VA goes all in on APIs

The Department of Veterans Affairs is going all in on application programming interfaces – APIs – as a way of delivering data to health care partners and outside developers.

The API effort is being organized via a new project, dubbed Lighthouse. Lighthouse is an API management platform that makes data feeds available to developers looking to incorporate VA data into online tools and applications.

The big picture, as announced by VA Secretary David Shulkin at the Health Information and Management Systems conference in Las Vegas, is that the veterans' agency is supporting industry health data standards including the API standard FHIR.

Shulkin introduced a health data "pledge" that has already been adopted by a roster of health systems including the Mayo Clinic and the Cleveland Clinic. This is designed to accelerate the adoption of the FHIR standard – short for Fast Healthcare Interoperability Resources -- as a means to getting health data to work across different healthcare system and different technology platforms.

The API standard already got a federal boost this week when the Center for Medicare and Medicaid Services announced that Medicare claims data would be available via Blue Button 2.0 using the FHIR standard.

The more systems that take the "pledge," the more reach the FHIR standard will have. VA has leverage to push the API standard because it's the single largest health system in the U.S., and increasingly its patient population is being given the flexibility to seek private care.

The move comes as VA is set to close on a multibillion deal with Cerner to replace the agency's homegrown Vista electronic health record with a version of the system being adopted by the Department of Defense. To sign the deal, VA needs approval from the House and Senate Appropriations committees to reallocate some 2018 funds. According to a Capitol Hill source, the move is being considered as part of the ongoing negotiations to fund the government before the current stopgap appropriation expires on March 23.

Before VA can begin using patient data to power health applications, the governance and structure of the Lighthouse system must be worked out.

That's where Drew Myklegard, a senior advisor to VA's acting CIO Scott Blackburn, comes in. Myklegard is the product owner of Lighthouse, and he's working with partners across the veterans' agency in every department. Right now, VA is seeking information from industry and developers on how to structure and support Lighthouse's internal functions, such as governance, developer vetting, acquisition, DevOps and more.

"We're moving VA toward an API-first architecture," Myklegard told FCW. "We look at Lighthouse as a startup. We're asking ourselves, how would you construct a startup like this?"

Micropurchases will play a big role in the development of the Lighthouse ecosystem, Myklegard said. The federal micropurchase threshold is set to rise from $3,500 to $10,000 with the next update of the Federal Acquisition Regulation. That lift, Myklegard said, will make it easier to find developers to work on discrete tasks needed to build in security, structure and consistent architecture into the program.

Lighthouse is looking to attract contributions from a community of people with experience in engineering, development, design, product management, security usability and more.

"This pushes us more toward the gig economy," Myklegard said.

The governance process will take about three or four months, Myklegard said. Once it is up and running, Lighthouse will support access to 600 back-end systems across VA. Myklegard said the department plans to manage its developer community on a federated model.

Any developer that touches personally identifiable information and health data will be vetted for security risks and will necessarily be in close touch with VA. But there are public-facing datasets that can be accessed without compromising any PII or health data that can be used by developers without a security check.

VA has already pushed out some apps on its own that combine existing agency data. For example, the Access to Care app, a pet project of Shulkin's that was sped into production in just 30 days, pulls together appointment wait-time information and maps it to information on VA facilities and quality of care reports.

Some API uses won't necessarily look like VA data. For instance, a real estate site could add a layer of data on VA facility locations as a way of enhancing service to veterans. An education site could include a layer of data on schools and programs supported by VA's education benefits. Myklegard expects the early products generated via Lighthouse to be based around public-facing datasets that don't require any special security on the part of developers.