Why patients are the medical API

Electronic health record systems used by hospitals, clinics, and specialists often cannot communicate with each other effectively.

As a result, patients frequently become responsible for transporting information between providers.

Use the patient journey scenarios described in the documents to illustrate this concept, especially the back injury case involving a primary care physician, chiropractor, spine surgeon, and physical therapy clinic.

Transcript

SPEAKER_01 0:00

Welcome back. It is really great to have you with us again. You know, you and I we share a bit of an obsession.

SPEAKER_00 0:06

We definitely do.

SPEAKER_01 0:07

Yeah. We both absolutely love uncovering the hidden why behind those everyday frustrations that uh that everyone else just seems to accept as a normal part of life.

SPEAKER_00 0:17

Aaron Powell Right. The things people just shrug off.

SPEAKER_01 0:19

Exactly. We like to look at a broken system and ask, how in the world did it get this way? Well, today's deep dive is going to scratch that itch perfectly. We are unpacking a massive, truly surprising design flaw in modern healthcare infrastructure.

SPEAKER_00 0:35

Aaron Powell It really is one of those hidden in plain sight issues. I mean, you interact with it, you get frustrated by it, but you might not realize just how structurally flawed the underlying mechanics are until you really look at the system architecture.

SPEAKER_01 0:46

Aaron Powell And for this deep dive, we've gathered a stack of incredibly revealing materials. We are looking through system analyses, detailed healthcare workflow documents, and some highly specific case studies.

SPEAKER_00 0:58

Aaron Powell Lots of data on this one.

SPEAKER_01 0:59

So much data. And the mission today is to explore a mind-boggling reality. Despite billions and billions of dollars invested in cutting-edge medical technology, the patient meaning you, me, literally anyone seeking care.

SPEAKER_00 1:14

Trevor Burrus, Jr.

SPEAKER_01 1:14

Yes. The patient has unintentionally become the API connecting entirely disconnected medical systems.

SPEAKER_00 1:20

Aaron Powell Yeah. And for those who might not spend their days reading software engineering manuals, um, an API, which stands for application programming interface, is essentially the digital messenger that lets two different software programs talk to each other seamlessly.

SPEAKER_01 1:34

Aaron Powell Right, like an invisible bridge.

SPEAKER_00 1:36

Aaron Powell Exactly. When you check the weather on your phone, an API is what carries the data from the National Weather Service directly into your app. And it happens in milliseconds.

SPEAKER_01 1:45

You don't even think about it.

SPEAKER_00 1:46

Don't. But in healthcare, as the workflow analyses clearly map out, that digital messenger simply doesn't exist between different independent medical practices. Instead, the patient is doing the heavy lifting.

SPEAKER_01 1:57

Which is just a wild concept to wrap your head around. You are the API, a human being who is often not feeling well, physically carrying the data from one building to another.

SPEAKER_00 2:08

It highlights the sheer absurdity of the current landscape. I mean, think about the contrast here. In modern healthcare, a typical medical issue doesn't just involve one solo doctor anymore.

SPEAKER_01 2:18

No, care is highly specialized now.

SPEAKER_00 2:21

Highly specialized. A single diagnosis can involve primary care doctors, specialists, diagnostic imaging centers, surgical teams, and rehabilitation providers.

SPEAKER_01 2:30

So many different touch points.

SPEAKER_00 2:32

You have all these highly trained professionals trying to coordinate complex, life-altering care, and yet the tools connecting them are shockingly outdated. We're talking about fax machines.

SPEAKER_01 2:43

Faxes in this decade.

SPEAKER_00 2:45

Yes. We're talking about phone calls where people are sitting on hold, unsecured email attachments, and manual spreadsheets. It's crazy. In an era where a surgeon can perform a delicate operation using a robotic arm, the front desk is still relying on a fax machine, emitting that high-pitched screech just to tell the surgeon why the patient is even there.

SPEAKER_01 3:04

Okay, let's unpack this. Because to really understand how we got here, we have to look at the technology that is supposedly doing this job. We constantly hear about electronic medical records.

SPEAKER_00 3:15

Right, EHRs.

SPEAKER_01 3:16

Yeah, we see doctors typing on laptops during our exams. So why on earth aren't those computers talking to each other?

SPEAKER_00 3:23

That is the core technological hurdle. There isn't just one universal medical record system in the country. There are hundreds of different electronic health record systems or EHRs operating right now.

SPEAKER_01 3:35

And the sources detail a few of them, right?

