“Innovation in hospitals isn’t new.” It may seem like an obvious statement, but as most health IT leaders can attest, it’s not. In fact, it’s a common misconception. The reality, says Darren Dworkin, CIO at Cedars-Sinai, is that innovation has always been a core philosophy at academic medical centers. What’s novel is the focus around delivery of care, and the pivotal role digital technology can play facilitating communication and enabling patients to become more engaged.
At Cedars-Sinai, innovation has always been part of the culture, whether it’s by being an early adopter of Epic’s Care Everywhere, working with Apple as a foundation member, or creating a “living lab” for startups through its Accelerator program. For Dworkin, this philosophy is the only way to move forward in the ever-changing health IT landscape. Recently, we spoke with him about the evolution in consumer engagement (and what it means for CIOs), how the recent Cambridge Analytica saga “opened peoples’ eyes,” the most significant way in which the CIO role has changed since he started 12 years ago, and what gets him most excited about the future.
- Lessons learned from Cambridge Analytica – “It has opened peoples’ eyes.”
- The “unintended consequences” of opening up APIs
- Aggregating data – “It’s hard not to get excited about that.”
- Cedar-Sinai’s “legacy of innovation”
- Creating an agile foundation for core systems
- Accelerator boot camp – “We don’t have a monopoly on good ideas.”
- Removing the constraints for startups
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We’re faced with this new chapter of ‘how do we support and enable all the wonderful things we can today through information sharing, but do so in a way that doesn’t have too many unintended consequences?’
When we had some early challenges with our first forays into information technology deployment, we pulled ourselves up and tried it again. Because of that, we’ve had a good amount of success in terms of laying down the agile foundation for our core systems.
It’s just been a very rewarding experience for us to help spawn these great companies, and hope that some of the infectious entrepreneurialism — that ‘go get them, we can’t fail’ perspective — rubs off on what sometimes can be a large bureaucratic organization.
One of the things we learned early on about startups is that they’re almost constrained by structure. That doesn’t mean that you can’t infuse the right amount of structure and process, but you want to be really careful about it.
I have to admit that as CIO, if I was putting my judgment hat on, I’d probably would have dismissed these folks long ago.
Gamble: It’s interesting how far we’ve come in terms of understanding the implications of sharing data.
Dworkin: I think so. The Cambridge Analytica-Facebook incident is now behind us, but I believe it’s opened peoples’ eyes to the fact that not everybody has the best of intentions. Now we have to find a balance. The well-intended rules and regulations around data blocking or preventing data blocking and opening up the API — all of those make sense. We were big supporters of them. We’re happy they’re in existence, because they were necessary. But like everything in life, there’s always a series of unintended consequences. And so now, we’re faced with this new chapter of ‘how do we support and enable all the wonderful things we can today through information sharing, but do so in a way that doesn’t have too many unintended consequences?’ What we’ve learned is that for a lot of these things involving data, there is no ‘undo’ button, and so you want to make sure you get it right initially.
Gamble: That’s a great point about Facebook and Cambridge Analytica. I think that opened a lot of eyes about things people in the industry have known for a long time, but a whole segment of the population didn’t understand. I think it will end up being a positive in terms of the educational component.
Dworkin: It is. What’s even more confusing at times is the fact that NIH initiatives like All of Us or Sync for Science are sort of melding together big ideas in terms of how we can aggregate pieces of information and create a bigger story or a bigger data pool, and make that data pool available for medical discovery. It’s hard not to get excited about that. But at the same time, we also need to be cautious to understand where some of this information is going.
And in healthcare, the stakes are even higher. For example, you might consent to sharing your information; that may include family history, which means that, in essence, you’re sharing your relatives’ information without directly asking them. And so we’re going to have a new series of conversations and details to think through that we haven’t had to before. None of these should mean that there are barriers to continuing the great work that we have underway. None of these means it needs to slow down, in any meaningful way, our ability to innovate. I just think we need to be very thoughtful about it.
Gamble: That’s a good way to put it. Now, within your own organization, it’s pretty clear from what I’ve read that innovation is really at the core of your philosophy, and I know there’s so much that goes into that. I want to talk about how innovation has become part of the fabric at Cedars-Sinai.
Dworkin: much as I’d love to take credit for our innovation — or even pieces of it — I should share that the legacy of innovation at Cedars-Sinai starts at the top. It starts with our CEO, Tom Priselac, who for more than 25 years has been a big supporter and believer in the role of innovation in academic medicine.
It’s entertaining to me when people think that innovation is new at hospitals — I don’t think that’s the case. The reality is that innovation has been around at academic medical centers for as long as they’ve existed. Quite frankly, it’s the reason why academic medical centers exist in the first place around research and discovery. People from all over the world come to look at and investigate US-based healthcare because of the worldwide reputation it has for its medical advancements.
