Month: August 2022

Technology integration is one of the greatest opportunities that we have in healthcare

Season 4: Episode #132

Podcast with Jared Antczak, Chief Digital Officer, Sanford Health

"Technology integration is one of the greatest opportunities that we have in healthcare"

paddy Hosted by Paddy Padmanabhan
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In this episode, Jared Antzack, Chief Digital Officer at Sanford Health, discusses the special considerations that go into serving their widely dispersed population and how they design digital solutions for that population. Sanford is a large health system that primarily serves the rural population across the upper Midwest, stretching over 250,000 square miles.

Jared’s role at Sanford ranges from being clinician-facing and consumer-facing to bridging their needs across technology, business needs, and consumer experiences. He states that digital is both about the front-end aspect of technology that users interact with as part of a broader experience and the back end that includes the infrastructure, architecture, databases, interfaces, and networks. Jared points to how the digital divide has become a social determinant of health and how they are removing the friction points to enhance digital patient experience and engagement. Take a listen.

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Show Notes

06:01Can you talk to us about your priorities and how that is impacted?
08:17 When you talk about the types of care that are important to the populations you serve are we talking about primary care, managing chronic conditions, or acute care procedures? What is the most important gap or need now that someone in your role would be focused on?
10:14 Can you give us an example of a digital enablement that you've launched and implemented that addresses your needs?
15:05How do you go about making your technology choices when it comes to implementing the solutions you referred to?
19:28What is the need you're trying to address? What is your advice for someone who is listening to this podcast, wants to approach you, and offer you a solution?
21:46 Should innovators be considering some very specific attributes of your population as they develop their solution for your population? What is your advice here?

About our guest

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

One of our goals with digital programs is to eliminate systemic racism in healthcare

Season 4: Episode #131

Podcast with Adam Landman, MD, Chief Information Officer, and Senior VP, Digital, Mass General Brigham

"One of our goals with digital programs is to eliminate systemic racism in healthcare"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Adam Landman, MD, Chief Information Officer of Mass General Brigham (MGB), formerly Partners Healthcare, talks about the four distinct user groups that Mass General’s digital engagement programs have identified and prioritized for improved experiences. In addition to fast and convenient patient experiences, Mass General’s digital programs focus on the needs of diverse population segments to improve access to care and eliminate systemic racism, which they consider a public health issue.

Dr. Landman also talks about their data and analytics capabilities, the need for robust technology infrastructure, and their experience and learnings from evaluating and engaging with young, innovative start-ups. Dr. Landman is also co-author of a paper in Nature Digital Medicine on deploying digital health tools within large, complex health systems. Take a listen.

Our Podcast Partners:

Show Notes

03:18 What are some of the top priorities and digital aspects that you’re currently working on as the CIO?
08:06Can you share the top priorities for improving the patient experience?
09:25 What are you hearing from your patients when it comes to the kind of digital experiences that they're looking for?
13:00 How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?
15:48What kind of technology foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?
18:13You stated that you start with the EHR first; however, do you have a strategy that involves other best in class tools, standalone point solutions, enterprise class platforms, or you build some things yourself? How do you approach these technology choices?
22:05What are the rubrics that you use when you start evaluating the digital health startup companies and how do you make sure all these solutions work well together?
28:45 What kind of data and analytics infrastructure are you building within MGB and what are those competencies focused on?
32:02 What’s your advice for your peers in the industry, and for innovative and young technology solution providers who want to be a part of your journey?

About our guest

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Q. Adam, tell us a little about the populations you serve at Mass General Brigham.

Adam: First, I want to address our name. You may know us as Partners Health care but now, we are Mass General Brigham. This new name more closely reflects the world-renowned hospitals that make up our system—Mass General Hospital and Brigham and Women’s Hospital—which are really the foundation and heart of our healthcare system. At a high level, the Mass General Brigham vision is to build the integrated academic health care system of the future in which we have patients at the center transforming care, improving outcomes, and expanding our impact locally, nationally, and globally.

Currently, we see about 1.8 million patients per year. We have 80,000 employees. Our inpatient capacity is >3200 inpatient beds. What is also unique about our system is our research enterprise. We really focus on performing breakthrough innovations and translating those innovations to the world. We have about $2 billion in sponsored research, which includes over 2700 clinical trials across our five academic medical centers—MGB Rigor, McLean Psychiatric Hospital, Mass Pioneer and Spaulding Rehabilitation. All of them encompass our academic mission and focus.

Q. What are some of the top priorities and digital aspects that you’re currently working on as CIO?

Adam: I speak today on behalf of an incredible team of colleagues that really enables us to do what we’re doing not just in digital, but also in health care delivery, overall. I want to acknowledge that we’re led by a new Chief Information and Digital Officer, Jane Moran, my new boss who’s really helped us with our strategic planning and prioritization, some of which I’ll share with you now.

Our priorities now center around experiences of our user groups. While this is something we have not thought about this way, traditionally, and it is a little new for us, I really think it’s the right strategy going forward. The four groups that we’re prioritizing are patients, providers, researchers, and employees. We’re putting together a strategy for each of these groups that focuses on meeting their needs regarding digital technology. I’ll just share two examples of that.

First, for our researchers, like other academic medical centers, we are focused on increasingly enhancing their access to the wealth of clinical data that we have and using modern cloud technologies and platforms so that they can use that data for approved research projects.

For our providers or our care teams, we have a lot of work going on to improve their experiences. One of our key projects is working on the in-basket experiences for our providers and patients. One of the best things about COVID was that we, like other health care organizations, saw a tremendous increase in the use of our patient portal. In fact, during the last two years, we’ve seen a doubling of the number of patients signed up for our portal and more of them actually engage with it. We absolutely want to encourage that, but we recognize that the system, the actual technology, and our workflows were not necessarily designed for the increase in message volume that we’re seeing.