SPEAKER_00 3:37

Yeah. The system analyses we reviewed named some of the biggest players in the space, platforms like Epic, Athena Health, eClinical Works, NextGen, and All Scripts.

SPEAKER_01 3:47

Those are massive multi-billion dollar companies. Surely they have the technical capability to send a file to one another.

SPEAKER_00 3:53

Oh, they absolutely have the technical capability. But you have to look at the historically context why these systems were built in the first place.

SPEAKER_01 3:59

Which was what?

SPEAKER_00 4:00

Well, these EHRs were fundamentally designed to manage patient records and crucially billing codes within a single organization.

SPEAKER_01 4:08

Also, internal use.

SPEAKER_00 4:09

Exactly. Historically, they were built to digitize a specific hospital's or a specific clinic's internal filing cabinet and to streamline their own revenue cycle. They were not originally designed as collaborative care tools, meant to communicate across competing networks of independent practices.

SPEAKER_01 4:28

Aaron Powell So it's less about technological limits and more about the original design intent.

SPEAKER_00 4:32

Yeah.

SPEAKER_01 4:32

Like building an internal company, intranet, and then wondering why it doesn't easily connect to the public internet.

SPEAKER_00 4:38

Aaron Powell That is a great way to think about it. And there are also financial incentives at play that kept data siloed for a long time. It's a practice sometimes referred to as data blocking.

SPEAKER_01 4:48

Because they want to keep you in their system.

SPEAKER_00 4:49

Precisely. If a hospital network keeps all your data within their specific EPIC system, it creates a moat. It makes it slightly more inconvenient for you to leave their network. So what happens? Your patient information becomes trapped in these separate isolated data silos.

SPEAKER_01 5:04

And they just don't communicate.

SPEAKER_00 5:05

Right. The EVIC system at the big regional hospital does not naturally or easily talk to the Athena health system at your local independent dermatologist's office.

SPEAKER_01 5:14

Which brings us right back to you, the listener, and what this actually looks like in real life. We have all experienced this exact friction. You walk into a new specialist's office, maybe you're nervous about a potential diagnosis. And what is the very first thing that happens?

SPEAKER_00 5:30

The paperwork.

SPEAKER_01 5:31

Yes. You are handed a clipboard with five pages of paperwork, and you're asked to sit in a waiting room and write down your exact same medical history all over again, completely from scratch.

SPEAKER_00 5:43

It is the universal shared experience of the modern patient.

SPEAKER_01 5:46

But it's not just the annoyance of the clipboard, is it? It's the barrage of repetitive, sometimes alarming questions you face when you finally get into the exam room.

SPEAKER_00 5:55

Right, because the doctor has no context.

SPEAKER_01 5:56

Exactly. The doctor or the nurse practitioner looks at you and asks things like, Do you have your MRI report with you? Can you list the exact dosages of the medications you're currently taking? Did your referring doctor send us your imaging results? Because we don't seem to have them.

SPEAKER_00 6:12

It's a profound realization. When you step back and look at the expectations being placed on the sickest people in society, there is a deeply held illusion among the general public.

SPEAKER_01 6:22

That everything is connected.

SPEAKER_00 6:24

Yes. Most patients just logically assume that their doctors share information automatically. You assume that because Dr. A told you to go see Dr. B, Dr. B obviously has a complete up-to-date file on your health.

SPEAKER_01 6:35

Which makes sense logically.

SPEAKER_00 6:37

It does. But the reality exposed in these workflow documents is that medical data frequently only moves if the patient physically transports it on a CD-ROM or a piece of paper, or verbally recites it from memory.

SPEAKER_01 6:50

It's easy to talk about this in the abstract as a massive systemic failure, but what does this actually look like for a patient on the ground? How does this play out over the course of a single medical event?

SPEAKER_00 7:00

Let's look at a case study from the workflow documents to ground this in reality. There's a great example of a patient named Mark Thompson. Mark is a 45-year-old guy who suffered a lifting injury at work and is dealing with severe radiating lower back pain.

SPEAKER_01 7:14

A very common scenario, but one that involves a lot of different specialists to actually fix.

SPEAKER_00 7:19

Precisely. Let's map out Mark's route, just to demonstrate how complex a seemingly straightforward referral journey gets under this fragmented system. Mark starts his journey at his primary care physician over at Generations Family Practice.

SPEAKER_01 7:33

Okay, stop number one.

SPEAKER_00 7:34

Right. They do an initial evaluation, prescribe some basic anti-inflammatories, and refer him out for a specialized evaluation at Carrie Chiropractic Center.

SPEAKER_01 7:44

Stop number two.

