By Jonah Comstock
One conversation topic that never seems far away at digital health industry events is the idea of data silos. Consumer health and fitness apps are letting people collect more health data about themselves than ever before. And increasingly connected electronic health records create a wealth of electronic data about patients. The real potential for that data, many people believe, will come when it can be combined with other data and integrated into other apps and platforms, rather than being locked away wherever it was originally collected.
This is increasingly being done through application programming interfaces, or APIs, which are offered by consumer devices like Fitbit, Withings, and Jawbone, but also electronic health records like drchrono, Allscripts, and Practice Fusion. APIs are also being used in high-profile platform plays looking to create an integrated user experience for the variety of digital health apps available -- services like Aetna Carepass, Kaiser Permanente's Interchange, or Runkeeper's Health Graph.
A recent history of health APIs
The now-defunct patient health information hub Google Health and its surviving competitor Microsoft HealthVault both made APIs an important part of their strategy as early as 2008. But back then, they were arguably too early for the space and weren't able to find many API-ready partners to integrate with. In 2011, RunKeeper launched Health Graph, an attempt to use APIs to create a health and fitness-focused social experience that would resemble Facebook's social graph.
“Imagine a system that can identify correlations between a user’s eating habits, workout schedule, social interactions and more, to deliver an ecosystem of health and fitness apps, websites, and sensor devices that really work, based on a user’s own historical health and fitness data," RunKeeper CEO Jason Jacobs wrote in a 2011 blog post that's no longer online. "The Health Graph has the potential to completely alter the health and fitness landscape.”
The next year, 2012, saw two big API moves: Aetna opened its CarePass API to developers and Nike+ started offering its API via hackathons and its own accelerator, specifically for companies building technology that would integrate with Nike+.
Aetna's CarePass began as a data sharing initiative, but evolved to be more of a consumer health dashboard that brings different apps together. It has gradually added a range of health and fitness apps and, just recently, medication adherence and stress apps.
“When we launched the developer portal I think we had a hypothesis that the data we were opening up — things like aggregated claims data that had not been opened up before or aggregated cost of claims information — would catch on in the developer community like wildfire,” Jesse Givens, head of CarePass product at Aetna, told MobiHealthNews last year. “When we put that out there, we found that people were interested in it, but conversations we had were far more focused around how do they get their app in front of our members and in front of a large user community.”
Nike+ Fuelband has always put a lot of stock and store in its brand and its own invented fitness metric of Nike Fuel. The accelerator had the goal of getting more currency for Nike Fuel by coaxing developers to create different ways for consumers to use it. As we reported at the time, "Nike listed a handful of examples for the types of startups it is searching for: training or coaching programs that help athletes reach their goals; games that use NikeFuel ‘to remind people that movement is supposed to be fun”; tools to motivate millions of Nike+ runners to perform better or train smarter; programs built around achievement and rewards for activity; wellness solutions that promote active, healthy lifestyles; social challenges that deliver motivation and challenges with friends; and master dashboards for the ultimate quantified self geeks."
In 2013, Kaiser Permanente joined the API game with Interchange, an open API that initially just gave developers access to information like location data and hours for KP facilities. Future plans for Interchange, though, involve making a lot more data available to consumers.
“We’re excited to see what developers come up with as we open up secure, public data sets,” Phil Fasano, executive vice president and chief information officer at Kaiser Permanente said in a statement last year. “Imagine being able to download a mobile app so customized that it shows you nearby restaurants that cater to your healthy lifestyle and offers food suggestions based on the amount of activity you have completed in the last week, your nutrition plan and friends’ reviews. Once you’ve finished your meal, a device synced to your app reports your blood-sugar levels and reminds you to pick up insulin, then tells you the nearest Kaiser Permanente pharmacy where you can pick it up. Interchange by Kaiser Permanente is the beginning of that possibility.”
Also in 2013, on the provider side, EHRs started to talk more and more about APIs. Mobile-based EHR drchrono opened an API to allow developers to build apps that would work within its mobile offerings. Practice Fusion promised an expanded API to connect its EHR to more health devices, and one of the first fruits of that API, an integration with AliveCor, debuted last month. And Allscripts CIO Stanley Crane boasted to MobiHealthNews last year that they were the only major EHR company to open an EHR to third-party developers.
“We’re allowing third-party developers to do things that our competitors would sue them for,” he said. “Can I say ‘blinging out our EHR?’”
How open is open?
Of course, whenever there's data sharing, there's a question of how much data to share and what kind of conditions to put on the sharing of data. There's another question of what the data sharer gets out of it, and this answer is different in different cases.
Misfit Wearables, maker of the Misfit Shine activity tracker, is planning to open its developer API, which may or may not be free, by the end of Q2 2014, CEO Sonny Vu told MobiHealthNews in a recent interview. He said the company is working on both an API and a software development kit (SDK). While an API allows integration between two apps (and requires the user have both apps on their device) an SDK can facilitate data sharing directly from the Shine to a third party app.
