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Why the Future of HIT Requires a Collaborative Approach to Development
By Erik Kins

There are two approaches to IT software development. The first is a closed approach, in which a company is proprietary about its software and, in the name of security and quality, is the single source of improvement. The second approach, known as open, facilitates the exchange of information between programs, making it easier for their software talk to other developers' software to hasten innovation.

Much like health care itself, HIT is most effective when collaborative. No single company can address all challenges, but we can advance more quickly if we work together. According to a recent RAND Corporation report, open technologies could help lower costs and improve care. That's why an open approach is critical to the future of HIT.

How Open Works
What is an open approach? In today's technological landscape, when we say a platform is open, it means that it offers a rich, comprehensive set of web services to reach deeply into the underlying system. This enables connecting systems more completely than ever before, exchanging data in relevant snippets rather than in volumes at a time to build truly cooperative systems.

A key component to this approach is an open application programming interface (API), or set of tools and specifications that describes how software should interact. APIs are not a new concept; in fact, they can trace their roots to the advent of computing.

Other industries have spent the last decade opening up APIs, leapfrogging the health care industry. Think about how any car dealer can pull up your financial information, or how your airline ticket can appear on your mobile phone, or any number of apps that run within Facebook—all of these innovations are made possible by open APIs.

An Innovator's Perspective
Steve Buttitta, president of ByteSized Solutions, a company with about 30 applications that work with Allscripts solutions, started consulting in health care integration about 15 years ago, when EHR systems were just starting out.

"I struggled a lot in the start because I spent my time fighting EHR companies to get access to their systems," Buttitta says. "As a result of this lack of willingness to collaborate, I had to shoehorn in many solutions with less-than-graceful executions."

EHR adoption has come a long way since then, but Buttitta does not see much progress across the industry when it comes to third-party integration.

"As an example, we had one client demanding that its EHR vendor work with us on a project. The EHR vendor dragged its feet so much that it took almost six months just to sign a nondisclosure agreement," he says. "Closed EHR vendors routinely use tactics like this, or blocking access to API, to drive consulting services back to the EHR vendor."

Buttitta notices big advantages when vendors offer open APIs. "Clients don't have to wait as long to get the products they need," he says. "Having seen what it can look like when an EHR vendor really becomes a true partner, it has me asking the question, 'Why can't it always be this easy?'"

The Importance of a Fully Supported Open API
Simply having an open API is just a start; it's also important to have fully supported APIs featuring updated documentation, sandbox environments, sample code, training classes, workshops, and live resources to help navigate the process.

A fully supported API improves collaboration with the EHR vendor and requires less customization. APIs also tend to be a more accessible, easier to use, and lower cost option when compared with other integration options.

Unfortunately, no one bats an eye in the health care industry when these resources are not present, and clients are charged exorbitant prices for an interface just to get started.

It shouldn't be this way. To truly make progress with interoperability, health care providers need open APIs from all of their vendors—whether it's a substantial EHR system, core financial solution, or specialized application.

Advancing HIT With an Open Approach
HIT should be a team sport on an open playing field. An open approach helps reduce the time from invention to delivery by making it faster for those innovations to plug in to existing products. If there is a new clinical decision support engine, or a new device, or a new specialty-oriented tool, open enables providers to have it quickly.

An open approach enables health care providers to take advantage of breakthrough technologies and improve health care delivery. With better patient care and financial advantages, we all win; we're fostering the innovations that bring about real change in health care.

— Erik Kins is vice president of innovation at Allscripts.