If you talk with any founder of a modern medical software company, someone who is a real tech entrepreneur with ambition to improve patient’s (and doctor’s) lives about integrating his/her system with an existing hospital or practice software, you will often encounter distorted, painful faces.

The reason is the abysmal protectionism of the “old economy” companies, which still dominate the market in medical software industry. These are dinosaurs, which may have once started with a similar passion in the 80s or 90s, but have long outlived their passionate founders and secured their market position by mere protectionism. With protectionism, I refer to their closed systems with old-fashioned or non-existing APIs. For any non-tech person: an API, also “application programming interface” is a communication possibility between 2 or more programs from different vendors. Implementing an API on the level needed in medicine is usually really trivial and may require few developer days. Mind you, an API can usually be developed once and be used by anyone easily. This is standard practice in all other industries and is being practiced even by the big tech companies like Google, Apple, Microsoft, etc. Opening up an API can also be a huge chance to create an app store/plugin store, where other vendors can sell their services through the platform vendor (e. g. Apple App Store works this way).

But of course, opening up for data is a possibility for a competitor to present the patient data in a better and more useful way to the doctors, who may ultimately fall in love with the competitor’s solution (instead of continuing riding the near-dead horse). And this is a threat to the existing old medical software companies, which dominate the market, because they know that their software is lame, slow, bothersome, and un-intuitive.

Any innovative software company, which can deliver a new piece of software, which can improve the work-day of a physician, needs an API to the main patient-record keeping program, e. g. a patient information system, laboratory information system, etc. As an example: The innovative company could have a software for artificial intelligence (we’ll call them AI-Tech), which should work together with the dinosaur hospital software, which we will call company Dino.

Now, the doctors are all-in for AI-Tech’s solution and wish for a swift and painless integration into their company Dino system. But they also present their worst pain-stricken face, when they say “but company Dino are not easy to talk to… plus, it will be very expensive for us”.

And this is, what happens: company Dino will first take forever to react to AI-Tech’s inquiries (weeks, months, deflecting). If someone from AI-Tech finally reaches them, they will answer “oh God, another API? This has to be a lengthy project and the customer has to pay at leaset €15,000” (for a click of a button usually, as the API often already exist in some way or other).

In another dick move, company Dino will try to talk the customer out of it completely – “hey, we also may develop an AI solution in the future, why not better wait for our new Dino version 1999.2?”. The customer may insist on getting AI-Tech’s solution and then a lengthy phase of integration will start.

The company Dino will still rely on a very old tech-stack (HL7 instead of REST API, etc) and during all the project-manager-to-project-manager meetings and developer-to-developer meetings, AI-Tech will notice that the dinosaur also does not have the sharpest…. teeth. Talking about software developers in company Dino? More people, who were initially trained on 70s/80s technology…

This will drag on for a long time and in the end, the doctors (if they haven’t given up hope) and AI-Tech may achieve, what they were trying for such a long time, but at a huge level of wasted time, energy and money.

As in this example, these much hated dinosaurs still exist in every hospital and most practices world-wide. They don’t know that their time has come… must come! We physicians and ambitious developers (I comprise both personalities in one brain) want software, which does not slow us down, but makes us faster. Software, which we love, software, which is easy to use – like our smartphone’s!

Who can solve the dinosaur problem then and move them to extinction? We cannot hope for many small asteroids exactly crashing onto these companies.

Instead, politics (maybe not at the government level, but at the physicians organization levels) have to issue laws that every medical software company *must* provide a free API, which is open to read all data. The physicians (or their IT department) would have an administration panel, where they can switch permissions on/off for other installed software. In our example, the hospital IT department could grant AI-Tech access to the API of the company Dino’s system (or parts of it).

So, this is a wake up call for anyone affected out there to rise and call for a medical API revolution today!!