SPEAKER_00 7:45

He goes there for a few weeks, but the severe pain persists. So he is referred again, this time out, to a spine specialist at Triangle Spine and Neurosurgery for a surgical consultation.

SPEAKER_01 7:56

Stop number three. So we are already at three completely different business entities, presumably using three different electronic record systems.

SPEAKER_00 8:04

And the journey isn't done. That consultation ultimately leads to spinal surgery, which takes place at Triangle Spine and Neurosurgery. Following the operation, Mark is referred to a completely separate facility, Apex Physical Therapy, for his rehabilitation. Stop number four. Finally, once he has completed weeks of rehab, he has to return to generations family practice for his primary care follow-up to close out the episode of care.

SPEAKER_01 8:29

Stop number five. But wait, isn't that incredibly dangerous? If Mark is the API here, the digital messenger. Actually, let me let you break that down. Where is the specific friction happening for Mark?

SPEAKER_00 8:41

What's fascinating here is where the friction occurs at every single stop on that map. Think about Mark's cognitive and physical load. He is in severe pain from a spinal injury, navigating the anxiety of major surgery.

SPEAKER_01 8:54

He is not at his best.

SPEAKER_00 8:56

Not at all. Yet he is the one sitting in uncomfortable waiting room chairs, frettling out new patient paperwork at five different locations. He is the one who has to make sure the spine surgeon knows exactly what conservative treatments the chiropractor already tried, so they don't waste time repeating them.

SPEAKER_01 9:11

And what about after the surgery? That seems like the most critical point for information to be accurate.

SPEAKER_00 9:15

That is where the risk really spikes. After his surgery, Mark is the one showing up at the physical therapist's office. He is now hoping that the physical therapist understands exactly what the surgeon repaired, which specific vertebrae were fused or operated on, so they don't accidentally injure him during his vulnerable rehabilitation phase.

SPEAKER_01 9:35

That is terrifying.

SPEAKER_00 9:36

Mark is entirely, unintentionally doing the administrative work of connecting these five disconnected facilities.

SPEAKER_01 9:42

So what does this all mean? If we pivot and look at this from a 360-degree view, the human impact across the entire system, not just for the patient, but for the professionals, is staggering.

SPEAKER_00 9:53

It really is a cascading failure. It affects everyone involved in the care journey, but as we noted, the heaviest burden falls on the patient.

SPEAKER_01 10:00

Right. From the patient's perspective, this is nothing but frustration, confusion, and anxiety. You are sick, or in Mark's case, recovering from invasive spinal surgery. The absolute last thing you should be burdened with is acting as a project manager for your own health data. You are scheduling a complex web of appointments, transporting physical records or literal compact discs with MRI data on them, and trying to accurately verbally explain highly technical surgical procedures to a new physical therapist, all while just trying to heal.

SPEAKER_00 10:32

And if we shift our perspective to the primary care physician, they're dealing with their own immense frustrations.

SPEAKER_01 10:38

How so?

SPEAKER_00 10:39

Well, the primary care physician, or PCP, is intended to be the quarterback of your healthcare. They're supposed to oversee the whole picture, but the current system architecture gives them a massive systemic blind spot.

SPEAKER_01 10:51

Because they lose track of you.

SPEAKER_00 10:53

The analyses explain that once the PCP sends that initial referral out into the world, they often lose all visibility into what happens next. It's like sending a letter into a black hole. They are left sitting in their office wondering, did Mark actually go see the specialist? Was surgery recommended? Did he ever finish his physical therapy, or did he drop out because of the pain?

SPEAKER_01 11:12

And they have no way to check easily.

SPEAKER_00 11:14

Without a reliable automated communication system, the doctor simply doesn't know until Mark happens to show up again months later.

SPEAKER_01 11:21

I imagine the specialist is equally in the dark, just from the other side of the equation.

SPEAKER_00 11:25

Exactly. The specialist is frustrated because they receive a patient in their exam room, but they have absolutely no clinical context. They have a patient sitting on the table, but they have no imaging reports. They have no clinical notes detailing what the primary doctor already ruled out.

SPEAKER_01 11:40

So they're starting from scratch.

SPEAKER_00 11:42

Often, yes. They might not even have the necessary insurance authorizations processed yet. How can you effectively and safely treat a patient when you're missing half the puzzle? It delays treatment, it leads to redundant testing, which drives costs for everyone, and it forces the entire clinical team to scramble.

SPEAKER_01 12:00

Which brings us to a group of people I had never really thought about before reading these materials, the referral coordinators.

