NEJM Perspective describes "A 21st-Century Health IT System"

“The 21st Century Cures Act [H.R.6 — 114th Congress (2015-2016)] requires that certified health IT products have an application programming interface that allows health data to be accessed and exchanged. The provision could shape the way that physicians and patients experience health care for years to come.”

In the foregoing quote from the May 18, 2017, edition of the New England Journal of Medicine (N Engl J Med 2017; 376:1905-1907 — DOI: 10.1056/NEJMp1700235) Perspective article entitled “A 21st-Century Health IT System — Creating a Real-World Information Economy,” Kenneth D. Mandl, M.D., M.P.H., and Isaac S. Kohane, M.D., M.P.H., advocate for the use of application programming interfaces as the best means for achieving the information technology (IT) interoperability among commercial electronic health record (EHR) systems marketed by independent software vendors (ISVs), some of whom apparently are more intent on maintaining proprietary interests including market share than on facilitating exchange of potentially life-saving protected health information (PHI) among patient-authorized healthcare providers.

As defined in Wikipedia, “… an application programming interface (API) is set of subroutine definitions, protocols, and tools for building application software. In general terms, it is a set of clearly defined methods of communication between various software components. A good API makes it easier to develop a computer program by providing all the building blocks, which are then put together by the programmer … An API may be for a web-based system, operating system, database system, computer hardware or software library. An API specification can take many forms, but often includes specifications for routines, data structures, object classes, variables or remote calls. POSIX, Microsoft Windows API, the C++ Standard Template Library and Java APIs are examples of different forms of APIs. Documentation for the API is usually provided to facilitate usage … Just as a graphical user interface makes it easier for people to use programs, application programming interfaces make it easier for developers to use certain technologies in building applications. By abstracting the underlying implementation and only exposing objects or actions the developer needs, an API reduces the cognitive load on a programmer. While a graphical interface for an email client might provide a user with a button that performs all the steps for fetching and highlighting new emails, an API for file input/output might give the developer a function that copies a file from one location to another without requiring that the developer understand the file system operations occurring behind the scenes …” (

Using APIs, EHR ISVs could protect their proprietary code and their healthcare provider clients’ EHR database integrity while enabling information exchange among their clients and those of other EHR ISVs. All that is required is the will and willingness to prioritize (or even to equilibrate) the safety and optimal case outcomes of patients over/with profit. An app built using an IT solution compliant with the Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS)™ integrated development environment (IDE) reference architecture (RA) can be included in an automated process application or “app” designed and deployed by a healthcare provider subject matter experts with minimal cost and IT complexity. A CHARTSaaS RA-compliant IT solution can provide a safe and secure IT platform for the the creation of apps incorporating APIs to achieve “intelligent interoperability.”

Please validate this proposition to your own satisfaction by reading the white paper at and then by reviewing the details of CHARTSaaS™ and the CHARTSaaS RA™ in these presentations:

Healthcare providers will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths. per Makaray and Daniel; thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment, and also accelerating the accrual and facilitating the application of medical knowledge.

Leave a Reply

Your email address will not be published. Required fields are marked *