The story of open interfaces began at the start of the 20th century with AT&T opening up their telephone interface to let other telephone companies communicate with its optical fibre network. This created one of the first continental information systems and led other countries to follow suit and allow international telephone calls.
The next such event at the end of the 20th century was the UK opening its telephone interface to internet traffic. This resulted in accessible internet in the UK and was quickly followed by the rest of Europe. The UK also led in opening up its mobile phone networks to new entrants, adopting GSM global standards (resulting in bridging gaps in inter-network communication) and initiating phone number portability services.
This open communication between giants in communication industries led to very cheap and dense mobile adoption across the world. Not only did UK benefit by more than £22 billion from the 3G auction held in 2000, it also helped create Vodafone the largest mobile phone company today.
Now that communication has opened up across the world and transformed every facet of society, the next step in digital transformations will come from digitization of records. The UK government again took the lead by funding IT in healthcare with paperless GP surgeries, before any of the OECD countries. UK is also expanding its funding to achieve paperless hospital records by 2020.
All this has essentially paved the way for APIs and open infrastructures that support communication across organizations, governments and even between countries. APIs will definitely be the key to taking the impact of this seamlessly communicating world to the last mile.
An interface is a layer of programming that allows a separate entity to communicate with a computer program. For example if you are using a calculator, the keys and the screen of the calculator form its user interface. This is true even if you are using the calculator program (calc.exe) on windows. Your interface is the calculator screen and the keyboard through which you are telling the program what it should do (calculations). This is called a GUI or Graphical User Interface which is the common interface used by programs nowadays for the ease of use by humans.
APIs or Application Programming Interfaces are those programs that have interfaces for other programs to interact with them instead of humans. APIs lets programs interact among each other without depending on human interaction. This enables communication between programs, computers and servers. This allows for work that would be impossible with human intervention. It creates massive efficiencies through automation and accomplishes work that would be otherwise impossible. For example: searching for a particular piece of information among billions of records.
Though the immediate fear when “open” infrastructure or APIs are discussed is the privacy of personal data, using APIs doesn’t automatically mean that one’s data is open for viewing or access by anyone. To work on real data, APIs would need permission from the administrator of the software and data, that is, your GP, your hospital, or you the patient, as per the ownership.
The data administrator has to give permission to a software developer for opening a record specifically. Opening up the API is different from opening up the record (specific set of information), and that is what protects records or personal information from widespread misuse.
The API effectively reduces investment in terms of money and time to learn how to use them because they communicate directly with the programs and software developers can spend time on other more effective things. The administrators also get to work with the best software developers concentrating on innovation to make healthcare better for you.
What is a good API?
The standard for good APIs are as follows:
- Its data should be machine-readable;
- The details of the API should be openly published;
- It should be open for testing;
- It should be without copyright restrictions;
- It should have global usage;
- It should allow data to flow in two directions;
- It should have all of these properties enforced for compliance.
Let us see how each of these work in real life.
The API data points should have machine readable codes understood by computers. This means computers can read, display and analyze the data as required. There are international standards for machine readable medical records: SNOMED CT, ICD9 & 10.
The API should be open in the true sense and the full specifications and access to see the API should be easy without the need to fill out forms. This is of course different from accessing the records as explained earlier. Developers should experiment with the API and learn with others before they can build something that will attract investors.
The approved software companies for NHS in England are forcing developers to justify their access to the APIs before they are allowed to see the APIs. This is a wrong approach as the justification is often unavailable till the developer can see and experiment with the API.
Open for testing
Companies like Google, Facebook, Twitter and Microsoft all use a Sandbox approach to foster innovation through a “quick start” strategy. A Sandbox is essentially a “safe” space created for developers to test their software without dealing with actual data but dealing with real worlds concerns and constraints on test data sets.
Ideally NHS England should fund a Sandbox that will let developer access test data in as quickly as 5 minutes of requesting. It would be simple to determine the funding based on the number of API calls received by the sandbox.
Open copyright for the API specification
The ability to re-implement and extend existing APIs has been the key to competition and progress in both hardware and software development. The emergence and success of many robust industries we now take for granted—for example, mainframes, PCs, and workstations/servers—has been possible by ensuring that competitors could challenge established players and advance on existing systems.
This was established in litigation when Oracle sued Google over its use of Java APIs in the Android OS. Google had own implementation of the Java API. However, in order to allow developers to write their own programs for Android (and create an open system), Google’s implementation used the same names, organization, and functionality as the Java APIs.
Thus in order to be able to extend and improve on existing solutions, the APIs should voluntarily have open licenses without copyright restrictions.
In order to get the best of the world rather than the local best, UK should choose international standards over UK standards. HL7 or FHIR are options that can be considered among others. This will also open up the market for UK developed software in the international market. This is how Freeserve, Vodafone, O2, and Lycamobile created their global leadership.
The NHS data set needs to be a two way communicator and should be able to receive data from NHS approved data sources as well as send data to GPs over APIs. The right to approve source of data should rest with the GP or NHS England and not with the software company.
A public testing protocol for every data point will ensure that the data is semantically usable by other software providers. This should be enforced by the regulator by buying software that is built to the policy of open APIs.
Jack Dorsey and Square
Countless innovations have now been possible because of open architecture. If we take the case of Jack Dorsey, previously co founder of Twitter, who discovered that his iPhone headphone socket could transmit more information than just audio and ended up creating Square, a device that can attach to the headphone jack of a smartphone and transform a smartphone into a credit card payment processing machine. This enabled transactions to the tune of $30 billion and allowed everyone with a smartphone to process credit card payments, whether they were a cab driver or a nail salon owner.
If Jack Dorsey had needed permission to make his discovery or to experiment with the headphone socket, this story might have been quite different today. This is the power of innovation that comes from open architecture and this is what is currently needed in healthcare.
Source Credit: Dr. Mohammad Al-Ubaydli | Nesta
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