SPEAKER_00 12:06

Oh, the unsung heroes of this entire fragmented mess.

SPEAKER_01 12:10

Tell us about what their day actually looks like.

SPEAKER_00 12:12

These are the administrative professionals working behind the front desk or in the back office of these clinics. They are tasked with managing dozens, sometimes hundreds, of patient referrals at once, and they're doing it almost entirely manually.

SPEAKER_01 12:25

Just brute force.

SPEAKER_00 12:27

Picture their day. They are managing dual monitors with conflicting spreadsheets. They spend hours dialing specialist offices, sitting on hold, listening to elevator music, trying to track down a fax that supposedly sent, but never arrived. They are leaving vague voicemails playing phone tag just to confirm if a patient actually scheduled an appointment. They were essentially trying to force a disconnected analog system to act like a connected digital network through sheer brute human effort.

SPEAKER_01 12:57

I've heard the term referral leakage thrown around in the business documents we reviewed, and it seems heavily tied to this administrative chaos, but I'm struggling to picture how a patient actually leaks out of a system. How does that happen in practice?

SPEAKER_00 13:10

Referral leakage is a massive structural and financial problem for healthcare networks. It occurs when a patient is referred outside of a physician's trusted, established network of care partners.

SPEAKER_01 13:21

Okay, give me an example.

SPEAKER_00 13:22

To visualize it, let's say your primary care doctor refers you to an orthopedic specialist they know and trust, someone whose work they respect and who they regularly communicate with. That specialist evaluates you and recommends physical therapy. But instead of the specialist's office coordinating with a physical therapist affiliated with your original doctor's network, they just hand you a piece of paper with a random clinic's name on it, or you just Google one near your house. You have now leaked out of the coordinated care network.

SPEAKER_01 13:51

And the numbers on this are wild. The system analyses state that 15 to 35% of all referrals leak outside of physicians' intended network because of this fragmented mess.

SPEAKER_00 14:01

Which is incredibly disruptive on two fronts. Clinically, it results in a total loss of care continuity. Your original doctor has no idea what is happening, and the new out-of-network provider has no easy way to get your history.

SPEAKER_01 14:14

So the API breaks down entirely.

SPEAKER_00 14:16

Exactly. But from a business perspective, it is devastating. It means reduced patient satisfaction, higher administrative costs trying to track you down, and significant lost revenue for those healthcare networks who are losing patients to competitors simply because their internal coordination is too difficult to navigate. It is a lose-lose situation born entirely out of bad system design.

SPEAKER_01 14:39

Here's where it gets really interesting. Because you don't just point out a massive systemic flaw without looking for the innovators trying to fix it. And the research materials point to an emerging category of software solutions called referral orchestration platforms. Specifically, they detail the mechanics of a platform called Canary.

SPEAKER_00 14:58

Right. And it's important to look at this objectively. We aren't looking at this as a specific product endorsement, but rather as a systemic design fix. We need to understand the mechanics of how a platform like Canary represents a fundamental shift in the infrastructure of healthcare data.

SPEAKER_01 15:13

So, what are the actual mechanics? How does it change the dynamic we've been talking about where the patient is carrying the burden?

SPEAKER_00 15:19

It removes the isolation by creating an agnostic bridge. A referral orchestration platform provides a shared, secure digital space where providers across different competing independent practices can coordinate care regardless of which EHR they are using. But the most critical innovation here is the shift from unstructured data to structured data.

SPEAKER_01 15:41

Let me make sure I'm picturing this right. What is the actual difference between unstructured and structured data in this context? Because to me, data is data.

SPEAKER_00 15:49

It's a crucial distinction. Unstructured data is what we have mostly been relying on. Think of a fax. Even if it's a digital fax sent to a computer, it is basically just a dumb picture of a piece of paper.

SPEAKER_01 16:00

The computer doesn't know what's written on it.

SPEAKER_00 16:01

Right. The computer can't read it. A human still has to open it, read it, and manually retype the patient's allergies, medications, and history into their own system. It is incredibly prone to human error.

SPEAKER_01 16:12

Okay, so what does structured data do differently?

SPEAKER_00 16:15

Structured data is like a smart spreadsheet. When a platform like Canary sends the referral, the data is coded. It means the patient's demographic info, their reason for the referral, and their medication list automatically populates directly into the correct fields of the new specialist's electronic health record without anyone typing a single keystroke.

SPEAKER_01 16:37

That is huge.

SPEAKER_00 16:39

And the crucial part is that this comprehensive, accurate information arrives before the patient ever steps foot in the new office.

