A Guide to Develop HIPAA Compliant Healthcare API

Key Takeaways

  • Healthcare developers must follow the three key HIPAA rules during API development: HIPAA security rule, privacy rule, and the breach notification rule.
  • HL7 FHIR is a data exchange standard for APIs and it makes use of technologies such as XML, JSON, and RESTful APIs for smooth data exchange.
  • Pay close attention to the requirements of the target audience during API development. For example, providers may need API for automated appointment scheduling and bill payments to save their time and money.

According to a report by McKinsey, APIs will deliver advanced services such as enabling machine learning, enhancing the use of currencies and digital wallets, and supporting operations. In the healthcare industry, APIs ascertain seamless data exchange between multiple systems and offer ample storage space. Further, HIPAA compliant healthcare APIs protect the security and privacy of ePHI during data exchange.

This article discusses key HIPAA rules and steps that developers can follow while building a healthcare API.

Key HIPAA Rules to Follow for Developing a Healthcare API

1. HIPAA Security Rule

The HIPAA security rule contains a set of standards for protecting crucial ePHI (Protected Health Information). PHI encompasses patient data such as medical records, lab results, demographic information, medications, etc. If this data falls into the wrong hands, then the patient is at risk of losing his/her privacy and may face problems such as scams, fraud, and other losses. The HIPAA security rule is applied to health care clearinghouses, health plans, and any healthcare provider who exchanges healthcare data in an electronic form.

The security rule mandates all those who exchange information (Covered Entities and Business Associates) to follow the three safeguards:

1. Administrative Safeguards

Administrative safeguards insist that covered entities (CE) must train their staff on HIPAA compliance policies and regulations. These safeguards also state that security personnel is required to implement the security procedures and policies. Additionally, administrative safeguards state that CE must conduct periodic evaluations to stay up-to-date with policies, and incorporate data authorization policies.

2. Technical Safeguards

Technical safeguards include procedures and policies to protect the technical aspect of ePHI. These consist of data encryption, restricted access to ePHI, audit controls, cybersecurity measures, and data backup processes.

3. Physical Safeguards

Physical safeguards are put in place to protect the area where data is stored on-premise. These safeguards encompass device security, workstation security, and facility access and control.

2. HIPAA Privacy Rule

According to the HHS, ‘the key goal of the Privacy Rule is to ensure that individuals’ health data is protected while allowing the flow of health information needed to promote and provide high-quality health care and to safeguard public’s well-being and health.’

The healthcare API developers must note that HIPAA privacy allows a covered entity to disclose PHI under six circumstances, otherwise, patients’ written consent is required to disclose PHI.

  • CE can disclose PHI for treatment, healthcare operations, and payment. For example, quality assessments, health premium payments, and coordinate care with multiple doctors.
  •  Disclose information to that individual whose information is about.
  • PHI is disclosed if an individual is in an emergency, incapacitated, or not available. The CE makes a decision that’s in the individual’s best interest.
  • The privacy rule permits data exposure in case of incidental uses and disclosures. In other words when certain disclosures happen as a byproduct of another required use/disclosure.
  • Fifth situation is when PHI is disclosed for the public interest.
  • The final permit allows CE to disclose limited information to be sued for public health purposes, research, and healthcare operations, provided that the individual enters into a data use agreement.

3. Breach Notification Rule

The breach notification rule mandates covered entities to notify individuals when their PHI is impermissibly disclosed and used, in a way that compromises the security and privacy of ePHI. To confirm that it is a breach, the following four factors are taken into account:

  • The extent and nature of ePHI involved, which also includes re-identification and types of identifiers.
  • Confirm whether the ePHI was acquired or only viewed.
  • The unauthorized individual to whom the data was disclosed.
  • Risk mitigation for ePHI.

4. Healthcare Data Exchange Standard for APIs

HL7 FHIR (Fast Healthcare Interoperability Resources) is a data exchange standard for APIs and it makes use of technologies such as XML, JSON, and RESTful APIs for smooth data exchange.

Interoperability is a major challenge in healthcare because it allows practitioners to access patient data easily and make informed decisions. FHIR makes use of RESTful APIs for easy data exchange between different systems such as multiple EHRs, patient portals, web applications, management software, etc.

Core Steps to Build a HIPAA Compliant API

1. Determine Requirements

While developing APIs, developers need to pay close attention to who is their target audience and what are their pain points. For example, for HIPAA compliant API, the target audience can include healthcare providers, patients, pharmacists, nurses, etc. Common expectations from a healthcare API are security, remote care, third-party integrations, and more.

Every target audience demands different requirements from a healthcare API. Providers may need API for automated appointment scheduling and bill payments to save their time and money. Whereas, for patients APIs play a crucial role in data exchange in situations when they’re switching their doctors

2. Maintain Documentation

Accurate API documentation not only attracts developers to work on novel projects, but also educates users on API applications, integrations, and websites. It’s the job of the healthcare developers to constantly update APIs and if failed to do so then users can get frustrated while looking for functionalities that no longer exist.

Additionally, comprehend the scope of API documentation, target audience, and purpose as this will help to create a precise document that addresses the API requirements. Moreover, avoid using jargon and stick to universally accepted standards during the documentation process.

3. Design a Pilot HIPAA Compliant API

A pilot HIPAA compliant API helps to analyze and test how a product works before working on it at a large scale. It also prevents major losses, risks, unsatisfied users, and wastage of resources.

A pilot API program points out issues, which can be rectified by healthcare developers. Additionally, feedback from the pilot program helps develop new strategies, concepts, and ideas to augment APIs.

4. Security and Testing of Healthcare API

HIPAA compliance regulations ensure the security and privacy of healthcare APIs which are discussed in the article. Further, developers can start testing APIs after every developmental stage because if there’s any bug then it can be rectified before moving on to the next phase.

Types of tests include reliability, functional, security, load, and unit and integration tests. Ensure to test functions in isolation and test under varied conditions that users may encounter.

5. Third-Party API Integrations

Developers use third-party integrations to save time and money spent on building functionalities and features from scratch. It also cuts down overhead expenses. Third-party integrations allow developers to easily include functionalities without compromising project timelines. By staying ahead of schedule, developers can focus on a robust HIPAA compliant API development process. It’s necessary to leverage secure third-party integrations so that developers can access support from experts with deep knowledge and understanding.

Arkenea – a top-rated company that specializes in healthcare software development, offers third-party API integrations for video conferencing, payments providers, chat APIs, ePrescriptions, Redox Engine, EMR, and any other specifications. We got you covered!