Flashback Q&A: 3 questions with HHS CTO Bryan Sivak

'What we’re trying to do is change the culture in some of the areas of the federal government'
By Tom Sullivan
10:23 AM
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Health and Human Services chief technology officer Bryan Sivak announced that he will step down from the job this month.

In so doing, Sivak is not just leaving the CTO position but also the entrepreneur-in-residence post he held simultaneously. Healthcare IT News Executive Editor Tom Sullivan spoke with Sivak in 2013 about disrupting government culture with both technology and modern business practices.

What follows is a condensed and updated version of that original interview.

Q: In addition to CTO, you are an entrepreneur in residence at HHS. What has that role entailed?
A:
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.

Q: What’s the most innovative example?
A:
CMS and ONC 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, 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 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. This is really a process that we could apply lean mechanisms to make it much more straightforward and streamlined. 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 [we] 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. When they ran their first measure through the new process it went from 3-5 years to three months, which is pretty amazing.

Really what we’re trying to do is change the culture in some of the areas of the federal government. It basically changed their entire mindset around this lean methodology, even to the extent that a woman at ONC came up to me 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: 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?
A:
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. And we want to start teaching people who might not know what the data means how to do interesting things with it.