SPEAKER_01 16:46

Which means the specialist actually has the puzzle pieces sorted and ready before they even walk into the exam room to see you. But the part of the analysis that really stood out to me was the journey tracking feature, the idea that there could actually be a tracking system for patient care. It sounds almost like tracking a package you ordered online, but for your health.

SPEAKER_00 17:04

That is a perfect analogy. And it completely eliminates that primary care physician's blind spot we talked about earlier. With a referral orchestration system, the referring providers can log in and see exactly when a patient schedules their specialist appointment.

SPEAKER_01 17:18

They can see the progress.

SPEAKER_00 17:19

Yes. They know when the surgical consultation is completed, when the surgery actually happens, and when the rehabilitation begins. Everyone involved in the patient's care is finally on the same page, operating from the same timeline.

SPEAKER_01 17:31

And it seems like it would completely change the lives of those referral coordinators, too. The documents highlight that these platforms include secure, high-pay compliant messaging linked directly to the patient's specific record.

SPEAKER_00 17:44

Exactly. So instead of chaotic, unsecured email chains or leaving vague voicemails and playing phone tag for three days with another clinic, the coordinators can just message each other securely. They can ask a quick question within the context of NARC-specific file, and the answer is documented permanently.

SPEAKER_01 18:01

But let me play devil's advocate for a second. We talked earlier about how these hospital networks built these data silos intentionally to create a moat. Getting independent, fiercely competitive hospital networks to adopt a shared platform must be like herding cats. What are the hurdles to actually implementing something like this? It can't just be as easy as flipping a switch.

SPEAKER_00 18:21

You are hitting on the exact friction point of medical innovation. Change management in healthcare is notoriously difficult. Providers are burned out, and asking them to learn a new software workflow is always met with resistance. There is the inertia of we've always done it this way with the fax machine.

SPEAKER_01 18:38

Right.

SPEAKER_00 18:39

Furthermore, overcoming the business hesitations, convincing competing networks that sharing data securely actually benefits them financially by reducing administrative waste takes time. But the economic pressure of referral leakage is finally forcing their hands.

SPEAKER_01 18:55

Because it's costing them money.

SPEAKER_00 18:57

Exactly. By mapping these practice relationships digitally, the system actively prevents that leakage. When a specialist needs to refer a patient onto physical therapy, the platform helps them select verified partners within that trusted network. It keeps the patient within a collaborative ecosystem which satisfies the business needs of the clinic while drastically improving the clinical experience for the patient.

SPEAKER_01 19:19

Ultimately, it finally removes the patient from the role of medical courier. It takes the clipboard out of your hands and lets you just focus on being the patient. So looking at all of the workflow data and these case studies, the big takeaway for you, the listener, is pretty profound. Healthcare networks absolutely need to operate as seamlessly connected ecosystems, not as isolated, walled-off organizations. And you, the patient, should never have to be the glue holding your own fragmented medical data together.

SPEAKER_00 19:50

If we connect this to the bigger picture, the real value of understanding the system is clarity. The next time you walk into a clinic and they hand you that multi-page clipboard and ask you if you brought your own imaging results, you won't just be annoyed. You will actually understand the systemic line spots that you are being asked to compensate for.

SPEAKER_01 20:07

Yeah.

SPEAKER_00 20:08

You will see the invisible API that you are being forced to act as.

SPEAKER_01 20:11

It completely changes how you view that frustrating waiting room experience. It's not just a slow receptionist, it's a failure of system architecture.

SPEAKER_00 20:18

It really is. Yeah. And I want to leave you with a final thought to mull over, building directly on this idea of the patient as the ultimate messenger of your own health data. We spent a lot of time talking about Mark, who is in severe pain but still fundamentally capable of driving around, advocating for himself, and filling out complex forms. True. But think about the broader implications for the population. If the entire healthcare infrastructure relies on patients to be the couriers of their own complex medical history, what happens when a patient is simply too sick, too overwhelmed, or too confused by a terrifying new diagnosis to remember their exact treatments?

SPEAKER_01 20:56

That's a scary thought.

SPEAKER_00 20:58

What happens when an elderly patient experiencing cognitive decline is expected to verbally transfer their intricate medication list to a new specialist from memory? If a system relies entirely on the sickest, most vulnerable people to be its most reliable data careers, it isn't just inefficient, it's incredibly fragile.

SPEAKER_01 21:24

Thank you for joining us on this deep dive. We always appreciate you spending your time with us exploring the why behind the hidden systems that shape our daily lives. Keep asking questions, keep looking past the obvious, and we will catch you on the next one.