Source Code: Your daily look at what matters in tech.

source-codesource codeauthorMike MurphyNoneWant your finger on the pulse of everything that's happening in tech? Sign up to get David Pierce's daily newsletter.64fd3cbe9f
×

Get access to Protocol

Will be used in accordance with our Privacy Policy

I’m already a subscriber
People

‘The tip of the iceberg’: The pandemic has laid bare the opportunities for health care innovation

Intermountain Healthcare's new CIO Ryan Smith on medical AI, data interoperability, and the other health tech revolutions underway.

‘The tip of the iceberg’: The pandemic has laid bare the opportunities for health care innovation

Intermountain's new CIO, Ryan Smith.

Photo: Courtesy of Intermountain Healthcare

A year ago, the idea of using no-code software development or truly portable electronic records in health care seemed years off. But for Intermountain Healthcare's new CIO, Ryan Smith, the pandemic has changed that.

Ryan sees the trends that had been emerging in the years before we were all stuck inside and argues that the digital revolutions that have already come to other industries, like banking, are on the way faster than ever for health. What's missing in medicine, though, is a national support structure and strong federal regulation to push legacy providers into the digital age, he says. The impetus for change may well come from Big Tech, with companies like Apple, Google and Microsoft taking a greater interest in health care. And the possibilities for what we'll actually be able to do with all that data once it's easily accessible are near endless. "We're really just at the tip of the iceberg," Smith said.

Protocol recently launched its Manual on the future of health care after the pandemic and hosted a panel with experts from across the industry to discuss how COVID-19 has already upended so much in medicine — and what will likely stick around after the dust settles. Smith — who had previously spent 19 years at Intermountain Healthcare, left in 2013 to pursue roles at other health systems, and recently returned as CIO — was one of the panelists.

Protocol spoke with Smith after the panel to hear some more of his thoughts on what the future of health care will look like after the pandemic.

This interview has been edited for length and clarity.

What's it been like starting in this role during a pandemic?

Well, it's been really interesting. Everything's virtual: All my onboarding with senior executives, my own direct reports, everything's just video visits, by and large. It's working — keeps things very focused. It feels a lot like a crash course, when you come into such an innovative organization such as Intermountain Healthcare, that has so many things going on — there's just an awful lot to learn. And I'm really appreciative for the 19 years I spent at the organization, up to seven years ago, but a lot has changed. It still feels a lot like drinking from a fire hose.

What are your goals in this new role? What challenges do you want to take on?

I think if we boil it down to probably a small handful of items, really positioning my team to help the company with its growth initiatives. Transparency is going to be a really important thing for me: A lot of IT organizations get criticized for being a bit of a black hole, in terms of sometimes the priorities they're working on, how their budgets work, and I really want to make sure that my team is really tightly aligned with where our senior leadership is taking the company.

Beyond that, security, privacy, those types of things — you call them table stakes, but they take a lot of time and effort and investment to get right. And that's an area that I'm absolutely committed to, of really being conscientious and careful about how we stand up systems, how we treat data and how we work with IT vendor partners.

I've heard from a lot of IT organizations that there's been this kind of no-code/low-code movement recently, empowering other departments to take some of the load off of IT, building their own solutions to problems. Has that come to health care yet?

No — it's coming. We might still be at the tip of the proverbial iceberg, but I'm seeing more of that, in terms of things like self-service analytics. Instead of having a whole bunch of data analysts that have to be in the middle of every business intelligence and data reporting and analytic requests, increasingly we can get curated data models, systems and tools, especially visualization tools, in a self-service way. Technologically savvy individuals — it definitely doesn't take software engineer-level or data analyst-level people — [can] really get in and use those tools to do a lot of things, like cohort analysis, managing their operations, etc.

It's an area that has a lot of early interest, but quite frankly, I think health care does still lag a lot of other industries from that perspective. [There are] probably some pretty good reasons for that. When you look at the complexity of our data and our workflows in health care, the high level of regulation, it does make it more challenging to have these low code/no code kinds of tools.

What does the future of portable health care data look like? How do we get to a place where it's easier for patients to be able to better understand their health — is the solution continuing to work with big players like Cerner or Epic, or are there more-distributed solutions ahead in the future?

The vendors do have their role to play as it relates to interoperability, but if you peel some of the layers back just a little bit and you think of the monolithic architecture of those EMR and EHR vendors systems and their platforms — the high-level modules, the capabilities that ends-users interact with — [they] are so tightly coupled with the underlying architecture and infrastructure. They're making a lot of progress towards opening up their systems and giving more APIs, web-service layers, [and in] some limited cases direct access to the database structures. But inherently, if you think about it, these organizations aren't necessarily heavily incented to really open up their systems, because what that's doing is signing up to be disintermediated by more-innovative players.

