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The New Rules of Healthcare Platforms: APIs Enable the Platforming of Healthcare

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BY VINCE KURATIS, BRENDAN KEELER, and JODY RANCK

Recent regulations have mandated the use of HL7 FHIR APIs (application programming interfaces) to share health data. The regs apply to healthcare providers, payers, and technology developers who participate in federal programs. Many incumbent healthcare organizations are viewing these mandates as a compliance burden. That’s short-sighted. We recommend a more opportunistic POV.

APIs facilitate the sharing of health data across different devices and platforms. By adopting APIs, healthcare organizations can transform themselves from traditional service providers into powerful platforms that can connect patients, providers, and other stakeholders in new and innovative ways.

This blog post is the fourth in the series on The New Rules of Healthcare Platforms. In this essay, we explore the many benefits of API adoption for healthcare organizations and the key considerations that must be taken into account when implementing APIs:

  • Healthcare’s Data Inflection Point
  • APIs Enable Platform Business Models
  • Barriers, Challenges, Reality Check

Healthcare’s Data Inflection Point

Compared to other industries, healthcare generates a disproportionately large amount of data. According to RBC Capital Markets, “30% of the world’s data volume is being generated by the healthcare industry. By 2025, the compound annual growth rate of data for healthcare will reach 36%. That’s 6% faster than manufacturing, 10% faster than financial services, and 11% faster than media & entertainment.”

Over the past 15 years, new regulations have driven digitization, data interoperability, and data sharing. The goal of regulations has been to liberate patient data that has previously been unstructured and trapped in patient silos. Venture capitalist Kahini Shah summarized these regulatory efforts in her article entitled Healthcare Data APIs – An Upcoming Multi-Billion Dollar Market?:

Recent regulation is forcing digitization, aggregation and transmission of medical records. Congress passed the HITECH Act in 2009, prompting the adoption of electronic health records. Before that medical records were paper based. Healthcare data is incredibly siloed, every American sees an average of 19 providers in their lifetime. Connecting these disparate electronic systems and having them exchange information is called interoperability. In 2020, the HHS and CMS implemented two rules that mandate patient access to their medical records and interoperability. These transformative rules give patients the right to access their data when they need and make it available via APIs. The interoperability rules state that there is no blocking – EHRs must allow data to be shared easily across different systems owned by different vendors.

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Forget Micro-Networks: How Avaneer Health is Building The One Health Data Exchange to Rule Them All

By JESSICA DaMASSA, WTF HEALTH

What BIG thing is Avaneer Health building with its $50 million SEED round backed by not-just-investors-but-also-partners CVS Health, Aetna, Anthem, Cleveland Clinic, HCSC, PNC Bank, Sentara Healthcare and IBM Watson Health? CEO Stuart Hanson stops by to clear-up the mystery that IS Avaneer Health, and how the massive data exchange platform it’s building is meant to connect the data coming out of the biggest payers and biggest providers in healthcare, directly and in real-time.

Hang on – is this the blockchain-based data exchange healthcare has been talking about for more than a decade?? It sure is trying to be. And what Stuart says is different about Avaneer’s effort is, indeed, the fact that it’s backed by some of the biggest brands in the business and that they see the business case in being able to more effectively share their data with one another. As he explains it, “this problem of data interoperability and data fluidity is bigger than any competitive business model that they need to worry about…”

Stuart is careful to explain what Avaneer IS and what it IS NOT, and this is critical to the company’s growth plans and revenue model. Avaneer is NOT a data intermediary; it’s not about aggregating data, normalizing it, de-identifying it, or applying any fancy machine learning algorithms to it to deliver “insights” on it. Avaneer is strictly a platform for secure, compliant data exchange, so, for example, Anthem can connect to Cleveland Clinic in real-time and verify insurance coverage. The revenue model is currently built around access to the network and will one-day-soon also take in fees from ‘Solutions Innovators’ (aka data-aggregating, algorithm-loving, insights-dropping health tech companies) that will offer their services as add-on’s to Avaneer’s customers who are plugged into the network.

What’s ahead for this stealthy start-up as it scales? Could they REALLY be looking to raise a follow-on seed round?? Find out what kind of investors they’re looking for and what’s ahead on their product roadmap in this in-depth chat.

The Sovereignty Network will help patients make money out of your health data

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By HAMISH MACDONALD 

Being a patient has always meant being at the bottom of a trickle-down pyramid in healthcare. Late to get information, our test results, our data, and as for earning the money that our healthcare data is worth – that is something the healthcare industry does without our permission or dues. We are left right out of that.

But what if we made clinical data tools available on your device, so that you could build the most valuable set of healthcare data that exists about you anywhere? What if you owned that particular data set as your personal asset? Well, we think that researchers are going to want access to it – and pay you for that access.