I am working with colleagues across the organization on approaches to improve the in-basket experiences. What’s nice about our chosen approach is that we recognize that we really need a multidisciplinary team—technology experts, members from our digital teams, and colleagues that can focus on policy as well as workflow and care redesign. We’ve brought these worker groups from across these areas to collaborate on how we can change levers and improve the in-basket experience.

At a high level, some of the things we’ve done is worked on removing non-value adds in basket messages. So, we’re turning off all duplicate notifications or acceptance notifications that aren’t needed. We’ve also worked on the policy side to set expectations for how our portal should be used with specific emphasis on results, review, and response by the clinical care teams. Gradually we’re working on making changes which we hope will improve the care team experience.

Q. Can you share one or two top priorities regarding improving the patient experience?

Adam: I want to emphasize that while I gave the example of providers, we are focused on enhancing the experience for the entire care team. Even on the in-basket side, while there is a focus on providers, we’re also thinking about how to improve the front desk workflows and make that as efficient as possible.

With regard to the patient experience, I think of one example which will be similar to many organizations that are working on this—the digital front door. How do we make it easier for patients to interact with us and get access to our services electronically? That’s one of our major priorities and one of my colleagues is leading our efforts in that space.

Q. What are you hearing from your patients when it comes to the kind of digital experiences that they’re looking for?

Adam: Many of our patients have a lot of expectations from us. I can share a couple of the key things they want. First, a fast and convenient experience. They don’t want to have to call us, wait on hold for long periods of time, and then, be transferred to multiple different people to accomplish what they want. They want to be able to interact with us quickly and easily. So, that includes being able to schedule appointments quickly, check their test results, correspond with their care teams, and do virtual visits. Those are all components of functions that we are trying to make as easy as possible as part of our digital front door work.

Second, our patients are appropriately concerned about security and privacy. So, I think it’s essential that for everything we do with our patients, particularly from a technology perspective, we must ensure that it is as secure as possible and that everything possible be done to protect their privacy.

Third, equity. This is something that our system has made a very significant commitment to. We’ve launched a United Against Racism campaign, which really acknowledges and calls out that our system believes that racism is a public health issue. It impacts our patients, our workforce, and the communities we serve. We are acting as a system to dismantle systemic racism, and this has important implications in our digital work.

Just to give you a couple of examples, when we’re talking about digital technologies, particularly for patients, we want to make sure that all patients have access to these services, especially these new digital tools. We’re increasing access to interpreter services through the virtual interpreter services. If patients doing virtual visits don’t speak English, we bring interpreters into that encounter to help with patient communication.

Another example concerns our team of digital access coordinators. These are additional resources to help our patients enroll in our patient portal. They speak multiple languages, take time out to answer patients’ questions and help them not just with enrollment but also how to use the portal’s services. That’s how we’re addressing equity in our patient experience.

Q. How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?

Adam: I’d say that I personally learned a lot about this during COVID because we recognized then that we needed technology to help us solve problems and design solutions around how we could make testing available to all our patients? How could we extend vaccination to them?

We also recognized if we used very sophisticated technologies, that could prevent some of our patients from accessing those services. As we think about our approaches, we bring in our experts from different backgrounds, so our team represents diversity, equity, and inclusion. Those team members are part of our solution and ensure that we consider all our patients’ needs. As we design solutions, the attempt is to enable as many patients as possible to take advantage of those services. For instance, we used quite a bit of text messaging. We found many of our patients, even our most vulnerable patients, had access to and in fact, liked interacting with us over text messaging. So, we use a lot of text messaging and web based tools. We have found them to be very, very successful.

We also found that we had a rather sizable population that didn’t have cell phones and that we only had landline phones for them. So, we used IVR tools with some additional AI capability to enable those patients to interact with an agent and even schedule appointments for vaccination directly over a landline phone.

We’ve baked into our solution process the need to ensure that our base technology solutions reach as many patients as possible. Where there are gaps, we address those with other solutions—sometimes, technology-based, and other times, just additional outreach and greater focus in those areas.

Q. What kind of technology, foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?

Adam: We absolutely think in terms of platforms, and this is something that Jane Moran has helped shape. In an ideal world, we want to leverage our existing platforms as much as possible to meet needs. But we also recognize there are limitations to those platforms which is why we need to consider other solutions.

As we think about patient experience, of course, our electronic health record forms the core there. We absolutely leverage our electronic health record. However, there are limitations to what that platform can do. So, we are also investing in a customer relationship management platform to help supplement our electronic health record.

We’ve also invested in additional tools—chat bots that sit on top of our electronic health record and have added some of these capabilities to help improve interactions with patients. We are in the early stages of using some of these technologies, particularly the chat bots, and so we’re really learning how well they work, for which use cases, and for which patients. We will continue to iterate and improve on those as we go.

Q. You started with the EHR and that’s what other health systems do as well, but they can’t do everything. Do you have a strategy that involves other best in class players, standalone point solutions, enterprise class platforms, or will you build some things yourself? How do you approach these choices?

Adam: Here’s how we are starting to think about this. We’re formalizing a process which we’re calling an Enterprise Architecture Review that we’ll go through when there is a new technology need to really consider and determine which solution, we’ll use to solve that need. First, we’re going to look at our existing enterprise platforms which may include our electronic health record. We’re building out a CRM system as well so that would be considered, too. Our HR and Finance systems are also platforms we’re looking to first, to solve requests that are coming in.

Then, if those major platforms don’t solve the issue, we might look to an existing product that might be in use across our enterprise because if we’re already using it, maybe we can extend that. If it’s already being used for this specific use case in another part of our organization so, we could look to sort of leverage that tool further.

