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Prakash Chandran (Host): MetaStar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Promoting Interoperability Program, as well as Behavior Health Technical Assistance Initiative. MetaStar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's regional extension center since 2010 and continues to provide attestation assistance and audit preparation as a consulting service.

We're joined today by Jason Suchon, a Public Health Registry Project Specialist at MetaStar. And he's going to be sharing information about how APIs are the future of health IT interoperability. This is a MetaStar Health IT Radio, the podcast from MetaStar. My name is Prakash Chandran. And so Jason really great to have you here today.

You know, over the last 10 years, there's been a lot of changes in the healthcare industry with regards to interoperability. I'd love for you to recap some of these changes and maybe give us a perspective of where interoperability is going forward from this point.

Jason Suchon (Guest): Thank you for having me Prakash. Both the Meaningful Use Program, as well as the Promoting Interoperability Program, that was utilized by the electronic healthcare record systems, that hospitals and providers are utilizing, has expanded interoperability in several different aspects. There is patient portal access where patients have access to their records.

There's direct secure messaging which allows providers to communicate back and forth with each other about a specific patient and do care management together for that one specific patient. One of the newest things is information blacking. It allows more free use of healthcare information being transferred from one system to another, or a specific patient.

And then one of the biggest things that has been ongoing thing has been Public Health Registry. Those have been really big and specific to the COVID-19 response. There's electronic lab reporting that is being reported to the state systems, immunization registry information, syndromic surveillance systems, there's case reporting systems and cancer reporting systems.

Moving forward, the Cares Act that was put together recently, will work on advancing interoperability initiatives going forward. They want more free and healthcare availability to be able to be exported out of the EHR. So, it can be utilized by the patient, or it can be transferred to another health system, if it needs to be.

The other thing that is moving forward will be standardizing API development across the electronic healthcare record systems. And that is utilizing fast healthcare interoperability resources also known as FHIR in two distinct approaches, a single patient data focus and a multiple patient data focus.

Host: Yeah, that sounds fascinating. So I'd love to talk a little bit more about the dynamics of how data is transferred between these systems using the API that you're talking about. And maybe let's just start with a high level definition of what an API is.

Jason: So an API stands for application programming interface, and it is a software intermediary that allows two different systems to talk to each other. APIs have been around for quite a while, actually in many other industries. I'll give you an example. The airline industry, when you go to purchase an airline ticket, you go to a specific broker essentially like Expedia or Travelocity or, some kind of broker in order to find your flight from point A to point B. When you do that, it is using an API to call out to all of the airline industries to say, do you have flights for this? And do you have space? And what is your cost? That is what an API is doing, is it's pinging all of those airline carriers for that information.

And then it's providing it back to you. So, that is what an API essentially does. FHIR has recently been developed to utilize as a standard in the electronic health care industry and standardizes the data and the formatting of that data and the sharing and receiving of that information in the healthcare industry, across all systems, using that similar API structure that the airline industry is using as an example.

Host: Yeah, that is fascinating. And I guess just a quick point of clarity is FHIR these standards that you're talking about, is this being done also retroactively or is this just being enforced for new systems moving forward?

Jason: So, HL7 was the technology that used to be used and probably still be used in the future in order to connect devices and systems together, and exchange information between systems. FHIR is a newer technology that is being able to easily transfer information and is more easily being developed to expand more rapidly with the new technologies that are coming out. You have remote patient monitoring systems. You have the Smart Health QR codes that are coming out that are expanding interoperability between systems at a rate that is faster than what other industries are seeing at this point.

Host: Yeah, this change really does sound like it's something that is very important and I can already off the top of my head, think about a couple different use cases, but I wanted to kind of look at it through the lens of the patient. Because these systems can now talk to each other in a standardized way, I imagine that patients will have their information accessible across providers. For the first time, they're really going to be able to own their health information and have that portability. Is that something number one, that's correct. And number two, can you give us other examples where these APIs might benefit the patient?

Jason: Yes, that's what APIs are supposed to be used for it. The patients are supposed to have access to their information and it allows easy transfer of information back and forth between the patient and the provider or the provider to provider, essentially. When it comes down to it, from a patient perspective, some of the remote patient monitoring stuff that you don't even think about, is occurring a lot. You have your fitness trackers, you know, your Fitbits or, other technology that you might be wearing, the wearables, right? You have blood pressure monitoring, you have blood glucose monitoring systems. You have insulin pump monitoring, you have sleep apnea machines that are out there that are all monitoring things that are specific to your health and all of that information can be transferred back to your provider and your provider can use that information to give you additional things that you might want to do in order to lower your blood pressure, lower your blood glucose, see how you are adjusting to a medication for the most part.

The other thing is, is the Smart Health QR Codes which is very interesting technology as well. Essentially, what it's doing is it's taking your information. So, let's say you sign up for an appointment, you get this QR code, you take it into your appointment, the registration people can scan your QR code and say, oh yeah, this is Jason. He's here for his appointment. And then it can give you information back saying, okay your appointments on the second floor or something. So that technology is also being used. When it comes back to COVID essentially, negative COVID test results are also available in those Smart Health QR codes.

So, the event industry, like going to a football game or going to a concert or something like that, having a negative test result is something that might be a required and using the Smart QR Health Code, essentially you would have that scanned at the event and they would be able to say, yes, you're negative. You can attend the event. So, those are some patient perspective examples of where these things are being utilized.

