How Stalled Obamacare Debate Could Hinder Healthcare API Progress

As issues that dominate the mainstream headlines go, there is perhaps no single issue that is more dominant than the desire of Republican politicians, from President Trump to the US Congress, to enact some sort of sweeping change or repeal of the American Affordable Care Act (aka Obamacare). Perhaps immigration and North Korea run a close 2nd or 3rd.

Through various business press, I learned of how the uncertainty was wreaking havoc on insurance companies that are pulling their hair out because of the lack of guidance they're getting when it comes to pricing their plans. But until today, I had not stopped to consider how lack of resolution with respect to the Obamacare conversation might negatively impact the API economy. That is, until I read this article from (DeSalvo: Healthcare data remains "very highly blocked").

As the headline suggests, despite many superhuman efforts to break down the silos that exist between dissimilar EHR (Electronic Health Records) systems with an eye towards significantly better outcomes for patients, huge barriers still exist when it comes to the democratization of healthcare data. Karen DeSalvo is the former head of the Office of the National Coordinator (ONC) for Health Information Technology; a Branch of the US Government's Department of Health and Human Services whose mandate dating back to the Obama administration was to seek better interoperability among the many disparate EHR systems. 

Somewhat serendipitously, competitor also published a story that extolled the virtue of APIs in removing those barriers (APIs: A remedy for Integration, innovation barriers). As editor-in-chief of ProgrammableWeb, I've seen the value proposition of APIs articulated hundreds of different ways. But in the context of EHR (and from that article), I thought this was a rather prescient description of the complexity of the problem and the efficacy of APIs:

Indeed, APIs are revolutionizing data sharing by making it possible to bridge legacy IT systems of record, such as electronic heath records (EHRs), with modern systems of digital engagement, such as mobile apps. Consider the following: The typical diabetes patient has information stored in the EHRs of various providers including their primary care physician, endocrinologist, ophthalmologist, podiatrist and others. In addition, many diabetic patients are now collecting personal health data – fitness, diet and blood sugar levels – via smartphones and remote monitoring devices.

One thing this benefit statement doesn't touch on however is the potential for EHR interoperation (by API or any other efficient means) to chip away at the financial burden associated with the healthcare system. In other words, not only does better interoperation harbor the possibility of improved healthcare, but it could do so at a drastically reduced cost to all stakeholders. As a percentage of the United States Gross Domestic Product (GDP), healthcare costs reached an epic 17.8% with the US government shouldering most of the burden (and greatly outstripping the same statistic for other Western nations). Inefficient record keeping and data portability of the sorts that could be greatly improved through API adoption is no doubt a key factor in any attempt to reduce those costs.

DeSalvo, who left her post at the ONC after the presidential election, alluded to other subtleties in cost containment when, according to, she said "As we move into this really intense era of cost containment in the country, the more access we have to the clinical information about outcomes is going to be so necessary because we’ll have to understand if the interventions are actually improving health—not just reducing utilization."

That and other notable comments backed up DeSalvo's opinion that EHR data is still very much "blocked" from freely flowing from wherever it currently resides to wherever it needs to go (for example, from your primary care physician to your endocrinologist). One bit of silver lining in an otherwise highly negative news cycle is that her Trump-appointed successor Donald Rucker appears to be pro-API, having said "You look at Silicon Valley, you look at modern computing, it's all about APIs.”

But the comments that caught my eye came at the end of the article where she noted how the uncertainty around Obamacare was also hindering progress. If Obamacare is repealed or significantly rewritten, DeSalvo is concerned that loss of care (due to increased costs or loss of coverage because of how insurance companies could refuse patients with pre-existing conditions) will result in a dearth of desperately needed data.

One example might simply be the loss of data that results from fewer medical visits. But another example, according to DeSalvo, happens when patients who are concerned about losing coverage due to a pre-existing condition fail to disclose those conditions. Such a failure to disclose means less data in the system which could impede improved healthcare, not just for the patient, but for other patients in similar predicaments whose data in aggregate might expose more effective treatments. Finally, another concern connected with the Obamacare debate has to do with the possibility that healthcare facilities will face increased costs which in turn might deprive their IT budgets of the funding that's necessary to implement forward looking technological improvements such as APIs.  So long as the outcome of the debate is viewed as a financial unknown for hospitals and other treatment centers, they are more likely to tighten their belts until they have better visibility into the impact of any new legislation. 

Meanwhile, as our democracy appears to be in a bit of a crisis given the lack of bipartisanship in Washington, DC, so too might any current hope to democratize our healthcare data anytime soon.

Be sure to read the next Healthcare article: How Hospital Administrators Are Obstructing Medical Record Exchange APIs