Not only that, how valuable would it be to have the most complete and accurate healthcare data set available about you under your ownership and control? How can you expect a doctor or yourself to reach the best conclusion with incomplete information about your health?!? Frustration, confusion, anxiety and poor health outcomes are often the result.

How The Sovereignty Network empowers you to build your own healthcare data set

Building the most valuable data set about you, for you, is what we have done at The Sovereignty Network. We elevate you as a patient to be a Data Owner. There are 4 easy steps to becoming a Data Owner and earning what your data is worth – and having a complete and accurate set of your healthcare data on hand for your peace of mind.

  1. We have clinically coded simple to answer FHIR and SNOMED CT questionnaires that cover the entire spectrum of your health. We call it “DCPLEG”. By filling out questionnaires in your personally owned and secure profile that represent your Demographic, Clinical, Psychosocial, Lifestyle, Environmental and Genomic data you paint a complete 360 degree view of your health.
  • Where Clinical data sets are also available, such as in the US via the newly implemented Patient API rule, you can also add your clinical data from your healthcare providers. The spread of the FHIR data interoperability standard around the world makes this increasingly feasible to accomplish.
  • Data Researchers are able to sit at their desktop and specify the precise criteria that they are looking for (anonymized, of course) using the same clinical codes that you and others have already filled out in your health profile above. E.g. Age, sex, condition(s), medication(s), procedures, deeper demographic information, environmental, lifestyle, psychosocial markers, etc. Through partners even individual base pairs within a whole genome can be specified. Through the Sovereignty Network they can then make you an offer that you can’t refuse, as it were. If you agree to the offer, only then can they make contact with you with their survey they invite you to complete.
  • We have invented a new class of work we call the “Data Coach” that works rather like the synaptic fluid between joints but here between the Data Researcher and you as the Data Owner. A Data Coach is a vetted healthcare professional / healthcare data expert who verifies on your behalf the specific criteria needed by the Data Researcher. If a Researcher is willing to pay you, say, $100 to fill out a 20-minute survey because you fit their desired set of criteria, you are probably willing to pay some fraction of that to qualified Data Coaches to verify the criteria. (And once verified, criteria likely don’t need to be verified for another Data Researcher).

Turning your data set into licensable income – or donating it to causes you support

Because you and only you own the copy of your healthcare data that you have built – your record, or specific parts of it, is now licensable.

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Clarify Health Solutions’ CEO on Data Analytics Startup’s Next Trick: Value-Based Payments Tech

By JESSICA DaMASSA, WTF HEALTH

Turns out, the Clarify Health Solutions story is about a lot more than data and analytics these days. Value-based payments? Acquisition of provider-focused, behavioral science startup Embedded Healthcare? Opportunities in real-world evidence??

Good thing founder & CEO Jean Drouin and I caught up at ViVE 2022. Not only do we get into the backstory of the business, which has built a self-service analytics platform for payers, providers, and life science co’s on top of “one of the largest-ever patient datasets” in the industry, but we also talk about the strategy that’s driving Clarify into the world of value-based contracting and how Embedded Healthcare’s tech will be used to augment and refine that new offering.

Jean talks in detail about his client mix, business model, and the two “healthcare golden rules” Clarify lives by as it scales up its business: 1) figure out how the payment method is going to work and 2) don’t mess with the work-flow.

Jean Drouin, Clarify Health, on the new data stack.

By MATTHEW HOLT

Clarify Health has linked (but anonymized) data on about 300m Americans, including their claims, lab, (some) EMR data and their SDOH data. They then use it to help providers, plans and pharma figure out what is going on with their patients, and how their doctors et al are behaving. CEO Jean Drouin, a French-Canadian who incidentally at one point ran strategy for the NHS in London, explained to me what Clarify does, how it’s going to help improve health care, where these data products are going next–and why they needed to raise $116m in March to build it out. Jean thinks about creating a single source of truth, and I asked him a couple of tricky questions about whether his customers would want to know the answer. A fascinating discussion. (Full transcript below)

Matthew Holt:

Hi, Matthew Holt here with another THCB Spotlight. And I’m with Jean Drouin, who has a French Canadian name, but is an American who’s lived in London–a bit like me–who is the CEO of Clarify Health. So Jean, Clarify Health is one of the new startups. You guys raised over a $110 million a couple of weeks back, which I guess is a small round these days considering what everyone else is doing.

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If It Ain’t Real Time, It Ain’t Really Real

By KIM BELLARD

Here’s a damning opening paragraph from an article in The New York Times about the frustrations that COVID-19 vaccinations are causing:

For a vast majority of Americans, a coronavirus vaccine is like sleep for a new parent: It’s all you can think about, even if you have no idea when you will get it.

Because, as Kaiser Health News reported: “Many states don’t know exactly where the doses are, and the feds don’t either.” 

