eTech Insight – New Healthcare API Solutions Will Drive Market Disruption - Cover

eTech Insight – New Healthcare API Solutions Will Drive Market Disruption

The Problem: Difficult and Costly Interfaces to Best-of-Breed IT Solutions

Almost all healthcare organizations have implemented integration engines (IEs) to create interfaces from disparate best-of-breed IT applications to their enterprise IT applications. Most of these interfaces are based on HL7 2.X interface standards (using the term standards loosely) to create the data streams between IT application systems. It may take time to create these interfaces to ensure the right data is passed between the systems at the right time. Once created, these interfaces are often difficult and costly to maintain. They may need to be updated if either of the connected IT systems is updated. IEs help to manage the uptime of these interfaces but add additional budgetary increases with their own maintenance and acquisition costs.

The challenges of creating and maintaining interfaces between healthcare IT applications resulted in the market moving to enterprise solutions (e.g., Epic, Cerner, and MEDITECH) that provided an entire suite of financial and clinical applications on the same architecture with 70%–80% of the best-of-breed functionality while eliminating many of the application interfaces in the environment, such as billing, laboratory, radiology, scheduling, and surgery, as well as EHRs and the ED.

This drove many best-of-breed vendors out of business or into mergers with companies with other best-of-breed solutions. While this reduced the costs and overhead associated with interfaces to best-of-breed systems, in many cases, the change was not well received by the impacted healthcare professionals. That was especially true when the best-of-breed IT solutions were considered superior in functionality to the enterprise solutions.

The Solution: FHIR-based APIs

Interoperability is the new focus of the ONC using FHIR-based APIs created by the HL7 standards group. As with HL7 2.X, there are different versions of the FHIR API standard as interpreted by the industry. We believe this will be resolved as the ONC continues to refine the standard with industry reviews. It will take years to replace all the HL7 2.X interfaces with FHIR-based APIs, which will introduce a bifurcated interface environment for healthcare organizations. In many cases, the IEs will be retained until FHIR-based APIs can replace the necessary HL7 2.X interfaces.

The Justification: Implementing IT Solutions with the Best Capabilities and Value

As a second generation of best-of-breed applications are emerging, FHIR-based APIs ensure that IT applications are selected based on needed functionality and overall value (e.g., acquisition cost, maintenance and support, development costs, and architectural compliance). Healthcare organizations should be able to select the most appropriate IT solutions for surveillance, telehealth, population health, and data analytics based on competitive needs without the concern for integration ease and cost. The emergence and adoption of FHIR-based APIs will increase healthcare IT market competition, and that competition will impact the current market dominance of the enterprise healthcare IT vendors.

The Players: New Entrants and Legacy Solutions Will Energize the Market

There are several players that will be involved in bringing new API solutions to the market. Here is a representative segment of the players that will be involved:

  • New Emerging Healthcare API Solutions Providers: Sansoro and Redox
  • Emerging General Industry Solutions (not solely focused on healthcare): MuleSoft, Apigee (recently acquired by Google), Amazon, and Microsoft
  • Legacy IE Vendors: Corepoint Health, Infor, InterSystems, Rhapsody, and iNTERFACEWARE

This market will be ripe for merger and acquisition activities because emerging entrants will force legacy vendors or general industry vendors to assess acquisitions or mergers versus self-development to drive market share.

Success Factors

  1. Select API solutions based on FHIR standards that can be easily implemented for many of the existing HL7 2.X interfaces.
  2. If the API solutions are using web services, make sure the transactions are secured with encryption services.
  3. Be prepared for potential acquisition and merger activities that may impact the API vendor. Have appropriate contract clauses related to ending the relationship if the acquiring party or services are not acceptable to the organization.


Legacy IE vendors, emerging healthcare-focused API vendors, and general-industry API vendors will create a competitive industry that will disrupt the current IE market. The movement from HL7 2.X interface formats to emerging FHIR-based APIs will enable healthcare IT solutions to be evaluated on a basis of true functionality and cost benefit as well as ease of operational support. Healthcare IT–market disruption is spelled API.

     Photo cred: Shutterstock, Corona Borealis Studio