CC BY-NC-ND 4.0 · Appl Clin Inform 2020; 11(01): 059-069
DOI: 10.1055/s-0039-1701001
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Application Programming Interfaces in Health Care: Findings from a Current-State Sociotechnical Assessment

Prashila Dullabh
1  NORC at the University of Chicago, Chicago, Illinois, United States
Lauren Hovey
1  NORC at the University of Chicago, Chicago, Illinois, United States
Krysta Heaney-Huls
1  NORC at the University of Chicago, Chicago, Illinois, United States
Nithya Rajendran
1  NORC at the University of Chicago, Chicago, Illinois, United States
Adam Wright
2  Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Dean F. Sittig
3  School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States
› Author Affiliations
Further Information

Publication History

05 June 2019

09 December 2019

Publication Date:
22 January 2020 (online)


Objective Interest in application programming interfaces (APIs) is increasing as key stakeholders look for technical solutions to interoperability challenges. We explored three thematic areas to assess the current state of API use for data access and exchange in health care: (1) API use cases and standards; (2) challenges and facilitators for read and write capabilities; and (3) outlook for development of write capabilities.

Methods We employed four methods: (1) literature review; (2) expert interviews with 13 API stakeholders; (3) review of electronic health record (EHR) app galleries; and (4) a technical expert panel. We used an eight-dimension sociotechnical model to organize our findings.

Results The API ecosystem is complicated and cuts across five of the eight sociotechnical model dimensions: (1) app marketplaces support a range of use cases, the majority of which target providers' needs, with far fewer supporting patient access to data; (2) current focus on read APIs with limited use of write APIs; (3) where standards are used, they are largely Fast Healthcare Interoperability Resources (FHIR); (4) FHIR-based APIs support exchange of electronic health information within the common clinical data set; and (5) validating external data and data sources for clinical decision making creates challenges to provider workflows.

Conclusion While the use of APIs in health care is increasing rapidly, it is still in the pilot stages. We identified five key issues with implications for the continued advancement of API use: (1) a robust normative FHIR standard; (2) expansion of the common clinical data set to other data elements; (3) enhanced support for write implementation; (4) data provenance rules; and (5) data governance rules. Thus, while APIs are being touted as a solution to interoperability challenges, they remain an emerging technology that is only one piece of a multipronged approach to data access and use.

Protection of Human and Animal Subjects

Humans and/or animal subjects were not included in the project.

Supplementary Material