If there really is not a tool that we have or an existing platform that would work, that’s when we’d look to another solution in the market. Ideally, there’s a solution out there that we could just purchase and use.

In some cases, we don’t find a solution that we can purchase and use. That’s where we’d love to find partners who want to co-develop and work with us to shape their tool to meet our needs. If it meets our needs, it probably meets needs from other healthcare systems out there.

Finally, if we cannot find a partner and if there’s nothing out there on the market, that’s when we would consider actually building the software ourselves. We do that from time to time, but we really want to have a rational approach to when we’re using those specialized resources.

I will put a plug in here. We did just write a paper on this, and I can share it with you. But for our listeners, we recently published a paper with a colleague, Jayson Marwaha, who was our first author on this paper. This was published in Nature Digital Medicine, and it really describes how we look at bringing new digital innovations into our organization. It summarizes what I was just talking about, more articulately—our process to look at innovations, where, which platform we’re going to use, and which technology leads.

Q. Adam, there is a lot of digital health innovation out there and billions in venture capital money. It can be quite confusing and can be quite risky to place your bets on one or more of these solutions. How do you go about at a very high level? How do you make sure all of these solutions work well together?

Adam: I feel fortunate that I have the opportunity to do some of this digital innovation. For many years, I oversaw the Brigham Digital Innovation Hub. Now, I oversee a small team across the enterprise. Our Digital Health Innovation team has been making some investments in collaborating with early-stage startups to improve health care delivery.

Perhaps the most important first step is identifying the problems that you want to solve and ensuring that there’s not already a robust solution to it. If there is a robust solution, that will meet the needs, you want to try to make sure you’ve looked at that solution first. Working with an early-stage startup can be really rewarding but has a lot of risks to it as well. So, before you’re looking at the new startups, check for established solutions that may exist.

There are so many new, exciting challenges in healthcare for which we don’t have solutions. There are exciting newer technologies that maybe doing things faster, better, and cheaper that we absolutely want to pay attention to in this space. But to your point, we want to have a rubric and a new way of approaching it.

So, while this may sound like an antithesis for people who like to innovate, we are actually going to add, as some of our strategic work in this space, more process to how we look at our investments in early-stage innovation. That’s because we want to be really systematic about it and increase our chances of success especially as we work with emerging technologies. We are going to try to proactively identify where the problems that we want to try to solve, are.

Second, the next step is to not be as opportunistic but have a process we go through to really look at the landscape of startups, critically, and evaluate them. In essence, what many of us are used to —doing RFPs or RFI—this really goes through that process with rigor. So, we’re looking at the startups, trying to select the best partner, and then, collaborating closely with them.

We want to understand what their experience is like, both on the technology side and in health care. What’s their leadership experience? How well do we work together? When you work in this area, what we’re really trying to do is work together to learn from each other and pivot, to try to find the right solution. So, both organizations need to be aligned on what are the problems that we’re trying to solve and how we are going to adjust over time to do that.

You need to get the right team that’s willing to make those changes, in place. Those are some of the things that I look for as we evaluate early-stage companies to work with and I continue to think that this is a really important area for us.

I will just add that we also have a $30 million AI Digital Innovation Fund, and we are specifically designed to be strategic investor, so this is reserved for early-stage companies that we are working with in some capacity. We will make moderate-sized investments at the series A and B levels in these partners.

Q. What specific capabilities or competencies do you think an organization like MGB needs to keep in-house and build out as you work with this ecosystem of technology partners? How do you bring it all together?

Adam: That’s a question that we’re trying to figure out, and I suspect many across the country are trying to identify as well. One context I’ll share is that the unique components of health care are that we work in a mission-critical organization. That’s 24*7*365. So, the technologies that we’re deploying have to work. We understand there will be some failures—some plans, some players—and when they happen, we have to be able to respond very, very quickly. Our traditional approach has been to in-source all of our expertise—our infrastructure expertise, our service desk, and our platforms really have been in-source.

We are like many organizations right now under significant cost pressures. So, we are starting to think about where we outsource. The questions that we’re trying to address, and I don’t have the answers yet, but I’ll welcome them from there, from you or from others that maybe listening is we can’t compromise on the quality and the service delivery aspect that we’re providing. But we’d love to be able to find ways of being more efficient in how we deliver those services. We’re still trying to identify if there are opportunities to outsource, where they are, or where they might be.

Q. What about the data and analytics infrastructure within Mass General? What kind of infrastructure are you building? What are those competencies focused on?

Adam: Like other organizations, we are also investing in our data infrastructure and more importantly, in moving our data infrastructure to the cloud. We have, for many years, had a very successful data lake and we’re now looking at what would it take to put that data lake into the cloud, to make sure all of our data is available, and ideally increase the amount of real-time data that are available. That’ll make it easier for internal users to access all of that data and use it to improve health care delivery. There’s infrastructure work going on to do that.

What I will share with you is, maybe a successful program that we’re leveraging the data from these environments via our Active Asset Management Program. This started at Brigham and Women’s Hospital a number of years ago. The concept around the program is how do we make efficient? For example, enabling efficient use of very high-cost fixed assets like operating rooms (OR). This program is really driven by operational leaders, but that requires data and data analytics to power it. So, our analytics team at the Brigham, led by Rob Horsford, pulled data from our electronic health record to start to show the utilization and you can imagine they broke that data down by day, time, service, and worked with the managerial leaders, including the provider leaders, to iteratively understand what data they needed to make management decisions. They got feedback on that and eventually created formal dashboards using Tableau and other tools to be able to display this data to the managers and hospital leaders, convene the right leadership stakeholders on a regular basis to review the data and more importantly, make management decisions based on this data so they could change staffing, reassign or blocks etc. timely.

