Neinstein Aaron, Thao Crishyashi, Savage Mark, Adler-Milstein Julia
Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, United States.
J Med Internet Res. 2020 Apr 3;22(4):e16813. doi: 10.2196/16813.
Health systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions.
This study sought to ascertain health systems' understanding, strategies, governance, and organizational infrastructure around patient-facing APIs, as well as their business drivers and barriers, to facilitate national learning, policy, and progress toward adoption.
We performed a content analysis of semistructured interviews with a convenience sample of 10 health systems known to be leading adopters of health technology, having either implemented or planning to implement patient-facing APIs.
Of the 10 health systems, eight had operational patient-facing APIs, with organizational strategy driven most by federal policy, the emergence of Health Records on iPhone, and feelings of ethical obligation. The two priority use cases identified were enablement of a patient's longitudinal health record and digital interactions with the health system. The themes most frequently cited as barriers to the increased use of patient-facing APIs were security concerns, an immature app ecosystem that does not currently offer superior functionality compared with widely adopted electronic health record (EHR)-tethered portals, a lack of business drivers, EHR vendor hesitation toward data sharing, and immature technology and standards.
Our findings reveal heterogeneity in health system understanding and approaches to the implementation and use of patient-facing APIs. Ongoing study, targeted policy interventions, and sharing of best practices appear necessary to achieve successful national implementation.
卫生系统最近开始启用面向患者的应用程序编程接口（API），以方便患者获取健康数据及进行其他交互。
本研究旨在确定卫生系统对面向患者的API的理解、策略、治理和组织架构，以及其业务驱动因素和障碍，以促进全国范围内的学习、政策制定以及在采用方面取得进展。
我们对10个已知为健康技术领先采用者的卫生系统进行了半结构化访谈，并进行了内容分析，这些卫生系统已实施或计划实施面向患者的API。
在这10个卫生系统中，有8个拥有面向患者的可运行API，其组织策略主要受联邦政策、iPhone上健康记录的出现以及道德义务感的驱动。确定的两个优先用例是启用患者的纵向健康记录以及与卫生系统的数字交互。被最频繁提及的阻碍面向患者的API使用增加的主题包括安全担忧、一个不成熟的应用程序生态系统（与广泛采用的与电子健康记录（EHR）绑定的门户相比，目前不提供卓越功能）、缺乏业务驱动因素、EHR供应商对数据共享的犹豫，以及不成熟的技术和标准。
我们的研究结果揭示了卫生系统在对面向患者的API的理解以及实施和使用方法上的异质性。持续的研究、有针对性的政策干预以及最佳实践的分享对于在全国成功实施似乎是必要的。
