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Eligible API - Build the future of health information

Posted on by Brandon Klein

The US health information systems pass records in disparate data formats. We've created simple REST APIs that normalize them for you

A number of amazing startups have been popping up of late to employ modern technology in the hopes of improving healthcare and education. This is important not only because these are two industries that touch each and every one of us, but because they are both equally consumed by legacy infrastructure and archaic standards. Yet, while startups continue to enter the space — something we should continue to celebrate — many are still shying away from some of the most challenging technical problems that stand to make a bigger impact than yet another sexy consumer mobile app.

Granted, this shouldn’t be surprising, given that both industries suffer from some seriously intractable problems, mostly courtesy of long-entrenched legacy infrastructure. Modernizing the infrastructures themselves, along with the way health companies integrate and exchange data is a difficult task — but it’s also an important one.

Eligible, a San Francisco-based startup and member of Y Combinator’s most recent batch, has decided to bite the bullet and meet this challenge head on. Big data stands to have a transformative effect on healthcare (and education and really every industry), but the key is putting that data in a language that is smart, universal and dynamic.

To do that, Eligible set out to build a modern, standardized set of protocols to make healthcare data and information more accessible, particularly healthcare eligibility. A member of the same Y Combinator class as Clever, Eligible is applying the same philosophy to healthcare data. In other words, just as as Clever (and LearnSprout) have created a modern set of REST APIs to unlock student data from the lumbering, closed datasets of Student Information Systems, Eligible is doing the same for healthcare eligibility.

The goal is to pull down the barriers that restrict the interoperability of disparate (yet critical) data sets, making them easier to manage and integrate. Of course, “healthcare eligibility” is a side of the healthcare infrastructure that the average person doesn’t see much of, and thus it may seem a bit boring or obscure (because it is), but it’s also an essential part of the process of receiving and managing care and is part of making the whole thing tick.

For example: Every time you go to the doctor’s office, seek treatment or go in for surgery, hospitals and doctors query insurance companies to see what kind of coverage you have and what treatments you’re eligible for under your current health plan(s). Traditionally, these requests are made manually, with the whole process taking place over the phone, by email, or maybe even by way of horse and carriage.

Naturally, with the aid of technology, the eligibility and information request process can be automated. And when one considers that there are about two trillion eligibility queries made by hospitals and doctors every year (a single procedure might involve five queries) — one starts to understand the amount of time, money and bandwidth that can be saved by automating those mechanics. In fact, it’s now understood to be such a critical need, that the Obama Administration (under its new healthcare policy) has mandated that insurers must begin automating their response to these queries.

Of course, automating and streamlining data exchange in the world of legacy Healthcare IT is easier said than done. Eligible co-founders Katelyn Gleason and Patrice Krakow have embraced the old technologies endemic to Healthcare IT (and the translation burden that comes with it) in order to solve what they believe is a very real (and monumental) problem both for developers and insurers. And, well, really everyone involved in the process (doctors, hospitals, administrators, developers, insurance companies, and, of course, patients).