"With the SDK, which is private, basically what we do is we select one partner in each industry. Healthcare, weight loss, fitness, fashion. We don't need a lot of partners, we need one or two that are really special. Basically, these are the folks that have amazing digital experiences already. And users can just use that -- they don't need us to get in the way."
Vu said that most fitness devices are opening APIs to third party developers because they allow companies to retain more control over what data they share and how it's used. He thinks that way of thinking about people's data will change as more and more integration occurs.
"For relatively straightforward reasons, people want to control data and access the data," he said. "I think it's unfortunate that some folks take the position of 'We're going to collect this data, we're going to keep it all, but you're going to have to pay us to get it.' That's kind of what we see happening now, but I have a feeling over time that's going to change. I have a feeling that even the notion of data ownership might change, and it might just come down to access levels, and the question is who gets to be the granter of those access levels."
In different API use cases, there are different motivations for opening up data. Fitbit or Jawbone might want you to be able to do as much as possible with the data you collect with their device, but they also might want you to have to interact with their app (and their advertising and branding) when you do. Drchrono and Nike's APIs offer developers a trade: you get the exposure of being on our platform, while we get new features and functionalities to offer our users. Walgreens, which opened up the API for its prescription refill service last February, explained the proposition pretty well.
“[Mobile apps] are just one way for us to interact with our customers. And we woke up to the fact that it may actually be even more lucrative to take that connectivity and open it up as an SDK, an API to third-party developers,” Abhi Dhar, group vice president and CTO for the e-commerce division of Walgreens, told MobiHealthNews at the time. “We have a rather popular mobile app, but in addition to that we want to offer the creativity of the developer community."
Other API plays, like Aetna's and Kaiser's, have more of a bigger picture return on investment. Aetna and Kaiser are both healthcare payers, so they benefit from giving consumers tools to better take care of their own health, because those tools could potentially reduce preventable hospitalizations or readmissions. If they can do that by releasing their own data to developers, that's an end in and of itself for them.
Still other groups are taking advantage of the trend toward integration and data sharing and building whole business models on streamlining that integration. One of the most high profile companies is Validic, which helps wellness companies, healthcare providers, pharmaceutical companies, and health plans get access to the data from apps and devices that have open APIs, essentially aggregating them into one stream. Validic made news in November when high-profile investor Mark Cuban participated in the company's seed round.
Digital health data sharing is still in its early days. The future will lead to more sharing, more open architecture, and data collaborations we can't even imagine now. Once everything from your Fitbit to your doctor's EHR to IBM's Watson can work together digitally in your pocket, the sky's the limit for connected consumer health.
Read on for a list of digital health APIs (and those coming soon), that every digital health startup should know.
25 (and counting) digital health APIs every health startup should know
By Aditi Pai and Brian Dolan
While there are likely many other important digital health APIs that developers should know about, MobiHealthNews has put together the list below as a starter. The dozens of companies listed here have either made APIs available already or promised to do so soon. Our emphasis was on APIs from companies that make data available and for use in third party applications. There are many companies, like EHR software providers, who hope to encourage developers to use data from their EHR systems and build apps that only work for the users of their EHR systems. Our list is focused on data that is shared so it can be used outside of a company's existing user base. Which digital health APIs did we miss?
AdhereTech's smart pill bottle.
AdhereTech: AdhereTech’s smart pill bottle actually senses the amount of medication inside the bottle, which helps in preventing accidental overdose. It also has its cellular connectivity built directly into the bottle rather than into a base station. On its site the company explains that its technology can "integrate with all existing apps, programs, and adherence solutions" through its API, but its not yet sold in the USA. Previous reports about the company have noted that it has an open API that lets third party developers create smartphone apps and websites to help patients track their medications, and the company has said it would integrate its data with that from other smartphone-connected health devices like blood pressure monitors and glucose meters. No apparent information about the API on the company's site, but it is touted as a part of the company's platform on its homepage: AdhereTech API
Basis: When Basis announced its activity tracking smartwatch was available for preorder in April 2011, media reports stated that an API was coming soon. The company offers users a smartwatch that tracks heart rate, motion, calorie counts (through its companion app), sleep stages, and perspiration. Basis has been responding to posts on its forums since 2011 with updates about when its promised API would arrive. One of the more recent updates was in December 2013 when the company responded to a question about projected release date with: "We are working on API access but don’t have a specific timetable". After last week's rumored acquisition of Basis by Intel, it's unclear if we'll ever see that API.
