Epic and Other EHR Vendors Caught in Dilemmas by APIs (Part 2 of 2)

The first section of this article reported some news about Epic’s Orchard, a new attempt to provide an “app store” for health care. In this section we look over the role of APIs as seen by EHR vendors such as Epic. Dr. Travis Good, with whom I spoke for this article, pointed out that EHRs glom together two distinct functions: a canonical, trusted store for patient data and an interface that becomes a key part of the clinician workflow. They are being challenged in both these areas, for different reasons.

As a data store, EHRs satisfied user needs for many years. The records organized the data for billing, treatment, and compliance with regulations. If there were problems with the data, they stemmed not from the EHRs but from how they were used. We should not blame the EHR if the doctor upcoded clinical information in order to charge more, or if coding was too primitive to represent the complexity of patient illness. But clinicians and regulators are now demanding functions that EHRs are fumbling at fulfillling:

• More and more regulatory requirements, which intelligent software would calculate on its own from data already in the record, but which most EHRs require the physician to fill out manually
• Patient-generated data, which may be entered by the patient manually or taken from devices
• Data in streamlined formats for large-scale data analysis, for which institutions are licensing new forms of databases...