Using the combination of the available data and management intervention, we were able to create more access for patients, which was great because they were waiting to have their procedures done.

There was also a revenue opportunity for the hospital. We’re now replicating this data and management system across Mass General Brigham and looking to use our new cloud-based data infrastructure as we scale this.

Q. What’s your advice or a best practice for your peers in the industry, especially smaller health systems that may not have the scale and the resources to do the kind of things that you’re doing? Likewise, what’s your advice for innovative and young technology solution providers that want to be a part of your journey?

Adam: I think the piece of advice that I will share for health systems and tech vendors is that we need to be agile. I really appreciated this during COVID, and I know there are a lot of definitions of agile out there, including that very specific technology initiative. But I think most health care organizations, including mine, when we approach technology, we want the technology solution to be perfect. So, we’d often spend months, if not years, planning projects, getting ready for the big implementation and then, implementing. Of course, because we’re talking about patient lives and patient safety, we absolutely still need to pay really close attention to the details and need to plan these initiatives carefully.

What I have found and what we proved during COVID is that we can work in a different way where we break projects down into smaller components. We roll these out more quickly, even on the order of days or weeks and follow that very closely. We check how that technology implementation is going and continue to tweak it over time, sometimes making changes every day in order to stabilize the system or correct issues that may have come up.

What I found during COVID is, we built phenomenal relationships with our operational partners. We were talking multiple times a day, working very closely with them, and delivering technology at an extraordinary pace. There were some unique aspects of COVID as well so, we focused all of our digital and operational resources on it and used a very different decision-making governance framework where we had incident command.

What I’m now seeing is that we’re going back to our old ways of working. I hope that I’m trying very hard to find somewhere in the middle, where we can be a little bit more agile and nimble and have these close relationships with our operational and technology colleagues and vendors so that we can move faster.

I think what we’re starting to see is that our health systems have a number of challenges. They are only coming faster. And technology is increasingly part of the solution for these, so we need to find ways of being responsive to all the demands coming toward us and continue to innovate. I think that this is kind of a huge opportunity for us as we think about how we work going forward.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

When you develop solutions for the most vulnerable, you make it work for everyone.

Season 4: Episode #130

Podcast with Anika Gardenhire, Chief Digital Officer, Centene Corporation

"When you develop solutions for the most vulnerable, you make it work for everyone."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Anika Gardenhire is the Chief Digital Officer of Centene Corporation – the country’s largest managed Medicaid services organization. In this episode, she talks about why it is important that their most vulnerable populations “show up” in their digital transformation programs. She highlights the importance of innovation for underserved and vulnerable populations and urges the technology vendor community to focus on building solutions for the most vulnerable populations.

Anika discusses Centene’s digital priorities and how they cater to their population’s specific needs by addressing digital literacy, closing the gap of digital divide, and supporting them with digital tools and technologies. Take a listen.

Our Podcast Partners:

Show Notes

02:13 How do you drive your digital priorities being a predominantly Medicaid-focused organization?
05:30Give us a couple of examples of programs that you’ve launched for your population.
08:50 You're partnering with healthcare providers to deliver the care that these vulnerable populations need. Can you share some examples of what that collaboration looks like?
11:21 Your populations may be living in areas that are bandwidth deserts or transportation deserts, or food deserts. How do you successfully wrap all of that?
14:18 Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?
16:30What about data and analytics? How are you deploying these capabilities to serve your populations?
19:11 Do you agree that working under constraints makes you more innovative? What challenges do you face in your role as the CDO when meeting your objectives?
22:18 What’s your one piece of advice for your peers in the industry who are on similar journeys or operating in a resource-constrained environment?

About our guest

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products. Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products.

Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Q. Anika, tell us a bit about your background. What does your role at Centene entail?

Anika: I’m a clinician by training—a registered nurse. I transitioned into Clinical Informatics several years ago and then moved into roles that are progressively more at the intersection of business and technology. I work in that function of being an intermediator, translator, and facilitator, and bring it together. I’ve been really fortunate to join Centene as the Chief Digital Officer responsible for our digital solutions and products, and really driving us toward an even more data-driven organization.

I’ve enjoyed working with the senior leadership team and helped them align around objectives and key results, and how to support the organization holistically by putting our collective efforts toward making the business more efficient and providing ongoing consistent value to our customers. It’s a fun job. It’s different every day and absolutely fulfilling and humbling to serve the membership that we serve.

Q. Centene is the largest managed Medicaid provider in the country. How does being a predominantly Medicaid-focused organization drive digital priorities?

Anika: There are a couple of things. One is really thinking about how we identify our customer segments as a large managed Medicaid organization. Also, we’re thinking about the fact that while we’re so positioned, we better product—a Medicare product—so, how are we supporting our customers?

Holistically, we serve the most vulnerable populations and typically, they have very specific needs from a digital perspective. We think about how to look at digital literacy given the endpoint devices that our applications might be on which might look different. How do we support and close the digital divide? What are the specific ways to support our membership and how can we provide digital tools and technologies from a rural health perspective?

A couple of things for us as we develop our personas to build digital tools which those of you in this space will know, concerns how much time you spend doing that. We think specifically about our Medicaid population and try to ensure that there are situations where they’re represented. Our representation really shows up in the personas that we’re building.

We also think differently about how we undertake customer research. We know that our membership, specifically, isn’t always those that you find responding to surveys. So, how do you build out competency around ethnography among other ways to really understand that membership becomes really important in the work that we’re doing?

One of the things that is really our team’s responsibility, and the responsibility specifically for Centene, is to ensure that our membership including, our very vulnerable populations, show up in digitally transformed health care. Often, we’re developing tools to be very transparent for middle America. It’s not that we shouldn’t necessarily do that, but this ensures that for all of us who really need those tools, we are thinking very specifically about how to also provide access to them in ways that meet people where they are.

