The Power of FHIR APIs in Healthcare

Saul Marquez: Hey everybody. Welcome back to Outcomes Rocket, AHIP Insights 2024. We’re here in Las Vegas, Nevada at the Wynn with the amazing Don Rucker. He is the Chief Strategy Officer at 1upHealth. So great to have you here, Don.

Don Rucker: Yeah, thank you, Saul.

Saul Marquez: So we’ve been having a lot of discussions, sharing insights from the conference, and we’re going to do that today with you. But before, tell us a little bit about you and your background.

Don Rucker: Well, I’m a doc who’s been interested in data actually since med school in the ’70s, working with a guy named John Eisenberg, who eventually went on to head AHRQ, and interested in the computerization of data since the early ’80s and have been involved, built a company called Datamedic, built the first Microsoft Windows EMR, was Chief Medical Officer at Siemens, rolled out one of the big widely used computerized physician order entry. Most folks may know me as the former national coordinator [of the ONC] where we implemented the Cures Act, FHIR APIs, and the Bulk FHIR API, which is really important for payers and provider accountability. 

And now at 1up, we’re putting some of that stuff into action with modern FHIR APIs and modern representations of data that allow you to do a lot of things. But most importantly, they allow you to actually think about clinical data because historically payers have not had clinical data and so they’ve had to infer clinical data from the thinnest of trails, which is ICD-10 codes and CPT-4 billing codes. That world is coming to an end, and we could talk more about that, but that world is coming to an end. And so how do you as a payer actually organize your clinical data? It’s a totally different data pipeline than the entire claims pipeline that you’ve built up. How do you do it in a modern, smart way and actually get at the incredible mess that is clinical data, because you have to organize the mess if you’re going to use it.

Saul Marquez: Totally. No, this is super insightful, doc. So where is the new data coming from?

Don Rucker: Well, so the new data is, it’s a combination of things. So obviously, with the widespread adoption of electronic medical records, we now actually have, let’s call it a source of truth, may not be an absolute source but let’s just call it a source of truth.

Saul Marquez: Let’s call it that.

Don Rucker: Just for the point of the podcast, operating on it. And the Congress and the Cures Act required these EHRs to have APIs. That’s what we implemented in ONC. And so you can get the data as a patient in real time, your app, but you can also, for your own analytic purposes, or if you’re doing an in-network contract with a payer, the payers can get that data through the Bulk FHIR API. So they’re getting the core data and obviously having the modern FHIR data standard enables this to be real. We’ve been trying to get clinical data for decades and have only been able to do the data that came off machines or really, really simple ADT feeds. But now with the advancement in the rest of the internet economy, JavaScript object notation, JSON, RESTful APIs, that’s what powers every app on your phone.

Every little icon on your phone is actually talking with some backend server. You may not think of it that way. When we press on the apps, we’re not thinking there’s a backend to it, but we have the ability now to use that same technology in healthcare.

Saul Marquez: That’s brilliant. Help us understand 1upHealth and your role in this transfer of data.

Don Rucker: So I’m the Chief Strategy Officer, which honestly is a little bit of a jack of all trades, somebody who’s been involved in building software for decades and practicing medicine for decades. I still practice.

Saul Marquez: It’s a great company.

Don Rucker: And being involved in federal policy. Our goal at 1up is really to enable the acquisition, which is very tricky and that’s why somebody would come to us preferentially, is because we’ve really nailed the acquisition pipeline. And that’s a lot of work that’s, as they say in the IKEA instructions, some assembly required.

So building a quality FHIR data pipeline’s a lot of work, and then having the data so you can actually compute on it, whether it’s classic statistics, modern ML/AI thing, all of those need, certainly the AI needs, regularized data. That’s a highly technical term. It sounds generic, but regularization of data is really an important feature if you’re going to be modern about it. And you have to have the platform that’s real time, that can drive APIs, can drive analytics, can drive behaviors consequently. And that’s what we build and we build it at vast scale.

Saul Marquez: That’s fantastic.

Don Rucker: It’s a venture-funded company. We have a whole bunch of A-list investors. So that’s what we do.

Saul Marquez: That’s brilliant. Appreciate you sharing the what and the how. Not a lot of people were able to make it to the meeting. And part of the point of our podcast today is to share insights from the conference. What’s risen to the top from you, from the panel that you were on, to other sessions you may have attended?

Don Rucker: Well, I mean there was just a session that closed with David Brailer from Cigna on re-architecting healthcare and moving it from a B2B2C, if you will, the classic payer to the employers purchasing plan service to consumer, and if we’re going to get consumers involved, and that really is the mandate that’s coming, that’s the essence of Medicare Advantage. That’s the essence of managed Medicaid. It’s increasingly the essence of a lot of commercial plans. Those are all data science things, first and foremost. You can’t just add something as a bolt-on to your claims pipeline and think you’re going to be good at it or adequate at it. And I think that’s the takeaway. Now, there’s a lot of confusion here, people, a lot of point solutions and fixes without understanding that computer science can actually do a lot of this vastly better than maybe alternative approaches, let’s say, but that’s life.

Saul Marquez: It is. No, I appreciate you sharing that. The re-architecting of the industry is something that we should all be thinking about our approaches to it just according to Don and the work that he and the team at 1upHealth are doing. There’s huge opportunities and the technology and the partners exist today. Don, final question for you, and then we’ll wrap.

Don Rucker: Okay.

Saul Marquez: What call to action would you leave our viewers and listeners with?

Don Rucker: Yeah. I think the call to action is really to think about how am I going to change my processes? Let’s assume you’re in that provider-payer pipeline for argument’s sake. How am I going to change processes so I can efficiently use clinical data, with all kinds of computing on it, whether that’s quality measurement, whether it’s network design, whether it’s prior authorization, whether it’s case management, whether it’s more directed payer-to-patient outreach. How can I do that with the same data stores and really start thinking about getting care earlier and more efficiently, because that’s where policy and economics are driving you. It is now finally, I’ve been in the space for decades, it is finally doable. So it’s a very exciting time after all of these years to see it finally be doable. So I think that’s the call to action to folks. Obviously from a purely commercial point of view, we’re happy to help you at 1up and at least have a conversation and folks can decide.

Saul Marquez: That’s fantastic. Well, you not only waited, you acted persistently since your college days.

Don Rucker: Yeah, med school.

Saul Marquez: Med school days all the way until now. It’s real.

Don Rucker: Yeah, 1978.

Saul Marquez: So now that it’s real, let’s get to work.

Don Rucker: Yeah, exactly. Glad it’s there while I’m still kicking. Truth be told, some days, some decades, I was wondering. I thought when I graduated from business school and computer science, I did a enroll your own program after residency, which I finished all of that in ’88, and I foolishly thought the EMR problem was going to be solved in three years. And I mean, it’s still a little unfortunate, there are EMRs that essentially effectively prevent automation as opposed to facilitating it. But they’ve responded to the policies we as policy makers have given them. So you can’t blame them. But the world’s changing.

Saul Marquez: It has, and the opportunities are here for all of us. Don, I want to thank you for joining us on our podcast today.

Don Rucker: Thank you, Saul. Appreciate it. Thanks.

Saul Marquez: It’s been a real treat and pleasure to have you and for everybody listening and watching, thanks for tuning in. Let’s take action on the work that Don has shared with us today. In the show notes, you’ll see ways to get in touch with Don to get in touch with 1upHealth, and stay tuned for more insights from AHIP 2024. Thanks, Don.

Don Rucker: Thanks.