Beddit: Beddit offers users a sensor pad that sits under their mattresses and sends data to a companion app about how they sleep that is then used to generate recommendations for how to improve their sleep. Beddit so far has only announced plans to offer an API for Beddit Pro, which is designed for scientists or other professionals conducting research. It's free to use for non-commercial purposes. Those who want to access the API will be able to do so through Beddit Cloud, which the company expects to be out in the first half of 2014. Beddit API
BodyMedia: BodyMedia was a maker of sensor-laden activity tracking armbands, and it was acquired by Jawbone in April 2013. At some point after the acquisition, BodyMedia announced on its website that the BodyMedia FIT API is no longer open to new developers. Instead, people can use the Jawbone UP Developer Platform to access data from what BodyMedia called the "Jawbone/BodyMedia family of products". The company also added that if developers are currently using the BodyMedia FIT API, they will continue to receive support. BodyMedia API
Cigna: Health insurance company Cigna recently launched its Health API at the mHealth Summit last year. The API will give "qualified partners individually elected customer health data," according to the company. Cigna said the API will allow its members to "share real-time health data across multiple third-party applications", including "mobile health and wellness applications built on top of Cigna’s data and supporting services." Click here for more on the Cigna Health API
Fitbit: Fitbit has developed a series of activity trackers, from clip-on devices to wristworn trackers. The company offers an API, but it's in beta and "under construction" according to Fitbit's website. Currently, the API is available to third-party developers to access and modify the Fitbit user's data, such as the user's daily step count or extra data from the tracker. Fitbit API
Garmin: Garmin, which has developed multi-sport fitness devices, offers an API for websites that works with most of its devices. With the API, Garmin Communicator Plugin, websites get information on when the Garmin device is plugged into a computer, where the user is traveling and what route he or she took, what the user's data means, and which locations the user tagged as a favorite. Garmin API
HealthTap: HealthTap offers embeddable widgets of its content and features to other app developers, publishers, and physicians who might want to include the content on their websites. Like Doximity, the company also offers an authentication feature that other app developers can use to prove a user is actually a doctor -- assuming HealthTap has them in their database. The company offers APIs for embedding question and answer from its community of patients and doctors and it offers health app developers a widget that shows how many doctors on HealthTap would reccomend the app to their patients. HealthTap API
iHealth Lab: iHealth offers users a variety of digital health tools including blood pressure monitors, connected weight scales, fitness trackers and glucometers. The company's API is open for third party developers and iHealth also provides developers with a sandbox in which to test its API. Data that developers can sync includes weight, blood pressure, blood oxygen, activity reports, and sleep reports. They can also access profile settings, including the user's picture, height, gender, and username. iHealth API
Jawbone: Recently Jawbone, maker of the fitness tracker UP, offered third party developers access to APIs via its Jawbone UP Platform. "The purpose of this API is to enable the exchange of select data in order to extend and augment the UP user experience and support complementary services," the company writes. "This can include data aggregation and visualization, gaming, marketing, rewards provisioning, and more." Jawbone's API enables developers to both share their app or device's data within the Jawbone app (displayed in the Jawbone user's activity feed) as well as display certain Jawbone data points in their own third party apps. Jawbone makes a variety of data points available through its API including those related to activity, mood, diet, sleep, and more. Jawbone UP API
Kaiser Permanente: Integrated delivery network (IDN) Kaiser Permanente made headlines when it announced a vision for a world where external developers help it address pressing health care challenges, like access, cost, and quality, through specific APIs. Kaiser made available its first data set -- its healthcare facilities' location data through an API. "The first data set of information available is a Location API, which includes Kaiser Permanente facility and location information for 37 hospitals and more than 600 medical office buildings, pharmacies, and emergency rooms, filtered by hours of operation and specialty," it wrote. "The Location API can be integrated with geolocation for proximity services, directions and other map activities." In the future Kaiser plans to add APIs that offer third party developers "access to an ecosystem of wellness devices and dashboards to manage health and wellness" as well as a "searchable index of Kaiser Permanente research publications and studies." Kaiser Permanente API
Lumo Body Tech: Lumo Body Tech offers users devices and apps that help them track and improve their posture. Its first device, LumoBack, is one that users strap on to their midsection. It connects to an app that alerts them if their posture is not ideal. Lumo Lift, a smaller clip-on device for upper body posture tracking, is the company's latest effort but it just finished preorders and has yet to ship. According to the company's terms of service, Lumo's API is available to third party developers, but the company just provides an email address to contact if a developer has inquiries. LumoBack API
MapMyFitness: MapMyFitness, which was recently acquired by Under Armour, wants to build the world's largest connected fitness platform and hopes to do so by opening its API up to everyone from small app developers to big brands. The company, which offers users a workout trainer and fitness tracker, has two APIs -- a standard API and an enterprise API. In the enterprise API, MapMyFitness takes care of all the technical barriers to integrating with their system, which could include storing big data and integrating with new devices. The enterprise API can also support five million requests per day and "sub-second" response times. MapMyFitness API
MC10: Although MC10, maker of flexible electronics that can track biometric data, has not advertised API integration on its website, the company is currently hiring for someone who can develop backend applications and manage "outsourced developers" for MC10's mobile software development. The API looks like it will help developers integrate with MC10’s body wearable sensors and mobile devices using Bluetooth and also integrate MC10's apps with back-end web services. MC10 API
meQuilibrium: meQuilibrium offers an online stress management application for employees that assesses and identifies sources of stress and then works to find ways to remedy them. The company offers an API to embed its offering into existing employee wellness portals if an employer customer already has one up and running. meQuilibrium API
Misfit Shine: Misfit Shine's API is currently in beta, though CEO Sonny Vu says it is available for the asking for developers who have "a compelling case." Vu said it will be "very similar to APIs available in other connected health products." The Shine API is due out by the end of the second quarter, but Vu is more excited about the company's software development kit, which they plan to share with a few select partners for a tighter integration.