Q. Can you give us a couple of examples of programs that you’ve launched based on all the research and the background of your populations?

Anika: A couple of things would be the work that we’ve done to support, for example, digital care management. When we think about digital care management and how we really support our population specifically, question arises of how do we think about what’s the minimum necessary to qualify for digital care management? How do you onboard that membership specifically? How do you, assess the level of digital literacy to ensure that you’re able to provide those services in a way that’s specific and unique to that population? How do you support vendors who might not have really thought about this membership first, and help adapt their products and solutions to provide the best, highest possible value to this membership, uniquely? That’s one of the things that we think about.

Then, you start thinking about – What are some of the things actually regulatory wise that we are doing, in order to really support our membership, that might look different? How does an organization like ours respond to the “no surprises, exit and transparency rules?” When we think about trying to specifically explain benefits or other types of tools and services to a membership that’s not been catered to historically, what does that need to look like?

When I talk about endpoint devices, it comes down to—How do I need to think about how heavy that application is to ensure that it will be valuable across all the endpoint devices that it might show up on for our membership?

These are two of the programs that I think we are laser focused on and that are really helping us ensure that we are accounting for the work we’re doing specifically for our membership. I also want to be honest that it’s part of the reason that I love what I get to do at Centene. Very specifically, the reality is that when you develop for the most vulnerable, you make it work for everyone. You really have the opportunity to devise simplicity and create consistency in the experience that will work for the whole because you’ve actually thought about those who have the most needs. It really creates opportunities for us to make an impact in a truly exponential way because we’ve designed solutions for those who have really specific needs or for the ways that they’re going to use them.

Q. When it comes to care management, you’re partnering with healthcare providers to deliver the care that these vulnerable populations need. What does that collaboration look like? Can you share some examples?

Anika: One of the things that if you’ve heard Sarah London our CEO talk, is that she’s been very specific about how we will partner with provider groups—FQHCs. How do you wrap services and support around the places that our members very specifically are going to receive care? There are a couple of things.

One, we think about those who are providing community services and how we can support them from a data and data integration perspective. How do we support our federal federally qualified health centers from a data perspective? How do we think about the future of risk? How do we support those value-based care models for our most vulnerable provider groups separately from FQs? How do we also support those who are really thinking about how to be comfortable taking risks? How do we support them in understanding contract arrangements?

We know that, when it comes to social determinants and the risks that we see in differences in care around race and ethnicity, if we can keep those providers providing care and support them in the communities that they serve to offer better outcomes for those populations, then, we must think in very specific ways about how to provide such a partnership.

It’s not only about how to provide digital solutions and products to them, but also how to support them in thinking about managing panels and taking on risk. Are we supporting them to supply the right data and digital tools at the point of care to help them continue to really impact outcomes for that membership?

The organization is doing a really good job of that. We are laser focused on continuing to build our capabilities that will explicitly support the very close relationship between the provider and the member/patient/consumer, however you want to title them moving forward.

Q. These populations have a bundle of needs, but they may be living in areas which are bandwidth deserts or transportation deserts or food deserts. How do you successfully wrap all of that?

Anika: We have an incredible number of value-added benefits around transportation and food services. I would call out, for example, programs in our North Carolina Health Plan where we have forums where we encourage members to offer input into what some of the most important things are and how we provide differentiated services to the community.

It’s also crucial that when we think about those types of services, we understand the member’s perspective about what’s really most important to them. This is so that they can really get it and leverage the opportunity to provide that type of input. So, there are a couple of things.

One, it’s really about understanding what’s available from a community services perspective. Is it something that we need to provide directly? Is there an opportunity to support a community-based service that’s already in existence but may actually just need some lift?

When it comes to how we provide some of those additional benefits around transportation, food, and/or partnerships with companies like Lyft, then, that’s a part of our entire benefit model. It may span, for instance, supporting transportation partnerships with being able to provide healthy food services or, being able to send out a food truck to a community event to provide for more gatherings and/or quite frankly, just combat loneliness. That’s really the value that we bring as a managed care organization where the care component is really the most important.

The work that we do and the relationships that we build with our members revolves around really understanding how we engage them and involve them in their care. That is the crux of what we’re trying to do. Our medical director team, our population health and clinical operations teams, and the role that we play from a digital perspective not only support our members and providers but all those that are involved in providing that care.

Our members are really important and that’s why when we think about our customer/consumer/provider, we also think of ensuring that we understand the care manager, the utilization management nurse, the pharmacist, and others that are supporting them. We work at how we are supporting those customers who surround them as well.

Q. The third leg of the stool concerns the technology vendor community that’s coming up with the innovation and the solutions. Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?

Anika: When we look at how we think about consumer research, innovating, and how we’re developing our tools and services, we try to ensure that we have a representative population. We also try to ensure that you are testing those solutions across the spectrum of healthcare and thinking about it from a wellness and care delivery perspective. It’s equally important that you test it in a rural setting, with an ethnically representative population for understanding youth and language changes among others. That’s incredibly important.

One of the greatest opportunities we have from a digital perspective, is to start to self-govern, for lack of a better term, and really think about the impact that we have on people. This is especially for those of us who are blessed to work in the health care space. When I think about the impact that we have on people, that’s as significant as perhaps big pharma and so, I think about the amount of rigor that it really takes to ensure that we are doing no harm.

We have a very specific responsibility to ensure that we are thinking about digital ethics, research, rigor, and the representative populations in the solutions that we’re developing. This ensures we’re able to provide access to care for digital health and to everyone who needs and should have it.

Q. What about data and analytics? Apixio is one of your portfolio companies now, so, how are you deploying all those capabilities to serve your populations?