It feels like in our industry, and I'm just generally speaking, some of the vendors do a much better job than others, but it feels like there's still a pretty tight rein of control around the level of access they're really opening up. At the same time, there's obviously a lot of federal pressures for data interoperability, but the government itself hasn't gone so far yet to be specific enough from a standards perspective that it really forces the level of interoperability that the country needs.

I'm hopeful that we can keep making rapid progress through policy and decisions at the state and federal levels. But I think to your point, a lot of this I believe ultimately is going to get done through consortium collaborations and private entities that are working to solve this challenge where real incentives lay, in terms of really enabling value-based care, reimbursement models and things like that. We just have to advance this interoperability equation at a much, much more rapid pace than what historically has happened. And, quite frankly, I think the pandemic is helping to accelerate that pace.

I recently saw how inflexible some of these things really are. My family was trying to figure out what medical records of my parents to keep, all of which were only available on paper printed out from doctors' offices, that theoretically, I should hold onto for the next 30-40 years in case anything happens to me. This feels untenable, especially in a future when everything else is so digital.

You're exactly right. On the bright side, even down to individual private physician-owned clinics up to very large integrated delivery systems like Intermountain Healthcare, the country has seen the digitization of the health care record in a really significant way.

The challenge though is still having that interoffice data interoperability. That really still today is a problem across the country. Different organizations are working hard to address that within their own geographies or referral areas, or partnerships that they have. But it's really challenging. If you happen to relocate your family to a different part of the country, that health care record is still really challenging.

We're seeing companies like Apple make some inroads into that. We're certainly seeing health information exchanges trying to help with that problem. But what we still lack is really this national support structure, like a national patient identifier, which would really help around the interoperability side, but more importantly, having the data standards that really permeate across all of these different electronic medical record systems and other systems, to help link it all together. The banking industry got this figured out a long time ago, and they wouldn't have been able to survive had they not gotten it figured out. Granted, medical data is, I would suggest, 100 times more complex than financial data.

This data is just so personal. I do wonder if it will be companies like Apple, which seem to have built their brand in recent years around data privacy, that figure it out.

I think you're right. The really big cloud vendors, they're challenged in that they don't have the level of health care expertise yet, but they've been eager to get into this industry. There's definitely some inroads being made that, I think, ultimately really help our industry get further digitized, and it can work electronically at much greater scale, by virtue of these cloud models and data analytic models that these companies really bring to bear.

But companies like Apple take their consumers and the absolute protection of data they hold a lot more sacred than maybe some of their peers. And therein lies the problem with these big cloud vendors really getting in, not fully understanding or being fully transparent, how some of that data and information will be leveraged for their own broader business purposes as they're forging these strategic alliances with different health care providers. It's an area that we've all got to be really conscientious and careful of, and understand what our consumers' appetites are around the protection and privacy of their data and their information.

What do you think AI's future in medicine is?

I'm a firm believer that data — and how we can apply analytics in particular, AI and machine learning, to that data — is really the new frontier of health care innovation. We'll still see innovation even around financial and reimbursement models and things like that, but at the end of the day, even those will be informed by better insight into the data

When we look at caregivers, physicians and nurses in particular, we have thrown a lot their way as a country in these last 10 years. We have forced through regulation for providers to have to come in and do order entry and have to electronically sign prescription refill requests; they have to do all their documentation in the electronic medical record. And that has really changed the nature of how physicians practice medicine, both in the hospitals as well as in the clinics. And it's not the only cause certainly that's contributing to physician and clinician burnout, but it's definitely an additive.

When we look at things, opportunities like conversational AI, being able to have a physician walk into an exam room, being able the whole time to keep direct eye contact with the patient instead of her back to the patient while she's charting in the electronic medical record with an occasional glance over the patient … Imagine having both hands free, making eye contact, having a very personal experience and talking through that examined workup that is being captured through conversational AI.

I think we see AI playing a big part in our ability to automate a lot of things today across health care operations and central-office functions. Things that are very human latent, very manual, tedious kinds of tasks. That will help us continue to provide higher levels of service and quality while also working to reduce the cost structure of delivering health care services, which is a key part of our mission.

These are just examples of how I think AI is going to be applied: helping with clinical trials to speed up delivery on those trials, being able to analyze a lot more data from much broader populations. We're really just at the tip of the iceberg, and everything else lurks below in terms of this massive opportunity around leveraging data. I feel like that's really going to be the next massive wave in health care from a transformation perspective.

Protocol | Fintech

Marqeta turns to a fintech outsider

Randy Kern, a Salesforce and Microsoft veteran, is taking a plunge into the payments world.

Randy Kern is joining Marqeta after decades at Microsoft and Salesforce.

Photo: Marqeta

Marqeta has just named a new chief technology officer. And it's an eyebrow-raising choice for a critical post as the payments powerhouse faces new challenges as a public company.

