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Executives from Amazon, Google, Microsoft and IBM on stage at the CMS Blue Button 2.0 Developer Conference in August 2018. From left: Dean Garfield, Alec Chalmers, Mark Dudman, Peter Lee and Greg Moore. (Microsoft Photo)

This past August, executives from Microsoft, Amazon, Google, IBM, Oracle, and Salesforce banded together to promote data sharing in healthcare. Nearly a year later, the world’s largest tech companies aren’t showing any signs of slowing.

Today, the tech giants renewed their commitment to healthcare data sharing standards with a new joint statement that highlighted the past year’s progress. They also put their weight behind a regulatory effort to update rules governing health data by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services.

“As a technology community, we believe that a forward-thinking API strategy as outlined in the proposed rules will advance the ability for all organizations to build and deploy novel applications to the benefit of patients, care providers, and administrators alike,” the companies wrote in their shared pledge, which you can read below.

But the tech heavyweights aren’t just promoting data sharing standards — they’re helping to define them.

“My team is looking at gaps in the interoperability landscape and capabilities that organizations are still missing,” Josh Mandel, chief architect at Microsoft Healthcare, told GeekWire. Once identified, Mandel said the team can start to address those gaps through the development of new standards. As an example, they’re looking at ways to improve how streaming data is captured from medical devices.

Update, July 30, 3 p.m. PT: In addition to the pledge, a coalition of big tech companies and healthcare industry names — including Apple, Humana, and the State of Washington — today announced that they would be testing new standards that give patients access to their claims data. The idea is to let people access their past healthcare information on the app of their choice, which they can use to inform new providers or make decisions related to insurance coverage.

The tech giants have much to gain from opening up healthcare data. As proof of this, the joint statement was preceded by news that electronic health record (EHR) vendor Cerner named Amazon Web Services its preferred cloud provider. That’s a major win for AWS, since Cerner controls more than a quarter of the market for EHR systems, which serve as the nexus for patient data within hospitals. Cerner said that modernizing its platform would clear the way for more APIs that can be built to leverage healthcare data.

Microsoft has been competing fiercely to convince developers in the healthcare industry to build on its platforms. The company built an Azure API for FHIR, which is a set of standards that codify how healthcare data should be structured. Last month, Microsoft hosted a developer’s conference focused on FHIR, and it has also contributed open-source software that makes it easier to implement these standards.

Progress highlights from the other companies include:

  • Google launched a beta version of its Cloud Healthcare API.
  • Salesforce continues to grow its Health Cloud offering.
  • Oracle has leveraged FHIR standards to collect data for clinical trials.

You can read the full text of the renewed pledge below.

As healthcare evolves across the globe, so does our ability to improve the health and wellness of communities. Patients, providers, and health plans are striving for more value-based care, more engaging user experiences, and broader application of machine learning to assist clinicians in diagnosis and patient care.

Too often, however, patient data are inconsistently formatted, incomplete, unavailable, or missing – which can limit access to the best possible care. Equipping patients and caregivers with information and insights derived from raw data has the potential to yield significantly better outcomes. But without a robust network of clinical information, even the best people and technology may not reach their potential.

Interoperability requires the ability to share clinical information across systems, networks, and care providers. Barriers to data interoperability sit at the core of many process problems. We believe that better interoperability will unlock improvements in individual and population-level care coordination, delivery, and management. As such, we support efforts from ONC and CMS to champion greater interoperability and patient access.

This year’s proposed rules focus on the use of HL7® FHIR® (Fast Healthcare Interoperability Resources) as an open standard for electronically exchanging healthcare information. FHIR builds on concepts and best-practices from other standards to define a comprehensive, secure, and semantically-extensible specification for interoperability. The FHIR community features multidisciplinary collaboration and public channels where developers interact and contribute.

We’ve been excited to use and contribute to many FHIR-focused, multi-language tools that work to solve real-world implementation challenges. We are especially proud to highlight a set of open-source tools including: Google’s FHIR protocol buffers and Apigee Health APIx, Microsoft’s FHIR Server for Azure, Cerner’s FHIR integration for Apache Spark, a serverless reference architecture for FHIR APIs on AWS, Salesforce/Mulesoft’s Catalyst Accelerator for Healthcare templates, and IBM’s Apache Spark service.

Beyond the production of new tools, we have also proudly participated in developing new specifications including the Bulk Data $export operation (and recent work on an $import operation), Subscriptions, and analytical SQL projections. All of these capabilities demonstrate the strength and adaptability of the FHIR specification. Moreover, through connectathons, community events, and developer conferences, our engineering teams are committed to the continued improvement of the FHIR ecosystem. Our engineering organizations have previously supported the maturation of standards in other fields and we believe FHIR version R4 — a normative release — provides an essential and appropriate target for ongoing investments in interoperability.

We have seen the early promise of standards-based APIs from market leading Health IT systems, and are excited about a future where such capabilities are universal. Together, we operate some of the largest technical infrastructure across the globe serving many healthcare and non-healthcare systems alike. Through that experience, we recognize the scale and complexity of the task at hand. We believe that the techniques required to meet the objectives of ONC and CMS are available today and can be delivered cost-effectively with well-engineered systems.

At Amazon, Google, IBM, Microsoft, Oracle, and Salesforce, we are fortunate to work with many teams and partners that draw on experiences across industries to support and accelerate the delivery of FHIR APIs in healthcare. Moreover, we are committed to introducing tools for the healthcare developer community. After the proposed rule takes effect, we commit to offering technical guidance based on our work including solution architecture diagrams, system narratives, and reference implementations to accelerate deployments for all industry stakeholders. We will work diligently to ensure these blueprints provide a clear and robust path to achieving the spirit of an API-first strategy for healthcare interoperability.

As a technology community, we believe that a forward-thinking API strategy as outlined in the proposed rules will advance the ability for all organizations to build and deploy novel applications to the benefit of patients, care providers, and administrators alike. ONC and CMS’s continued leadership, thoughtful rules, and embrace of open standards help move us decisively in that direction.

Signed,

Amazon, Google, IBM, Microsoft, Oracle, and Salesforce

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