Anika: When we think about data, Big Data, contextual data, Artificial Intelligence, and Machine Learning, it’s such an important part of the work that we do, today. It’s an incredible part of what we’ll continue to do. It will help us ensure that we’re doing our best to supply things like a next best action to a care manager and undertake interventions that are most highly aligned with the most important benefits to provide to a particular population. Now, that maybe by geography or perhaps a group which has another type of similarity. That’s where data helps our understanding.

I think there is a “know me” component around data that is so important. But when we think about consistency and how we supply the entirety of the team that is going to surround the individual at the center, we must make sure that they know the things that they need to know at the time that they need to know it. When I think about the data story, it’s really the ability of being able to provide the right data at the right time for the right appropriate action for the individual. The action component for the individual is most important whether we’re asking the consumer or a member to do it themselves or asking a member of their “care team” to provide. It’s understanding that action and the outcome that that action had for the member and then, being able to supply the right next suggestion, that’s really the most critical component of what we have to do.

Q. Do you agree that working under constraints makes you more innovative? What are the challenges you face in your role as CDO when meeting your objectives?

Anika: I am a genuine believer that innovation is born out of friction. So, necessity without question breeds innovation. There is absolute necessity to innovate in the face of scarcity for when you have scarce resources, you are always thinking about how to do more with less. How do you do your best with what you have? That is a constant focus. It creates what is a great responsibility not just around fiscal responsibilities but also in ensuring that we are helping get the right resources to those most in need. That is absolutely one of the wonderful opportunities that we have. To your point, one of the pretty significant challenges is really an opportunity to rise to the occasion. It’s an opportunity again to serve the entirety of our patient populations using those innovative solutions.

When I think about sort of what constraints it might put on me specifically, or the team that I have the great privilege of serving, it’s really about prioritization and focus. When you think about trying to innovate, there is often so much that you want to do and so many things that you could do.

I often say most Chief Digital Officers want to build flying cars. I want to build flying cars too. It’s a natural thing for many of us, but, even more importantly, I want to ensure that we have a tarmac to take-off from. We have solid footing, rules, and an understanding so that when we get to the air, everybody is safe and comfortable. It does the thing that that flying car is supposed to do—get us there faster, safer, and better.

Making sure that those foundational things are in place is important. It gives me an opportunity to really think about what those foundational things are and how important they are to have solidified in concrete. Then, we can think about the additional things we really want to provide and the impact and value they’re going to have on the health care continuum for that membership. Finally, we can create laser focus on executing in the best possible way for those very specific things and deliver that value.

Q. If there’s one thing that you’d like to leave behind for your peers in the industry who are on similar journeys or operating in a resource constrained environment, what’s your advice going to be?

Anika: I think my advice will be—make sure that your digital transformation strategy, your digital strategy, and your technology strategy are centered around people, especially for those of you in healthcare. This is a very, very human industry so, I think of digital transformation very specifically. We are doing something tomorrow that’s different than what we did today because we created a thing. It’s having real, fundamental, important impact and delivering real significant value to people. We are driving through the change that we need humans to make to take best advantage of it. So, again, staying laser focused on ensuring that you are bringing people along your journey is the piece of advice that I will give.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We’re expanding our concept of access beyond just a face-to-face encounter to all the digital encounters that allow us to stay more connected with patients

Season 4: Episode #129

Podcast with Denise Basow, MD, SVP and Chief Digital Officer, Ochsner Health

"We’re expanding our concept of access beyond just a face-to-face encounter to all the digital encounters that allow us to stay more connected with patients"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Dr. Denise Basow, a primary care physician by training, is the Chief Digital Officer of Ochsner Health – a health system that predominantly serves Medicaid populations in a risk-based payment model. She talks about how they’re using digital programs to drive improved healthcare outcomes and reduce care costs.

In this episode, Dr. Basow discusses their telemedicine capabilities, which include digital medicine technologies, remote patient management, digital tools to drive innovation and transformation, and digital coaching programs to drive patient engagement and outcomes. Take a listen.

Our Podcast Partners:

Show Notes

02:50 What kind of population do you serve, and how does that inform your digital priorities?
06:01What building blocks do you work with as you approach your population's digital needs?
08:14 What kind of programs have made an impact for Ochsner?
12:30 Are there any learnings you'd like to share with listeners working with similar populations? How do you get your patients to embrace the technology?
15:36 How do you make your technology selection choices – build versus buy? Do you start with the EHR first or best-in-class?
21:38 Can you share anything about access-related solutions where you're driving engagement through digital tools and technologies?
24:43 What does Ochsner’s governance model and strategy look like?
28:12 Can you share some of the best practices or learnings with your peers in the industry, especially those who are addressing similar populations and maybe in earlier stages of their digital journeys?

About our guest

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.

Denise-Basow,-MD-profile-dektop

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We want to build a data set that connects life science and healthcare organizations into one learning community

Season 4: Episode #128

Podcast with Terry Myerson, Chief Executive Officer, Truveta

"We want to build a data set that connects life science and healthcare organizations into one learning community"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Terry Myerson leads a very interesting organization – Truveta – that’s trying to aggregate healthcare data from health systems across the country in a de-identified form. They then combine this data with other sources to generate insights that drive clinical research and outcomes and develop new therapies and molecules.

In this episode, Terry discusses Truveta’s value proposition for health systems and life sciences organizations, their data sets to generate insights and the technological challenges in bringing the data sets together. We also touch on a variety of other topics, including the digital health startup landscape. Take a listen.

