Q&A: HHS CTO Bryan Sivak on Disrupting Government Culture

HHS CTO Bryan Sivak

By Tom Sullivan
Editor, Government Health IT

The term disruption is perhaps a bit overused in the technology and healthcare sectors these days, but if there is one place where it’s needed most, that just might be the federal government.

In his role as CTO of Health and Human Services, Bryan Sivak is looking to inject innovation into his department, and others, drawing on experience earned in both the public and private sectors to effect a culture change. Prior to HHS, Sivak was Chief Innovation Officer of Maryland, CTO of the District of Columbia, and a founder of software companies InQuira and Electric Knowledge.

Government Health IT Editor Tom Sullivan spoke with Sivak about HHS programs that aim to improve traditional practices within the federal government by bringing people in from the outside world then tasking them with solving complex problems quickly, what he’s anticipating in the imminent second round of HHSentrepreneurs, and his take on former HHS CTO Todd Park’s vision to transform the department into the NOAA (National Oceanic and Atmospheric Administration) of healthcare.

Q: One of the HHSentrepreneurs told me that the program is, and I quote, “disrupting the traditional model of getting things done inside the federal government.” So what are the most disruptive aspects?
 The key element is that we’re bringing people in who have very different sets of experience than your typical government employee but only giving them 12 months to execute, at the maximum. And because they’re coming in to solve some really interesting and somewhat difficult problems and they have such a limited timeframe they almost by definition have to do things in a different way. We’ve been seeing that across almost of the projects in the first round. To me, personally, it’s been very fascinating to see the roadblocks they’ve been running into and how they’re overcoming them. It’s been actually kind of wonderful.

Q: What’s the most innovative example particular to the HHSentrepreneurs program?
 I have a whole bunch. But just off the top of my head, one of our projects, with CMS and ONC, basically they have a joint program where they are determining clinical quality metrics. The idea is to take all this electronic data that health records are collecting and figure out ways to combine that data, generating algorithms, for example, that spit out measures of quality for various types of procedures and services. So the process itself is pretty interesting. When we started the project it took between 3 and 5 years to develop a metric because it’s a relatively complicated process and there’s all kinds of documentation, different stakeholders, and other things. There’s this one guy who works at ONC, he came from a health system, his name is Kevin Larsen and at the health system he participated in some lean efforts — you know, lean manufacturing type of stuff, Six Sigma, etc. — and saw some amazing improvements within the health system. In fact, he said this is really a process that we could apply lean mechanisms to make it much more straightforward and streamlined. And so this woman, Mindy Hangsleben, who’s a lean expert, she quit her job at Intel and moved to D.C. for this yearlong position. The first thing she did, the first thing you do in any lean effort is look across the entire process to identify what your error rate is to try and figure out what’s going wrong and how often it’s going wrong. And the first thing she discovered is that this process had literally a 100 percent error rate — there was error in every step of the process. Which, honestly, we think is a good thing because that means there’s only one direction you can go. She dove right in with a lean methodology and they actually just ran their first measure through the new process and it went from 3-5 years to three months, which is pretty amazing.

But what’s even more amazing to me and the whole reason we’re doing this program is not necessarily to — I mean we do want them to be successful in solving the problems they’re here to solve — but really what we’re trying to do is change the culture in some of the areas of the federal government. And when you look at the people she’s been interacting with in these organizations, it basically changed their entire mindset around this lean methodology, even to the extent that a woman at ONC came up to me the other day and said, “I’ve even optimized my grocery shopping based on lean methodology.” If that’s not having an effect, I don’t know what is. So it’s been pretty amazing.

Q: I have to ask: Will you be publishing quality measures for grocery shopping?
We can ask about that. We could all use that. But that’s just one example. Each of the programs has its roadblocks and interesting ways of getting around that.

Q: You are embarking on a second round of HHSentrepreneurs. What’s on tap for round 2?
 Instead of four projects, we have six. The gamut of different ideas has expanded. What I think is pretty cool is that it’s not just technology stuff. Some of them are technology related, but a lot of them are process and efficiency related so I’m excited about that because it brings different ways of thinking and different skill sets into the government. What we’re hoping to get is a really strong cohort of people to apply and hopefully be selected for each one of those projects, people who are willing to do new and interesting things. One of the aspects I find interesting about this program is that many of the solutions are going to be portable outside HHS, not just something we will keep on the inside. Many, many elements of the federal government can take advantage of this stuff.

Q: Vivek Kundra said when he was CTO of DC that he and his staff regularly used technology at home that was so much more sophisticated than what they were saddled with at work. Has that been your experience, and how has it shaped what you bring to the job?
 In a certain sense it is what it is when these agencies have their very stratified policies about what they will and won’t support. So one of the things we’re tying to do is prove that there are different ways of still maintaining security while allowing people to work with technologies and devices they might be more comfortable with. In some ways we’re the perfect pilot for any kind of bring your own device scenario. We’re a very good pilot group for different types of technologies as well, so collaboration or issue tracking software, for examples, and different devices or pieces of equipment necessary to solve problems.

A great example is one of the projects in the first round with the Office of the Assistant Secretary for Preparedness Response. Basically, the project is designed to help us locate people in disasters who have durable medical equipment, which are electrically-powered devices that typically have problems in emergencies as soon as your battery discharges. What happens today is that in emergencies these people tend to flock to emergency rooms because they’re the last places to have power but sometimes the emergency rooms are destroyed and, furthermore, the last thing you want in the ER is a whole bunch of people plugged into the wall just because they need electricity. Frank Sanborn is our entrepreneur for this project and he had a great idea, which was to take some potentially hackable commodity hardware using Raspberry Pi and essentially building a prototype device that can be plugged into durable medical equipment that will both read the current capacity and state of the battery and also transmit out in real-time the status of that device so you can locate people to triage the situation and bring help to those who need it first. We’re looking at holding hackathons on the hardware, we’re going to run pilot tests in various places. It’s really pretty cool.

Q: Your predecessor Todd Park had a famous line saying that he wanted to make HHS the NOAA of healthcare. Are you continuing that push and if so how?
 Sure. I don’t know if I would really call it the NOAA of healthcare because what we do is a little bit different. But I will say that we are sitting on a vast treasure trove of data that can be used in any number of ways — things that we’ve seen and things we can’t even begin to imagine — and it has the power to fundamentally transform healthcare and the delivery of human services. So we’re continuing this effort in a real big way and we’re actually in the process right now of developing an execution plan for the next couple of years, which is going to have a few different elements to it, not just data liberation, which was the primary focus of the last few years, but also adding in components for better disseminations to get different groups of people involved from the outside world. And we want to start teaching people who might not know what the data means how to do interesting things with it. So stay tuned, we’re going to have some exciting developments coming up.

Q: What else should I be asking about HHSentrepreneurs?
Just that I want to encourage people to apply. We have a bunch of applications in already for the next round but I’d love to see more people, maybe even from outside of the healthcare world. The best things happen when you get people with different sets of experiences, different backgrounds, mingling together in one place.

This Q&A article was originally published on Government Health IT.