Randy Kern, who joined Marqeta last month, is a tech veteran with decades of engineering and leadership experience, mainly in enterprise software. He worked on Microsoft's Azure and Bing technologies, and then went on to Salesforce where he last served as chief customer technology officer.

Keep Reading Show less
Benjamin Pimentel

Benjamin Pimentel ( @benpimentel) covers fintech from San Francisco. He has reported on many of the biggest tech stories over the past 20 years for the San Francisco Chronicle, Dow Jones MarketWatch and Business Insider, from the dot-com crash, the rise of cloud computing, social networking and AI to the impact of the Great Recession and the COVID crisis on Silicon Valley and beyond. He can be reached at bpimentel@protocol.com or via Signal at (510)731-8429.

As President of Alibaba Group, I am often asked, "What is Alibaba doing in the U.S.?"

In fact, most people are not aware we have a business in the U.S. because we are not a U.S. consumer-facing service that people use every day – nor do we want to be. Our consumers – nearly 900 million of them – are located in China.

Keep Reading Show less
J. Michael Evans
Michael Evans leads and executes Alibaba Group's international strategy for globalizing the company and expanding its businesses outside of China.
Protocol | Policy

What can’t Jonathan Kanter do?

Biden's nominee to lead the DOJ's antitrust section may face calls to remove himself from issues as weighty as cracking down on Google and Apple.

DOJ antitrust nominee Jonathan Kanter's work as a corporate lawyer may require him to recuse himself from certain cases.

Photo: New America/Flickr

Jonathan Kanter, President Joe Biden's nominee to run the Justice Department's antitrust division, has been a favorite of progressives, competitors to Big Tech companies and even some Republicans due to his longtime criticism of companies like Google.

But his prior work as a corporate lawyer going after tech giants may require him to recuse himself from some of the DOJ's marquee investigations and cases, including those involving Google and Apple.

Keep Reading Show less
Ben Brody

Ben Brody (@ BenBrodyDC) is a senior reporter at Protocol focusing on how Congress, courts and agencies affect the online world we live in. He formerly covered tech policy and lobbying (including antitrust, Section 230 and privacy) at Bloomberg News, where he previously reported on the influence industry, government ethics and the 2016 presidential election. Before that, Ben covered business news at CNNMoney and AdAge, and all manner of stories in and around New York. He still loves appearing on the New York news radio he grew up with.

Protocol | Enterprise

Couchbase plots escape from middle of database pack with $200M IPO

The company has to prove it can beat larger rivals like MongoDB, as well as fast-growing competitors like Redis Labs, not to mention the big cloud companies.

Couchbase celebrates its initial public offering on the Nasdaq market.

Photo: Nasdaq

At first glance, Couchbase appears to be stuck in the middle of the cloud database market, flanked by competitors with more traction and buzz. But fresh off a $200 million IPO Thursday, CEO Matt Cain relished the opportunity ahead to prove why his company can beat out rivals the market considers more valuable.

The NoSQL database provider's public offering helped propel Couchbase to a $1.2 billion valuation. But unlike one of the last big data-related IPOs, market leader Snowflake's historic debut on the public markets last December, Couchbase has some work to do to differentiate itself.

Keep Reading Show less
Joe Williams

Joe Williams is a senior reporter at Protocol covering enterprise software, including industry giants like Salesforce, Microsoft, IBM and Oracle. He previously covered emerging technology for Business Insider. Joe can be reached at JWilliams@Protocol.com. To share information confidentially, he can also be contacted on a non-work device via Signal (+1-309-265-6120) or JPW53189@protonmail.com.

People

SPACs are so Q1 and other takeaways from a disorienting year in IPOs

Amid the frenzy of tech IPOs this year, a few surprising discoveries stand out.

Through it all, the house always wins.

Image: CSA Images/Getty Images

2021 is shaping up to be a disorienting year for tech IPOs. The first six months brought us the Alex Rodriguez SPAC, an $85 billion Coinbase debut and a mysterious delay in the Robinhood S-1 filing that was ultimately cleared up when the firm paid a token fine.

Amid the recurring frenzy, it's easy to slip into a familiar pattern of analysis: Wait for an S-1 to drop, react to the financial disclosures, then see whether the stock "pops" after its trading debut. By the time one stock starts trading, several tantalizing new S-1s are already up for inspection. The problem with this cycle is that it stops too early: A stock's opening-day pop only really reflects the extent to which a few overworked investment bankers underestimated investor demand. A pop makes for headlines. It doesn't make a company.

Keep Reading Show less
Hirsh Chitkara
Hirsh Chitkara (@ChitkaraHirsh) is a researcher at Protocol, based out of New York City. Before joining Protocol, he worked for Business Insider Intelligence, where he wrote about Big Tech, telecoms, workplace privacy, smart cities, and geopolitics. He also worked on the Strategy & Analytics team at the Cleveland Indians.
Latest Stories