Host: That is just so cool. What about the administrative staff? How might they benefit from these APIs?

Jason: So the administration staff, like I gave you the example of the Smart Health QR Codes, you know, it gives you a physical distance from a person when you are scanning someone in to verify that they're there for their specific appointment. Another thing is, is like hospital bed occupancy planning, right? So when the pandemic came about, there was, FHIR actually was utilized for that kind of occupancy reporting to be able to say, okay, how many ICU beds do we have within our state. A FHIR protocol was set up in order to be able to communicate that information to the state to say oh, we got 300 ICU beds available.

Our emergency department has X amount of beds. Our regular occupancy has this amount of beds. So, you could kind of see where things were going in regards to the hospital occupancy, in regards to the pandemic response and that was fastly developed so that it could be easily communicated from a hospital system to the state so you could get updates on a daily basis is what we were seeing. There's also equipment monitoring that happens, kind of like an asset management system. So, if an administrative staff is looking for a wheelchair or something, you can put a device on the wheelchair to essentially track it throughout the hospital, to say, okay, we've got 20 wheelchairs available to be used, and then being able to know where those wheelchairs are throughout the facility, if you needed.

Host: Yeah, that is amazing. So, you know, we've talked about the API benefit and some examples for the patient, for the administrative staff, but what about the healthcare provider? What are some examples of where APIs can assist them?

Jason: So from a healthcare provider perspective, there's a couple of different ways that things are expanding and being used. One example is the growth chart. When you went in as a kid, essentially, you had this growth chart that told you where you were height-wise or weight-wise in regards to your age and the individuals who might be in your class or might be the same age as you. Essentially, what can be done is API call could be sent over to your EHR system and get you that summary data to show you an individual who might be at the top of the list an an individual who might be at the bottom of the list and then give you that average essentially. So, you see the growth curve of you over time, and then it's comparing the summary information that you see from other individuals essentially. So, that's one example.

Another example is using artificial intelligence. That's a big term that's being used by everyone has been used for quite a while for clinical decision support. And when it comes down to it, artificial intelligence is being used to kind of derive those clinical decisions that are being done by a health care provider and giving them evidence-based information on what best treatment to work with someone on, specifically. And then another thing is, is that patient healthcare record transfers. That's one of the key pieces too. If I am going from provider A to provider B, transferring my record from provider A to provider B is really important.

And we are a mobile society, not everyone lives in the same place, all their life. So, when it comes down to it, being able to take your record with you to your next location that you're moving to, is very important to be done.

Host: So just before we close here today, Jason, are there any other places that you can see healthcare APIs potentially being utilized down the road?

Jason: Outside of a primary care realm and health care, there are some other avenues that I see expanding. Population health is one area. Assessing similar individuals through artificial intelligence for best treatment options. That's how population health can use APIs potentially. Public health identifying like specific major disease outbreaks to be able to isolate and minimize the outbreak is really important.

So, that's something that we've actively seen recently, right? Clinical quality measure reporting, reporting specific measures that your health care facility needs to adhere to from a federal or state perspective and being able to automatically potentially report that stuff to the state entity or the federal entity or any society that you may be a part of as a provider. Social determinants of health, that's one of the big areas that a lot of people have been talking about. And when it comes down to it, it ends up being where a individual might be able to find food, housing, or access to transportation. Right? So, from a healthcare perspective, a different lens has to be put on social determinants of health.

And when it comes down to it, those three things could potentially be integrated somehow with the health care system to say, okay, you can go here to get food. You can go here to possibly get housing and we can assist you with transportation in some kind of method. That's something that could be utilized. You have employee health programs that are being developed, right. Where they're giving you incentives to specifically go out and get your 10,000 steps a day, you know, for the most part or 30 minutes of physical activity and they want to track those things. So, that's something that employee health programs might use.

And then you have the payers and insurance side, right? So your insurance might be similar to employee health program saying, hey, we want you to get 10,000 steps a day and hey, your insurance might be a little lower if you do that. When it comes down to it, payers and insurers are probably going to want to utilize this technology as well.

When it comes down to it, the patient, what the patient will get out of the payer and insurance stuff is maybe more visibility into what it's going to cost for specific procedure to be conducted on them, if they have to have a surgical procedure of some sort or whatever. So, that's where I see things coming down the road.

And things are expanding quite a bit when it comes down to APIs and what the health care industry is being utilized for in the future I'd say.

Host: Well, Jason, definitely an exciting future to look forward to with everything that you're talking about. Any final words before we close here today?

Jason: Well, I want to thank you for having me on the podcast today. And I'm really excited to be able to come back and talk about these topics. It's something I'm really passionate about and MetaStar is really passionate about. So, moving things forward in this technology aspect of things is very exciting and things are moving in a fast manner. So, don't be surprised if you don't see this happening at your facility sometime soon.

Host: Well, that sounds great. Jason, thank you so much for your time again.

Jason: Thank you.

Host: That's Jason Suchon, a Public Health Registry Project Specialist at MetaStar. Thanks for checking out this episode of MetaStar Health IT Radio. For more information on this topic and to access the resources mentioned, please visit metastar.com/podcast. That's M-E-T-A-S-T-A-R.com/podcast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name is Prakash Chandran. Thank you so much for listening and we'll talk next time.