Our Podcast Partners:

Show Notes

00:29 What’s the market need that Truveta is trying to address?
05:48How many health systems are members of Truveta’s consortium? What do they get out of it?
07:10 What kind of data do you gather from the results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?
08:55 Can you talk about the types of insights you have given back to your members? Tell us about some of the use cases you've been able to generate using this data set.
11:53 How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?
13:14 You're not selling the data, but you are selling insights generated from the analysis of the data --- is that correct?
15:10 What’s been challenging from a technology standpoint in bringing all these datasets together from across the world's healthcare organizations?
20:20 What do you see as the current moment in digital health funding landscape?
21:44 What's your advice to a startup founder who wants to get into digital health today?

About our guest

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Q. Terry, how did Truveta come about? What’s the market need that you are trying to address?

Terry: Truveta is a company with a vision that we can save lives with data. Using data, we can help researchers find cures faster, empower every clinician to be an expert, and help families make the most informed decisions about their care. That’s our vision and mission.

What do we offer? At the end of the day, we’re raising for any medical product, the most complete, timely, and highest quality data to understand the benefits and the risks of how that product should be or how the procedure or device should be used in a health care environment. There’s always an origin story here about how the company came to be and this one, I think, is just so interesting and eventful.

B.J. Moore, who’s been on the podcast, and I were colleagues at Microsoft two years ago. Since then, he’s moved to Providence. I’d left to join a venture capital firm. I had also become fascinated with the intersection of data sciences and life sciences. B.J. and I stayed in touch and when the pandemic started, he introduced me to this project where, there’s this effort inside the health system to try and understand what’s going on with this pandemic. The health system didn’t have the tools in the early stages of the pandemic to ask and answer questions about whether they should treat symptomatic patients with Dexamethasone or Remdesivir. We’re hearing both work well, but which one should be used? Who should be intubated for how long? There were just no tools to ask or answer those questions.

Building on that, Providence, Northwell and Trinity Health Care, three organizations that didn’t know each other so well at that time, tried to collaborate, ask, and answer questions like that. But they had no regulatory or technical framework or legal frameworks to work together, share data, ask, and even answer questions. We could build, learn from each other, and compare results but there was no ability to do that. Then, we had a life science company, a pharmaceutical company, which was selling these drugs and trying to learn they had no ability to learn off of the same data.

So, this idea that we could build this unprecedented data set that would connect life science and health care organizations into one learning community, that would really drive learning, and help us find those cures faster, figure out the safety, and effectiveness of these various medical products or procedures happened to be one of those that felt like just this incredible opportunity for the health care systems to come together and build something new for the world.

Q. Can you tell us a bit about your background? You did spend a long time at Microsoft and B.J. was your friend. So, how did you get here?

Terry: I spent almost 22 years at Microsoft. For the last decade, I was leading Windows Surface and Xbox. B.J. and I left Microsoft in 2018 and it was the pandemic, in 2020, that reconnected us.

When I got connected to this project in Providence later, I realized that Truveta was an idea that actually started in 2018. It revolved around how health care systems could put their data together to create a data set which they could learn from. It was white papers and PowerPoints. It was a great idea but it took a pandemic for us to really galvanize that and turn it into a company. Without the pandemic, it was just my awareness of the issue or the lack of this.

When you first get exposed to Truveta as an idea, you go, “How could this not exist already? How could it be that we don’t have a data set representative the full diversity of our country? How’s it that we can study any drug disease or device? How could this not exist?”

I didn’t know it didn’t exist. When I got exposure to the fact that it didn’t exist and there was a coalition of willing health systems that wanted it to exist, it just felt like the most meaningful thing. I could spend the rest of my career working on it.

Q. With regard to the Truveta System, how many health systems are members of the consortium? What do they get out of it?

Terry: Truveta started with four health systems in September, 2020. We announced 14 in February, 2021, and now, there are more than 20 large, leading health systems across the United States. More will be announced soon.

I think it’s just amazing how they’ve come together. They’re motivated by participating in this learning community for health, so, they can ask and answer questions, get data representative of the United States, and share those studies with each other while building on each other’s work. That access they get is going to help them take better care of patients.

We’re taking their data as normalized, structured, and de-identified data. They get access to all this for use in their health care operations and we pay them. So, they make money when their data is used by others in their research and they are compensated.

Q. What kind of data do you gather from results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?

Terry: The healthcare systems send us medical records which are fully de-identified and validated by a third-party. Those de-identified medical records are being made available for research. Today, we have a partnership with LexisNexis, which is giving us three other important data sets to bring into the corpus.

Before that, there was a token which allowed us to link medical records in the de-identified space across health systems. It’s all coming together into one longitudinal medical record.

They’re also giving us the fact of death. Only one-third of people die inside a health system and so, LexisNexis has its Death Registry up-to-date, daily. Through it, we’re actually seeing if people die on the date they die. Being able to assess death as an outcome for research is very important when without the state and health systems, one doesn’t know if you died.

The third thing is, they’re giving us the largest claims data set in the country. We think about it as we get these deep medical records from all of our 20 + health systems and then, we also get to link it with the medical bills or the claims records.

Last but not the least, we get from LexisNexis the socioeconomic data. This is incredibly vast and includes the social determinants of health. All of that’s coming together as are insights about it. You got the 20 + health systems, fact of that token socioeconomic and mortality data. I maybe forgetting something, but it’s also together in the group of longitudinal records they identified for research. It’s a lot of data.

Q. Can you talk about one or two types of insights that you’re getting back to your members? Tell us a bit about some of the use cases you’ve been able to generate using this data set.

Terry: We talked about COVID and in fact, one of the collaborations we’ve announced since then which we’re quite excited about is Pfizer using the Truveta data set to assess their vaccines and therapeutics in the United States. This company has led the innovation response to COVID globally, and no company responded like Pfizer, one might argue. The fact that they would be using our data, is exciting. It’s terrific and I’m honored.