Think about that: in 2021, we can’t – or don’t – track something as vital as where vaccine doses are, in the midst of the pandemic they were designed in record time to mitigate. Nor, as it turns out, are we doing a good job of tracking how many have already had them, who is now eligible for them, or assuring that essential workers or disadvantaged populations are getting them. 

Amazon tells me when my purchases have shipped, where they are in the shipping process, and when they’ve been delivered.  They even send me a picture of purchases sitting on my porch to make sure I notice. Walmart’s supply chain management is equally vaunted. 

Health care executives evidently aren’t required to learn supply chain management. 

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How Can Patients Get Medical Records from a Closed Medical Practice?

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By GRACE CORDOVANO, DEVEN McGRAW, and AARON MIRI

The HIPAA Privacy Rule gives patients the right to copies of their medical records, with rare exceptions. When patients need a copy of their medical records, most start the process by calling their doctor’s office and asking for how to get access. The receptionist or office staff point them in the right direction, whether it’s instructing them to write down their request and sending it to the office, pointing them to contact the medical records or radiology department (if the practice is large enough), or assisting them in setting up their patient portal, if the practice is using an electronic health record (EHR). Being able to connect with a person inside the four walls of medicine is often crucial for many patients and their carepartners who may be unsure of exactly how to request their records.

But what happens to those records when a doctor closes or leaves the practice?

Independent practices close for a variety of reasons. Physicians may merge with a large practice or health system, retire, they may sell or close their practice for personal reasons, they may file for bankruptcy, or they may get sick and die. The COVID19 pandemic has had devastating financial consequences on many small, independent, and rural practices, leading to their consequent closure, acquisition, or merger.

What should patients do when their doctor’s office closes, and they need a copy of their medical records? This is especially challenging when a doctor may not have had an EHR, as is the case with many independent practices as well as more rural settings. On September 26, 2020, a tweet from Cait DesRoches, Executive Director of OpenNotes, inquired about how a family member may get access to medical records from her physican’s practice that closed, triggering a robust conversation that led to the realization that patients and families are not well informed in these circumstances.

Prevention is Worth a Pound of Cure

It can be much more difficult to get copies of records after a practice has closed. Patients should get copies of their medical records as they are generated instead of waiting until they’re needed. HIPAA Privacy Rule guidance states that individuals can get digital copies of digital information (or even digital copies of records kept on paper, as long as the practice has a scanner). Companies are developing tools and services that enable individuals and their care partners to collect, use, and store health records. Request digital (or paper, if that is preferred) copies of blood work, imaging, discharge instructions, and corresponding reports before you leave the practice.

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COVID-19 is Bringing Data Privacy into the Spotlight – This is How Healthcare Companies Should Respond

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By DAN LINTON

Privacy concerns across the country continue to increase, and consumers expect their healthcare information to be private. Headline-making data sales, skepticism of Silicon Valley privacy practices, and COVID-19 contact tracing concerns compounded with a general lack of consumer awareness have continued to generate an ongoing storm ofnegative press and political scrutiny.

With COVID-19 continuing to rampage throughout the country, there is a need for the contact tracing and other technology applications to assess public health. At the same time, changing HHS rules are giving Americans more access and control over their own health data. Both availability and the promise of positive impact of data on people’s lives has never been greater.

Despite the critical need and incredible potential, there is still a great deal of confusion, lack of awareness and heightened concern among consumers. Studies show that the vast majority of Americans think the potential risks of data collection outweighs the potential benefits.

Clamping down on data privacy stifles innovation, and moving forward as we’ve been doing presents a potential privacy minefield. So, what should the healthcare industry do about it?

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Is Covid-19 the Argument Health Data Interoperability Needed? | WTF Health

By JESSICA DAMASSA, WTF HEALTH

“This pandemic highlights why we need that free flow of healthcare data. So that we can make better decisions sooner.”

In the way that Covid-19 has proven the utility of telehealth as a means for health systems to reach their patients, has the pandemic also become the final argument for healthcare data interoperability? Has this pandemic been the worst case scenario we needed to make our best ‘case-in-point’ for why U.S. healthcare needs a national health data infrastructure that makes it possible for hospitals to share information with one another and government health organizations?

Interoperability advocates have been clamoring for this for years, but Dan Burton, CEO of data-and-analytics health tech company, Health Catalyst, says this public health crisis has likely created an inflection point in the interoperability argument.

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A Patient’s View of the Cures Regulations

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By ADRIAN GROPPER, MD

How should we react to 1,718 pages of new regulation? Let’s start by stipulating the White House and HHS perspective: 

“Taken together, these reforms will deliver on the promise to put patients at their center of their own health care — you are empowered with control over your own health care choices.” 

Next, let’s stipulate the patient perspective via this video lovingly assembled by e-Patient Dave, Morgan Gleason, and the folks at the Society for Participatory Medicine. In less than 3 minutes, there are 15 patient stories, each with a slightly different take on success.

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