New CTIO at HIMSS is excited about big data streaming, open-source and noSQL databases
HIMSS announced its first-ever chief technology and innovation officer this past month, with the hiring of Steve Wretling, a veteran CTO and CIO with deep experience in IT standards and specifications, enterprise architecture, mobile tech and more from his years in various positions at DaVita and Kaiser Permanente.
Having been on the job for several weeks now, Wretling has some big ideas about the challenges healthcare is facing and the ways he can guide HIMSS in harnessing emerging technologies and innovative clinical and operational practices to help fix them.
Wretling spoke to Healthcare IT News about his plans for improving stakeholder collaboration, homing in on more effective patient-centered care, tapping the potential of emerging data management technologies and more.
Q. Chief Technology and Innovation Officer is a newly-created position at HIMSS. As the first person to fill this role, what are some of the areas you're most excited to tackle?
A. I'm really thrilled to start seeking some answers to key questions that I think need to be asked. And they're questions that a lot of folks in the ecosystem have: What does it take to compete and thrive in the new digital health economy? Or what are the challenges to innovation in digital health? I think also there are further questions on what does it mean to provide care outside of the traditional spaces of the hospital or the clinic. Those are key areas that I think need definition, investigation, and leadership for what the digital health future is going to look like and should look like.
Q. What are some big challenges, at HIMSS and across healthcare, that you're hoping to help improve? As you know, there's no shortage of them.
A. As we look across healthcare as a whole, with all of the emerging technology, and the growing amount of information – now even more so with the addition of devices and patient-generated healthcare data, one of the key and paramount areas to consider – and work to lessen – is physician and clinician burden.
They already have so much they have to handle. How do we keep simplifying the environment and help work through the data to be able to make good clinical decisions? It's one of the key challenges we have.
Another challenge is influencing how systems and services are built and conceived. I believe that those services should be built to be patient-aware. And that means understanding that a patient's life is a series of events and not just a login. Every patient has this ongoing narrative, and we need to do a better job of listening to it and understanding it.
One of the other things we need to get back to is really understanding the key use cases when it comes to interoperability – to help drive value and efficiency for care and outcomes. For example, should we be looking more at interpretation and translation standards, versus the message specs themselves?
And I say this because we are at a place now with tech to consider self-integrating systems using intelligence and AI. And focusing more effort on the content of the messages for exchange of the information. And so I'd really like to pursue this challenge in the ecosystem to see if we're still focusing on the right places in those efforts.
Q. What are some lessons you learned at DaVita, and before that Kaiser Permanente, about the ways technology can drive innovation?
A. I think technology is often the great conversation starter. The important thing is to be sure there is a conversation. Educating business partners on new technology on a regular basis is extremely helpful to drive innovative thinking.
Either to new capabilities or services or new tech approaches. It really elevates the conversation. Whether you take advantage of it or not, that awareness is half the challenge. Once that awareness is there and the conversation is happening on a regular basis, it's easier to lock into the overall strategies and projects being planned for an organization.
In some cases, it will create new thoughts or new ideas for business lines or services, and programs, just by opening up lines of creativity and thinking in new ways.
Another thing I've found to be extremely helpful is being able to show business partners working prototypes of what they're asking for. I think it's so important to be able to drive innovation.
Because many times the clinical and business partners, without realizing how the information is digested or how the process comes along with implementation, you have a mismatch of what reality is, what they asked for and what can be done.
Many times innovation is a collaboration with the developer and the technical team, interpreting and giving ideas and options of how to deal with information or how to utilize technology that isn't creating the best innovation.
It's important to have communication among teams before you go all out in building the system. You just can't expect business and clinical partners to tell you exactly what they need, or to know what the technology is capable of unless you collaborate on innovation.
Q. Are there specific new technologies – or use cases in healthcare that are ripe for improvement – that you're particularly excited about?
A. There's a lot going on. I'm especially interested in new and emerging tech in the big data sphere. As more data is generated, and the ecosystem demands access to more data, such as genomics and personally generated health data from multiple sources, the need to utilize data at the point of care for clinical decision support will emerge even more so.
In that vein, I'm seeing a few technologies that are emerging that might be able to help us tackle some of those new challenges.
Certainly the noSQL genre of database is one of those. But more recently Apple recently opened up its FoundationDB database, which is able to provide transaction, reliability and scalability at really significant levels. Early reports are that it's a leader on performance as well. We'll have to see how that plays out, but that's one I'll want to keep my eye on.
Another area is streaming – that allows the transmission of data as a steady, continuous flow. It's been used traditionally for video, but now we're seeing broader uses for higher rates of data transfer. There are techniques that can apply rules to those streams and allow rule execution at a very high rate on a really high execution of data.
And what I'm seeing is that we've got some really big players – Google, Amazon – have their own streaming capabilities, and there are some emerging players out there: Confluent.io is leveraging Apache's capabilities, and that could make a significant impact on our ability to access and make decisions on data.
Both of those technology segments will allow us to listen to the patient – pulling data, listen to events for the patient, and then act on them for the best clinical decision support possible, whether it's the physician or to the patient themselves.
With these approaches, the paradigm can shift. Instead of accessing information on the patient when they're in front of the physician or in the ER setting, all of the data is following a patient – whether it's wellness data, clinical data, lab results, how they're sleeping, their Fitbit, etc. They can come together and we can start to listen to the patient in a dramatically different way to help drive decisions with that data.
Q. What are the first few items on your to-do list, tactically and/or strategically?
A. I've been in the role for just over six weeks now, so what I'm focused on are finding and confirming the key gaps and barriers that are holding the industry back in innovation. And then I'd really like to focus on collaborating across our communities on the right areas to close those gaps. The other thing I think is important is laying out what it takes to embrace the disruption that's currently underway, and how to enable the ecosystem to take advantage of information. And the last thing at the moment I'm really focused on is I'm looking to connect with key leaders across the healthcare and health IT leaders across the community and ask for their engagement. I really want to bring some of the nontraditional tech players into the conversation, along with existing leaders, to help us elevate and think about technology and innovation in different ways. And hopefully, we can accelerate our future.