. In fact, digital health dollars are likely to pour in over the next two years as well, with healthcare IT startups poised to take in $2.5 billion more over the next two years, Accenture estimates. Funding should focus on four segments, including engagement (25%), treatment (25%), diagnosis (21%) and infrastructure (29%), the study found.

So what use are the dying companies that will soon litter the digital health landscape? According to Accenture, more-successful firms can reap big benefits by acquiring the failing startups. For example, healthcare players can do “acqui-hiring” deals with struggling digital health startups to pick up a deep bench of qualified tech staffers. They can pick up unique technologies (the 900 firms analyzed, collectively, had 1,700 patents). And acquiring firms can harvest the startups’ technology to improve their products and services lineups.

Not only that — and this is Anne, not Accenture talking — acquiring healthcare firms get a wonderful infusion of entrepreneurial energy, regardless of whether the acquired firm was booking big bucks or not. And I speak from long experience. I’ve known the leaders of countless tech startups, and there’s very little difference between those who make a gazillion dollars and those whose ventures die. Generally speaking, anyone who makes a tech startup work for even a year or two is incredibly insightful, creative, and extremely dedicated, and they bring a kind of excitement to any company that hires them.

So, backed by the corporate wisdom of Accenture, I’ve come to praise zombies, not to bury them. While they may give their corporate lives, their visions won’t be wasted. With any luck, the next generation of digital health companies will appreciate the zombies’ hard work and initiative, even if they’re no longer with us.

Experiences Crafting a New API at Amazing Charts

Posted on August 21, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A couple months ago, Amazing Charts announced an upcoming API for their new electronic health record, InLight. Like athenahealth, whose API I recently covered, Amazing Charts is Software as a Service (SaaS), offering its new EHR on the Web.

The impetus toward an API wasn’t faddish for Amazing Charts; they had a clear vision of what they wanted to achieve by doing so. They found that their interactions with various health care providers–payers, labs, radiologists, and others, along with accepting medical device data–has been hampered by reliance on common standards that involve HL7 messaging and EDI. The HL7 standards are inconsistently implemented and EDI is non-standardized, so each interface requires weeks of work.

I talked to Prayag Patil, product manager of patient engagement solutions at Amazing Charts. (They also offer patient portals to the institutions they serve.) For all their data exchanges, he said, they expect a RESTful API to provide standardization, speed, and simplicity in implementation. It should also be more suited to quick, fine-grained data transfers.

One of the common complaints of the older HL7 standards such as the CCD-A is that they are monolithic. EHR vendors and healthcare providers shove a lot into them without deciding what the recipient really needs. As Patil says, “it makes the 80% use case hard to do.” Nor is the standard used consistently by all correspondents (labs, practice management systems, devices, etc.), so extracting what’s really important at the receiving end is harder.

They’ve found that sluggish exchange has real effects on patient safety. For instance, a set of lab results, medications, and other information from a hospital discharge should be available immediately. If you wait, the patient their primary care provider won’t have it just after discharged, when its value is often critical, and the patient might lose interest and not bother to look at it later.

Amazing Charts, like athenahealth, also recognizes the value of a third-party marketplace. Patil says that innovation tends to “come from the smaller, scrappier vendors” that are enabled to produce useful apps by open APIs. The company already has a third party marketplace for apps in care coordination, revenue cycle management, patient engagement, and other tasks. But up to now the APIs weren’t published, so their developers had to work individually with any vendor who came to them, offering tools and the help needed to integrate with Amazing Charts’ service.

The company plans to introduce a patient engagement platform that will be open and accessible, with a focus on using standardized RESTful APIs to enable third party app developers to offer solutions. The company also plans to increase participation by creating thorough documentation for the APIs, and standardizing them. They are looking forward to standards such as FHIR, SMART-on-FHIR, and OpenID/OAuth, which are better specified and more consistently implemented than the currently available interfaces.

Here are the lessons I draw for others who are looking enviously at projects with APIs: going forward without all the pieces in place will be like driving on one flat tire. You just won’t get the results that you hoped for when investing in the project.

I applaud Amazing Charts for taking the difficult first steps toward API access, and doing it with good goals in mind. Their experience shows that an open API is still a hard process to get going–even as more and more companies take the leap–and one that calls for coordinated efforts throughout the organization in software design, publicity, documentation, and support.