What’s relatively new is the focus in the last half-dozen or so years on the delivery of care. Within that segment of delivery, there’s been an excited — sometimes overexcited — focus on how digital can help with that delivery. And so innovation around digital healthcare delivery is certainly a newer segment. I think the fun part at Cedars is that we’ve been able to play at the forefront of that in many regards. A lot of it comes from the fact that when we had some early challenges with our first forays into information technology deployment, we pulled ourselves up and tried it again. Because of that, we’ve had a good amount of success in terms of laying down the agile foundation for our core systems like lab, radiology, and certainly our EHRs and all the other things that take up time and attention at IT shops within large health systems. Of course, those things are never done, but it has afforded us the ability to layer on top of that a lot of new and exciting solutions, which these days tend to take the form of innovation.
Gamble: Right. A lot of people see innovation as something that involves tools or toys, but that’s not want it means. Now, Cedars-Sinai has something called the Accelerator Boot camp. That’s really interesting to me, because it seems like it offers a way to work with startups and lend Cedars-Sinai’s own resources to pinpoint the solutions that are really needed.
Dworkin: We call the program the Cedars-Sinai Accelerator. I like to joke that we created it not because the world needed another accelerator — there are plenty of them — but because it fills a need for us. We’ve been doing what is traditionally referred to as technology transfer, which is supporting our amazing faculty here at Cedars-Sinai that invents and thinks of great concepts. Technology transfer, as it’s traditionally defined, typically takes those amazing internal discoveries and helps that innovation find wings outside of the euphemistic four walls of our health system. And so we think of it as technology or innovation that starts from the inside and moves its way out.
One of the great things about the culture of Cedar Sinai is that our folks understand that we do not have a monopoly on good ideas, good innovation, and fresh ways of thinking. And so we really wanted a way to take innovation from outside the euphemistic four walls and bring it back into the health system. We thought one of the best ways to do that is to infuse our team with a wet lab or a working lab with digital startups.
We created the Accelerator because it gives us an opportunity to bring in a dozen or so companies at least once a year — sometimes more often — and take them through a formal program, which helps educate everybody. It educates the startups in terms of letting them understand how healthcare delivery really works, and it also educates our faculty, our staff, our administration, and our nurses, pharmacists, dietitians, and supply chain folks all across the organization in terms of how startups think. There have been amazing lessons learned, and it’s just been a very rewarding experience for us to help spawn these great companies, and hope that some of the infectious entrepreneurialism — that ‘go get them, we can’t fail’ perspective — rubs off on what sometimes can be a large bureaucratic organization, as any big hospital can be.
Gamble: Is there anything that stands out from the programs you’ve had so far, as far as an innovation or possible solution?
Dworkin: I’ll give a couple of examples, but I’ll back up just a little bit and say that one of the things we learned early on about entrepreneurs and startups is that they’re almost constrained by structure. That doesn’t mean that you can’t infuse the right amount of structure and process, but you want to be really careful about it, and so one of the things we did in terms of selecting companies was to put into place a selection committee.
The selection committee takes the applications we get for each class — we had more than applications for 10 spots in our last class — and whittle them down. This enables us to throw out some of the really wacky ideas and the things that we think might not exactly be illegal, but are things that perhaps a nonprofit healthcare institution shouldn’t be doing, and brings us down to a smaller number. Then we whittle it down again using a team of folks that focus on the Accelerator to make sure the concepts are real and viable. The remaining companies are put in front of a selection committee made up of clinicians and administrators from around the health system. They’re hearing all these rapid-fire pitches and telling us, ‘hey, this idea really resonates.’
We’re letting the ideas themselves drive the structure, the strategy, and where we’re going, and I think that has been a big piece of the secret sauce. A great example I can offer is we heard a pitch from a texting company. I have to admit I was guilty of rolling my eyes and thinking, ‘another texting company — just what healthcare needs.’ But when the front office staff of our ambulatory clinics heard it, it just clicked with them, and they became very passionate about wanting to work with the company.
The core thesis they shared with us was, ‘listen, there are a lot of ways to text back and forth for them as individuals and patients, but it was always tied to their own cellphones. There’s no way for the front office staff as a team to text and communicate with patients and send reminders, instructions, directions, and forms — those types of things.’ And it took off like wildfire. Today, that application is live across our health system in 200-plus clinics, and it generates more than a million text messages a year. It’s something that really started from the grassroots and took off. And I have to admit that as CIO, if I was putting my judgment hat on, I’d probably would have dismissed these folks long ago.
Chapter 3 Coming Soon