Moves: Moves not only opens up their API to other developers, the company has also created a list showcasing good examples of devices that have integrated with the Moves app. The company offers a fitness tracking app, which can passively track its users' movements -- the app runs in the background. Some of the apps that Moves lists as its partners include OptimizeMe, TicTrac, Nudge, and Everymove. Developers can collect daily summaries for users, which include step count, distance and duration for each activity tracked. The developers can also go deeper and access activity breakdowns, places the user went, a storyline of the user's activity, and a list of specific activities the user did. Moves API
MyFitnessPal: Not unlike some of the other companies on this list, nutrition and fitness tracker, popular fitness platform MyFitnessPal, only offers a private API, which is available to "approved" developers. When requesting an API, the developer must fill out a form that specifies if they are developing a mobile app, creating a fitness device, or our another kind of fitness company. MyFitnessPal is also curious about whether the company is focused on nutrition, a healthcare provider, a wellness service, a wellness service, or just interested in the API for personal use. The company also offered developers six options for what they're interested in doing with the data -- post or pull user activity data, post or pull nutrition data, and post or pull the food database. MyFitnessPal API
Nike: Nike+ is selective about which developers integrate with its API, but its website explains that Nike+ will give developers access to the activity data that is linked to Nike+ FuelBand and Nike+ Running devices. Two apps that Nike+ features as developers that have integrated with the Nike+ products are Path and Lose It. Nike API
Precor: Last September commercial fitness equipment manufacturer announced a developer portal that includes APIs that third party developers can use to tap into the exercise data collected by its equipment software, Preva, which is installed at 1,400 gyms around the world. "Fitness facilities, mobile app developers and service providers use the company’s open API to bring Preva data, such as individual workout summaries, lifetime metrics, goal types and progress and rewards earned, into their own apps, products and services." Precor Preva API
RunKeeper: While RunKeeper has not official API for its flagship app, third party developers can access RunKeeper data through the company's Health Graph initiative. Since 2011 RunKeeper has offered APIs via its Health Graph program, which counts dozens of partners now and includes integrations with all kinds of apps -- not just health-related ones -- including FourSquare, Twitter, Facebook and more. RunKeeper Health Graph API
RxRevu: RxRevu offers users a web portal or smartphone app on which to view data on how to save money when buying medications. The company has over 2,000 recommendations on how to save money instead of immediately buying the brand name medication and uses 12 different cost-saving strategies before providing the user with the best recommendation. The company is offering its API, which was announced recently, to developers with healthcare platforms and applications. RxRevu API
Sensiotec: Sensiotec is the maker of proprietary Ultra-Wideband-based technology that claims to “sees inside the body” through the transmission of nanosecond pulses that can detect micro movements from the heart, lungs and torso, which the company then uses to generate heart, respiration and movement data. The company also offers an API that allows developers to build new apps with its data or interface with existing ones: "The server can transmit patient data to any number of nursing stations, personal computers, cell phones, tablets and pagers simultaneously." Sensiotec API
TigerText: TigerText is a secure texting platform with an emphasis on the healthcare market. Third party developers can integrate TigerText's secure messaging app via its API. TigerText suggests EHR software developers and pharmacy companies as two potential groups who might integration its app via the API. TigerText API
Walgreens: Walgreens, a national pharmacy and retail clinic chain, offers a prescription refill API. With the API, third-party developers of smartphone and tablet apps can integrate Walgreens' order, transfer, and refill prescription functions. The developer is also able to add text alerts when a prescription is ready for pickup. Walgreens API
Withings: Withings offers users different health and fitness devices, including a blood pressure monitor, connected scale, baby monitor, and activity tracker. Withings' API gives developers access to a variety of data collected from the devices and apps. This includes weight, body fat, lean mass, blood pressure and heart rate. Withings features Walgreens, Lose It!, MyFitnessPal, and RunKeeper as apps that use its API. Withings API
