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Idea Expand certification criteria for EHRs to include a published API layer

By Liana Woskie | 01 Dec, 2014

Currently, the vast majority of EHR systems are proprietary, and vendors do not make their application programming interfaces (API) available. As a result, interactions are limited to each healthcare provider’s system making integration of outside data or tools effectively impossible.* (See attached article from Keith Marsolo in the Journal of the American Medical Informatics Association.)

As such, many EHRs are slow to innovate and cannot respond to the changing needs own the patients and providers they serve. While private companies have not needed to make their proprietary systems more accessible, the federal government has been (and continues to) subsidize the purchase of these systems, and should have substantial interest in favoring products that are open to human-centered innovation. Published APIs would enable innovations in the usability of EHRs by enabling outside entrepreneurs and developers to design customized user interfaces and tools for their populations' specific needs.
Policymakers have readily available channels to prompt vendors to begin publishing their APIs. The most compelling would be to include a published API layer in the federal criteria for EHR certification ( This approach would give vendors a choice and those that are not willing to publish their API could still sell their products in the marketplace. However, vendors that chose to do so would receive substantial benefits, including certification (assuming that they meet other criteria) and the ability of the purchasers of their products to receive federal subsidies through Meaningful Use.

(Adapted from 2013 Report to the White House Office of Science and Technology Policy)


Attached resource:

  • Informatics and operations—let's get integrated (external URL)

    Link leads to:


    A/Prof. Terry HANNAN Advisor Replied at 6:16 PM, 2 Dec 2014

    As a clinical informatician the technical aspects relating to APIs is beyond my capabilities. Despite these limitations this posting reminded me of the criteria Mamlin and Biondich defined for the success of eHealth systems. These are:
    • COLLABORATION-across people and institutions
    • SCALABILITY – able to meet the needs of millions
    • RAPID FROM DESIGN – to facilitate data capture
    • USE OF STANDARDS-critical for data capture to measure care and interoperability
    • SUPPORT HIGH QUALITY RESEARCH-from effective long term data capture
    • WEB-BASED AND SUPPORT INTERMITTENT CONNECTIVITY-supported by modern web technologies
    • LOW COST: preferably free/open source
    • CLINICALLY USEFUL: feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used.
    • [File attached]
    The single MOST critical criteria is the system must be clinically useful. We now need to be constantly reminded that the “patients must become the best informed clinicians”.

    Attached resources:

    A/Prof. Terry HANNAN Advisor Replied at 7:11 PM, 2 Dec 2014

    As of today there has been a new posting that is relevant to these discussions. It has been posted from the University of Texas Health Sciences Centre and is free to download. My thanks to Dr Jiajie Zhang, PhD, Director, National Center for Cognitive Informatics and Decision Making in Healthcare.
    Terry Hannan
    Dear Colleagues,
    We are pleased to announce the availability of a free new book from the ONC supported SHARPC project: "Better EHR: Usability, Workflow, and Cognitive Support in Electronic Health Records".
    The electronic versions (both pdf and iBook) are freely available to the public at the following link:
    The Office of the National Coordinator for Health IT (ONC) funded four Strategic Health information technology Advanced Research Projects in 2010. Better known as SHARP, the goal was improving the use of information technology in healthcare. One of the projects was called SHARPC, which studied patient-centered cognitive support - the idea that information technology should support physicians' reasoning and decision-making while using electronic health records (EHR) systems. SHARPC was a collaboration of eleven academic and medical institutions. The effort was led by The University of Texas School of Biomedical Informatics at Houston, which created the National Center for Cognitive Informatics and Decision Making in Healthcare. This book documents some of the results of SHARPC's research: new theoretical frameworks, better ways of designing EHR systems, and new tools for implementing health information technology.
    The SHARPC project has generated a large number of deliverables in the forms of publications, reports, software packages, algorithms, knowledge bases, tool sets, guidelines, inspirational prototypes, interactive ebooks, tutorials, videos, etc. Nearly all of these are available from our website:
    Jiajie Zhang, PhD
    Director, National Center for Cognitive Informatics and Decision Making in Healthcare
    Dean & Dr. Doris L. Ross Professor
    School of Biomedical Informatics
    University of Texas Health Science Center at Houston
    7000 Fannin, Suite 600 Houston, TX 77030

    Lygeia Ricciardi Keynote Speaker Replied at 2:29 PM, 10 Dec 2014

    I think this is a great idea and certainly worth exploring. For the record, the Office of the National Coordinator for Health IT (ONC), the Agency for Healthcare Research and Quality (AHRQ) and the Robert Wood Johnson Foundation (RWJF) recently released another report that supports this approach. See "Data for Individual Health" at

    To underscore what Liana said, if EHRs had APIs, with appropriate permission individuals' health data could be pulled directly from their doctors' health records and incorporated into a variety of consumer apps and tools to help people better understand their own (or a loved one's) health and set and meet individualized goals.


    Lygeia Ricciardi

    Joaquin Blaya, PhD Advisor Replied at 9:26 AM, 13 Dec 2014

    Liana, I couldn't agree with you more and think this is a great idea. How would you get this to be implemented? I see this having hte same difficulties as trying to implement standards such as HL7, SNOMED, and others where the vendors see it as a threat to their hold over their clients. So there would need to be a strong decision by the government or regulatory agency to make this happen. How do we help in making that happen?

    This Community is Archived.

    This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.