The other research that has been published is on Colonoscopy screenings in response to Chadwick Boseman’s death. Being African-American and he died of Colon cancer so there was some research done on Colon cancer screenings in the African-American community.

Also, there was some work done in response to the baby formula shortage actually going on in the country trying to understand if there were infant hospitalizations or other infant health issues as a result of the baby formula shortage. This idea that we have this dataset representative of our country and the ability to ask and answer questions quickly is new.

We’re having interesting use cases popping up everywhere but at the end of the day, this is our customers’ research. There’s a research project going on in Savannah, but I’m not talking about what they’re using. But Providence is using our data, Pfizer is using our data or even unnamed customers– they’re using our platform for their investigations and we do expect them to publish quite a bit here in the next year. But it’s their research, not our research to talk about.

Q. How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?

Terry: Security and privacy are just critical. They’re foundational to the company. For full details, we actually have white papers—-a white paper on Security and a white paper on Privacy—on our website, which I would encourage anyone who really wants a double click on these to go get them.

We have the HIPAA too, which is our healthcare privacy law in the United States which sets in place two standards for de-identification—one called Safe Harbor, where you lose geography and timestamp information and expert de-identification.

Truveta follows the expert de-identification model so, we have expert determiners that assess all of our systems. The white papers have some great information so, I would encourage anyone who wants to read more to go there.

Q. The monetization model for Truveta is derived from the use of the data, not necessarily the data itself. You’re not selling the data, but you are selling insights generated from the analysis of the data — is that correct?

Terry: I’m not sure. The health systems themselves have access to study the data for their own research. But life science firms that are engaged with it right now are subscribing to study a disease or set of diseases and so on. We tell them to come and analyze the data, look for safety effectiveness or health equity issues in COVID or Multiple Sclerosis or heart disease. You’re subscribing to a disease so, you can ask and answer as many questions as you want during the time of your subscription.

Q. Don’t they get to take a copy of the de-identified data stack into their environment and use it for other purposes such as marketing campaigns etc.? I assume there are permissible uses in there.

Terry: I think there’s two different questions that you might ask there. There’s the data which is to be used for health care research, and not for advertising. Using the data for advertising is explicitly not a permissible use.

But there are circumstances in which they will need to take data out if you’re making a regulatory filing. If you are, there are just some scenarios where we do allow them to extract patient cohorts. Therefore, the concept of the subscription.

Q. Let’s talk about the tech stack for Truveta. It is built on Microsoft Azure as a cloud platform. What are the other big components of the tech stack? What’s been challenging from a technology standpoint in bringing all these datasets together from across the world’s healthcare organizations?

Terry: We’ve talked about two of the biggest challenges—Security and Privacy.

The third biggest challenge is Normalization and it’s not even the fact that it comes from diverse health care systems. Different conditions record outcomes, side effects, recommendations in a different language, often in their vernacular — that’s probably influenced by where they were trained.

So, you have these vast amounts of clinical notes that have so much insight on patient care and that normalization of unstructured data into an ontology of structured terms that can be used for analysis that the AI which drives that process, which actually is another white paper on our website, is a data quality white paper, which goes through that whole process of how we take all that unstructured data and turn it into a high quality data stream for analytics.

So, security, privacy, and normalization are the challenges and then there’s scale. High volumes of data is one thing, and Providence is an incredible system but B.J.’s also got a number of scale challenges.

When you add Providence, Trinity, Northwell, Tenet and Baptiste you know it’s a large lot and that’s the Truveta data challenge— far larger than any one health system anywhere in the world.

Q. To get a sense of the scale and the magnitude of how large the data set is, are we talking about what percentage of the U.S. population it covers among these top 20?

Terry: When you include the LexisNexis claims data, which fills in the gaps and when you’re looking at 100% of adult Americans, then, you know, for Non adults I wouldn’t know the number.

Q. There’s a lot of similar efforts underway now – the Sequoia Project for one to tackle the interoperability issue, and then, you’ve got Graphite, which is kind of a spinoff. There’s also Intermountain and Providence. Are these complementary to each other? Or do you see them as competitive?

Terry: Everyone’s solving a similar but different problem. With Truveta, we’re not solving the exchange of identifiable medical records, we’re not solving being an API layer for applications inside the healthcare system like some of the organizations you just described. But at the core, we’re all looking at security, privacy, and normalization of healthcare data.

As this industry matures, the shape of the boundaries will evolve over time, partners will become competitors and competitors will become partners. But there’s this many different takes on this problem in terms of connecting health care and life sciences to create one shared truth which we can use to really study health.

Thanks for that though. It’s a very unique point of view and I love being part of it.

Q. Truveta’s a unique organization but it’s also a startup and you’ve raised venture capital money. What is going on in the digital health funding landscape? What does the slowing down in funding mean for digital health startups and their customers who make bets on companies that may now be at some kind of financial risk?

Terry: Truveta actually has not taken any venture capital money. Our approach is that the health systems are the biggest stakeholders in Truveta’s success, they contribute their data and so, they should be the owners. I think it’s a very unique approach so no, there’s no venture capital in the company.

I did spend two years in venture capital and it was interesting that the two years I was there, it was easy to invest in everything when the valuations were going up. Somehow high prices made it easier to invest. Now, we have all this uncertainty—war, inflation, layoffs — and somehow the low prices are making it harder for people to invest.

There’s tremendous irony in that. However, for the next decade, I think the companies that make it through the next couple of years will be some of the best investments in the world because it’s an opportunity. We just talked about, the big data on health and I think, those companies are being founded right now.

Q. What’s your advice to a startup founder who wants to get into digital health today?

Terry: My advice would be — Have a great idea. Have a great team. I think that if you have a great team and you’ve got a great idea, you’ll be able to attract capital. You have a bad idea and a bad team, then, that will be harder.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.