The State of US Healthcare APIs

About this paper

The United States has the best standard in the API economy — HL7 FHIR — and, on the evidence, the worst scores in this series. The 21st Century Cures Act made every certified EHR publish a FHIR endpoint; it did not make any of them build a developer product, and this report scores exactly who treated the rule as an obligation and who treated the open standard as an opportunity.

Seventy-seven US healthcare companies, read the way an agent would read them, average a full band below US payments — because a mandate produces compliance, not quality. The API-native challengers out-publish the incumbents on self-serve FHIR breadth; the gated giants comply; governance is near-zero; and in the sector where consent is the entire moral foundation, not one company exposes it as a machine-legible contract. The full report maps the inversion, the FHIR-vs-proprietary split, the consent gap the agentic era will hit at full speed, and where the value actually sits.

What's inside

1. Executive summary — the mandate produced compliance, not a product
2. The state of the sector — the mandate produced compliance, not a product
3. The resource taxonomy — FHIR is the language, but only half the sector speaks it
4. The composite Kin Score — and why it's the foundation
5. Agent-readiness — the lowest in the series, and consent-blind
6. The blueprint — what the leaders satisfied, and what nobody has
7. Standards and artifacts — why the spec was never the hard part
8. Security, auth, scopes, and consent — strong on scopes, silent on consent
9. Provider-by-provider intelligence — the challengers, the gated incumbents, and the caveats
10. The investable thesis — the value is in the open layer

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