As Patient Bulk FHIR APIs and Payer to Payer FHIR APIs come online, health plans must scale solutions to meet the demands of the Interoperability Rule, 21st Century Cures Act services as mandated. This is a challenge that is rarely discussed in webinars, but it is essential to the successful operation of these services. And Axway’s Amplify API Management Platform has the tools needed to accompany healthcare organizations on the road to interoperability.
Essential interoperability building blocks
The challenge is extensive, from enabling self-service connectivity, providing robust security & audit, to scaling up to meet a difficult-to-estimate traffic volume. Self-service and automation are the clear answer to minimizing the impact on staff and systems.
We have a clear viewpoint that interoperability requires security integration to identity management systems, a portal for discovering APIs, data integration services, and traffic management. These services span the gamut of the interoperability lifecycle:
- Registering to receive “the secret” or API security token necessary to connect with external organizations via APIs. This requires integration with identity management systems, both on-premise and in the cloud (e.g. Azure).
- Powering API consumption by publishing, securing, documenting APIs so that developers can quickly find, review, understand, and use APIs. Scaling integration requires moving away from project-based work to self-service documentation, code examples, and testing.
- HIPAA compliant security across all protocols to ensure data privacy while providing open, flexible data exchange.
- Data integration services to source, transform and consolidate data from HL7 native repositories, typical claims/encounter repositories, and third-party sources such as Pharmacy Benefit Managers (PBMs). Hand-crafted integrations risk breakage over time as change occurs, i.e. when new versions of FHIR are released.
- Managed File Transfer to enable batch-based exchange over existing channels within the payor ecosystem.
- Traffic management to validate tokens, monitor and ensure service levels are maintained, notify service managers and partners, log and report activity. Effective traffic management uses policy engines and parameters to consistently enforce the process and procedures required by the health plan and regulation.
Amplify has the tools to power healthcare
As a leader in both Gartner and Forrester rankings for API Management vendors, Axway offers a cost-effective platform that delivers the interoperability, developer services, and gateway management necessary to make integration easy and secure, to ensure service levels are met, and to do so in an automated manner that is scalable and manageable.
The Amplify API Management Platform provides key capabilities to reduce costs and automate processes:
- The marketplace enables Discovery.
- A single place for a target audience (internal teams or external partners) to find integration capabilities for their reuse. This includes flows for traditional integration patterns, custom-developed APIs, pre-built connectors, and choreography flows that can be searched, selected, tested, and deployed without an IT specialist’s support.
- New audiences (3rd party developers, partner health plans, ad-hoc integrators) find, test and deploy integrations with limited support of IT.
- Allows IT and integration specialists to become the “producers” of integrations that integration “consumers” can reuse to scale integration capability more efficiently in the organization.
- IT policy and security are pre-defined into the integrations sanctioned in the catalog.
- Centralized Management secures and delivers service according to defined policy.
- Central and unified management layer for governance, security, and control of files, flows, and interfaces (APIs) across environments, private and public clouds.
- Enforce policies, establish credentials, and monitor usage. Further, this is where different integration artifacts are deployed and published to the catalog.
- Centralized management of deployments, policies, and test integration artifacts — files, flows, and interfaces (APIs).
- A single set of dashboards to monitor API usage and availability to ensure service levels.
A truly “open” approach to integration
Opening your business to partners and third parties requires an approach that goes far beyond acquiring, building, and implementing new tech solutions. The hard work centers around your organization’s ability to change to open ways of working.
In other words, to open everything and make your business consumable, individuals need to be truly “open to everything.” To open your business without driving up administrative costs, project-based integrations must be replaced with self-service automation.
Comprehensive solutions need to enforce compliance with organizational policies such as security, redaction, or transformation and must deliver curated developer experience for the full lifecycle of integration: from registration to discovery to promotion to monitoring.
Critically, whatever solution you choose to deliver open ways of working must build on the investment you have already made. Amplify does just that; no need to replace or refactor existing APIs.
The data integration challenge
Health plans are organizations that consume data to help their members be healthy and thrive through accident and illness. It is, therefore, no surprise that the Interoperability Rule creates data integration challenges at an unprecedented scale for health plans.
Amplify has a full suite of data integration tools that can be deployed to address facade or repository patterns used to deliver claims records as FHIR resources. Integrations built today will need to weather change, i.e. supporting a new version of FHIR to provide faster time to market, deliver deep knowledge of HL7 integration patterns such as FHIR and IHE, and provide better experiences for our customers and partners.
Healthcare Interoperability will continue to roll out: are you ready?
Secure, scalable, payer-to-payer exchange builds on the Patient Record bulk FHIR API created in the first phase of the 21st Century Cures Act Interoperability Rule regulation. In the payer-to-payer exchange, many of the same structures used to identify members, plan, and group identity will be used again.
Additionally, payers may wish to share more data with each other than mandated by the regulation. Axway has the solutions and capabilities to help healthcare members and partners achieve data sharing. Our industry-leading API Management solution is capable of publishing APIs published by others from health plans to health records to proprietary cloud vendors.
For example, plans that created their own FHIR server and resources can use Amplify to exchange security tokens, discover and test APIs, and manage traffic across the wide range of message sizes and request patterns that may arise. If a member chooses to use Smile CDR or a commercial API vendor’s FHIR server, we can confidently manage and expose these FHIR APIs to support payer-to-payer exchanges.
Axway is confident that we can provide the integration services needed to enable payer-to-payer exchanges to reuse what is available and delivering new services to ensure secure, scalable data exchange between payers and between payers and partners.
Given our extensive work with large and small healthcare partners globally, we understand the problems and opportunities. Let us enable you to develop and operate strong integration services, simplifying connectivity and standardizing service approaches to streamline operations and reducing the cost to comply across your organization.
Learn how Axway is helping accelerate Highmark Health Solutions in their Platform Journey.