I had an opportunity to chat (again) with Dr. Yan Chow, who is currently leading the Innovation and Advanced Technology (IAT) group of Kaiser Permanente IT.
IAT identifies, assesses, and makes internal recommendations on new and emerging clinical information technologies that will impact health care in the next two to five years.
The group is affiliated with KP’s Sidney R. Garfield Center for Health Care Innovation, an advanced 37,000-SF laboratory for care delivery simulation. The Center houses a full-sized medical/surgical ward, OR, L&D suite, outpatient offices, and a home environment. New space designs, technologies, and workflows are tested in as real a setting as possible without risk to patients or disruption of operations.
Early this year, I was fortunate to catch Dr. Chow speak about IAT in one of the meetups I attended over at Silicon Valley. “IT spending in healthcare is on the rise. However, there’s a lot of challenges and issues with new technology because new technology has no track record. (So) It’s very hard to make a business case,” said Dr. Chow.
He is extremely passionate about what he does and would you believe it that his team has looked at close to 2,000 healthcare applications and technologies since the start of the group 7 years ago?
IT Governance in Healthcare
My questions were (really) from Dr. Muin, Medical Doctor and a Healthcare IT Professional in the Philippines. (Incidentally, he blogs here.)
How do you decide which projects to prioritize? What kind of engagement do you get from top management/board? From staff? From doctors? How do you make sure that projects are aligned with hospital strategies? I wrote Dr. Chow an email and brought up the topic. He replied warm-heartedly and offered his insights, documented (non-verbatim) below:
KP is made up of 3 entities: Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and the Permanente Medical Group. Kaiser Foundation Health Plan and the hospitals are non profit and the Permanente Medical Groups are for profit. (So) Being separate, there’s a lot of different kinds of governance and co-governance. “Most operational levels in Kaiser have both a physician and a non-physician business person. Usually, we employ co-governance especially for the big ticket items. (And) That’s how historically Kaiser has been.”
“There’s always a debate about who knows best? Is it the clinician or the administrator? The way it goes is that physicians tend to govern the clinical side of things and the non-physicians the business side of things. It’s been designed to have co-governance in most levels. It’s been a good structure for a long long time for Kaiser.”
“In addition, Kaiser Foundation Health Plan and Kaiser Foundation Hospitals have national groups, such as HR, IT, and compliance … where it makes sense to be national. There’s a national, regional, there’s a local level. On the other side, the Permanente Medical Groups are regional in nature, they also have local leadership. They didn’t have national until 15 years ago when they formed the Permanente Federation so they can have some parity with the non-profit side.”
“When our innovation group looks at new technologies and we think there’s something interesting, what we’ll do is contact potential stakeholders inside our organization. Say it’s an online diabetes tracking system, we then talk to a number of endocrinologists and ask about their opinion on it. See what they think of it. Then, (if they’re interested) they can work with the company (offering the technology) and see if they can apply for some seed investment from our innovation fund to do a project proof of concept. Or they can also use their own funds.”
The seed funding for innovation projects come from the Innovation Fund for Technology, a program that IAT helps administer. In addition, the grant decisions are made by a Board that represents many different parts of Kaiser Permanente.
Dr. Chow notes that there’s decentralized governance at Kaiser and at some level, the infrastructure level is national. However, on the local level, the markets are different, so the needs are different technology-wise.
“At the IAT, we’re more like a research and development group and we look at the future, and figure out what’s happening. We’re like an analyst firm, like a Gartner. We have very strong interest in tailoring technologies that we see out there to Kaiser. We involve people who may be interested. If there’s interest, we can help with training, education, so that we can help the innovator bring the innovation to their department.”
Dr. Chow said that to get started with a pilot, one could apply for innovation funding from his team. If all goes well (if the one looking at the proposal likes the idea), then they can do a small pilot for 6-12 months. After the proof of concept, they can then check if the idea is good or not, and then if they decide to run with it, they can come up with their own money or operational money to move to next steps.
Dynamics of IT in Healthcare
“IT in hospitals didn’t use to be as impactful as it is today,” said Dr. Chow. “I’ve always been interested in technology. When I started as a doctor, there weren’t a lot of options. If you were in technology, you could work for IBM and deal with mainframes. But today, there are so many options, a whole range of things to do in healthcare that has to do with technology and you don’t even have to be a doctor. I’ve been involved with some startups, working half time as a physician. The last 15 – 20 years have been part time IT. This position became available seven years ago, right about after I finished with my MBA from Berkeley. I wanted to do something involving business, medicine and technology .. so when the position for analyst became available, it was the perfect position, so I signed up, got the job, and now I’m the medical director for the group.”
I asked him further what they were really trying to accomplish.
“It’s one of a kind group. It’s one of the few groups inside and outside Kaiser that has a multidisciplinary approach to technology strategy. You know how we always talk about evidence based medicine, that medicine is based on research and literature? This is about evidence-based innovation. So testing innovation, and making sure it works.”
“Innovation has the ability to help us in terms of improving quality and affordability of healthcare. The way you know is you have to test it. That’s what’s so exciting and looking at technology — does that really work in healthcare?”
“There’s a very exciting innovation community out there,” he said.
Big Data in Healthcare
I couldn’t resist asking: What about big data in healthcare?
“Physicians have too much data. The nature of healthcare data itself is 20% structured 80% unstructured and highly complex. The goal is to turn big data into actionable information, and in turn actionable information to good decision making. So data into information and then to insight that helps with decision making. The ultimate need is for physicians themselves to step in and give guidelines on how to use big data because only physicians can really tell what’s not, what’s relevant, what’s important, what they’re willing to practice with, what’s actionable. If it’s not a standard in practice, it’s going to be very risky.”
He adds that if physicians practice data-driven medicine using big data, then they’re essentially practicing statistical medicine or correlational medicine. “If a thousand people like you do this, you should do this,” he explained. This is very different from what has always done. The gold standard has been hypothesis driven medicine — randomized clinical trials. “The problem is with these kinds of studies .. it takes 5-7 years. It’s hopelessly behind technology.”
“As far as figuring out whether you should use a certain drug for a certain disease is still pretty much driven by clinical trials. The problem is that you can’t use the same approach with technology because technology is changing too fast. Have to use a different approach. Have to use a data driven approach, which is very statistical in nature. Statistical data drives, ‘you belong to this group, so this is how we’re going to treat you’. It takes what you have and what you’re doing and stuff and uses that instead.”
Mobile in Healthcare
When asked about mobile health and telehealth, Dr. Chow mentioned that the biggest impact of telehealth and mHealth is going to be on quality. “The reason is because telehealth gives us a way to collect data that we didn’t have before. It gives us visibility into the lives of patients.”
Incidentally, Dr. Chow shares that KP has over 120 pilots in telehealth today.
He shared: Mobile is going to be a huge trend, it has surpassed the PC in many populations. Mobile is going to provide visibility (from provider to consumer), as well as connectivity. Visibility is really important because there is really a huge difference between what people declare they’re doing with what they actually do. Today, with a smart phone and the users’ permission, you can track people and find out what people are doing, so you can make your health care intervention more effective.
About Dr. Chow
Dr. Chow has had a successful clinical practice at KP for several decades. He was also involved in regional IT management, overseeing a number of operational systems for 60,000 providers at 60 sites. He also led experimental projects such as KP’s first PC interface for mainframes and created KP’s first networking forum for physicians.
Dr. Chow has founded and advised a number of startups in the Internet, health care technology, storage, and database spaces.
He has 3 U.S. patents and has been an author and invited speaker at industry conferences.
Dr. Chow earned his A.B. with honors from Harvard University and his M.D. from the University of California at San Diego.
In 2005 he received his MBA from the University of California at Berkeley’s Haas School of Business, where he graduated as valedictorian.
Founded in 1945, Oakland, California-based Kaiser Permanente is the nation’s largest not-for-profit integrated health care system with 17,000 physicians, 173,000 employees, 37 medical centers, 611 medical offices, 9 million health plan members in 10 states, and annual revenues of $49+ billion. Kaiser Permanente comprises the Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups.
Picture courtesy of Michael Allen.