Health 2.0: Exclusive Interview with Susannah Fox, CTO of HHS

Susannah Fox, CTO of HHS, shares how she is fostering patient empowerment and engagement through technology. Matthew Holt, Co-Chairman of Health 2.0, had the opportunity to personally chat with Susannah and learn more about the democratization of healthcare!

Don’t miss Susannah Fox at the 9th Annual Health 2.0 Fall Conference. Purchase your tickets here!

Matthew Holt: Matthew Holt here, delighted to be on with a really wonderful amazing person in healthcare who is not only my friend but also the CTO of HHS, Susannah Fox.  Susannah, thanks so much for joining us.

Susannah Fox: I am thrilled to be talking with you.

Matthew Holt: Well, so those of you who don’t know — Susannah originally was a journalist at U.S. News and World Report and spent many, many years at Pew Research, and is basically leading the survey research understanding the patient experience — probably in healthcare as a whole but studying the patient experience with the use of technology.  She happens to be the first proper keynote speaker we ever had at a Health 2.0 conference back in 2008, attended Health 2.0 in many different places with us, and has been a great friend and colleague.

And then she more recently spent about a year at the Robert Wood Johnson Foundation as an Entrepreneur in Residence.  And amazingly enough, RWJ and HHS today did a player swap in which Bryan Sivak who was the CTO of HHS went to Robert Wood Johnson and Susannah went to HHS as CTO. So, Susannah, I hope I got that history about right.

Susannah Fox: Yes indeed, yes.  What was fun about Bryan and I is that when I was being recruited for the CTO role, I didn’t tell anyone at RWJ, and then when I left they had been quietly thinking about Bryan for the role of Entrepreneur in residence anyway.

Matthew Holt: Who gets the player to be named later?  And who is the player to be named later?  All right, so let’s talk a bit.  I want to capture a couple of things that we’re going to talk about.  Obviously, you’re going to be at this year’s Health 2.0.  We’re going to have a little chat and then you’re going to be sitting on our panel mostly about the patient experience and the impact of technology on patient experience and patient outcome, something like that, that’s very close to your heart.

So why don’t we start off a bit on just a little bit about the work you were doing at RWJ because some people don’t know exactly what you’re doing there and you’re doing some really interesting, deep research there.  So why don’t you say a little bit about your experience there?

Susannah Fox: At the Robert Wood Johnson Foundation, I was the second entrepreneur in residence.  The first one was Thomas Goetz.  It’s a really interesting role because they want to bring in an outside perspective to the foundation.  What I decided to look at was how to encourage the foundation to open up more doors and windows to the outside world.  How might we listen more to the communities that we want to serve and therefore serve them better?

The other initiative that I was working on while I was there was recognizing the importance and really the gift of failure that when there is a grant that’s made that doesn’t go very well, that can be as much of a positive learning in the end as a grant that goes really well.

Entrepreneurs know this that if you try out a new project or a new product and customers say, “No, I won’t use that,” that’s actually a gift because you know what not to do.  And so, those are the sorts of principles that I was talking about with the foundation.

Matthew Holt: Sounds good.  Speaking as a “forced entrepreneur,” I’m not sure I like that whole “failure is a gift notion.” It’s a gift that you pay for, not the other way around.

Susannah Fox: Well, that’s with trying small things and trying little experiments all the time so that you don’t get caught investing a huge amount of money on something that’s not yet tested.

Matthew Holt: Yeah, I think that’s probably very true across foundations as a whole.  Many of them have been guilty of starting long, long initiatives that in the end didn’t pay off much and not doing sort of that fail-fast experimentation at the start that you’re trying to encourage now and you’re actually trying to encourage at HHS.  That’s great.  Can you say a bit more about your patient experience?  You were doing a little bit of it at RWJ as well.

Susannah Fox: Sure.  What I have been doing for the last 15 years, I started doing it while at the Pew Research Center and then continued it with the Robert Wood Johnson Foundation, was always staying as close as possible to the frontlines of healthcare. Tim O’Reilly has this great phrase that “If you want to see where the future is heading with anything but especially with technology, you need to follow the alpha geeks, the hackers.”  In healthcare, the alpha geeks are people living with rare disease and life-changing diagnoses.

And so, what I tried to do is spend time in communities either in real life going to conferences or online in virtual communities, spending time with people who are living with rare conditions because they’re going to push the envelope in every direction in healthcare and in technology.  It’s really by following them that I get my best ideas and see where things are headed.  And that’s also what I’m bringing into HHS, the sense that we need to stay close to the customer, close to the end user.

Matthew Holt: Wonderful.  So now you’re at HHS, let’s talk a bit about that.  First off, you’re the chief technology officer.  But strictly speaking, although you’re following someone who is a deepwater geek in Bryan Sivak who is a technologist who ran technology companies, you’re a sort of journalist/researcher with a deep interest in technology.  That probably implies something about what HHS is looking for in terms of its technology interaction.

HHS started with Todd Park who was all about opening up data sources and Bryan Sivak who was about — and you can correct me if I’m wrong — building tools and relationships to use that data on top of those data sources and obviously following on Todd’s work.  That work I’m sure is continuing.  I know I’ve seen some great stuff at HHS in the technology office and you can talk a bit about who’s doing what there.  And great foundations have been laid for that.  And obviously, there is Health 2.0 and the Health Data Initiative and a bunch of other people as well obviously working on that and that’s continuing.  But give me a sense about your special interests and your special flavors that you’re going to bring to this.

Susannah Fox: Well, I’ve always been interested in understanding how people are engaging with technology and engaging with healthcare.  That turned out to be a keyword also for the people who were interviewing me for this job.  When I kept saying, “Now, you understand that I’m more of an anthropologist than a technologist?” they would say, “Yes, yes.”  And I would say, “Okay, I’m really interested and even to the point of obsessed with patient empowerment and patient engagement.”  And they said, “Yes, exactly, thank you,” because they understand that technology these days is not necessarily about the code, it’s about culture.

In bringing me in as the chief technology officer now, they’re acknowledging that what we really need to do is have a holistic view of how technology is affecting American healthcare. What’s great is that this really is a continuation of the work that Todd and Bryan did because part of being the chief technology officer, it’s really the chief innovation officer.  Bryan added the title also of “Entrepreneur in Residence” at HHS.  It’s bringing that sensibility of an outsider view into the secretary’s office so that our role here and the Idea Lab and as CTO is to look across the landscape and look a little bit into the future and help people here at HHS to anticipate the future better.  The best way to do that is to, again, follow the alpha geeks to make sure that you have the perspective of your customers which again is a core principle of being a great entrepreneur, to always be sure that you’re serving your customer.

Matthew Holt: Can you say a little bit about the infrastructure you already have there and the kinds of projects that you’re actually working on now and what we can expect to see?

Susannah Fox: Yeah. We divide the work of the Idea Lab into three areas.  The first is promoting internal innovation.  That is where we teach the entrepreneurial principles and design thinking to people who work here at HHS and across all the 11 operating divisions.  We do that in three ways.  We have an Ignite Accelerator program, that’s a three-month program that’s pretty competitive to get in.  Once people get in, they bring in a problem to be solved.

Matthew Holt: Is that internal HHS stuff or is that anybody?

Susannah Fox: Yeah. People apply who work at the CDC or the FDA.

Matthew Holt: Somewhere across the organization.

Susannah Fox: Somewhere all across the operating divisions.  They then come in for individual mentoring and training to try and solve a problem that they’ve encountered in their work.  What’s wonderful is that we also bring in advisors from the University of Maryland.  We give these folks who are working for the federal government the opportunity to think like an entrepreneur and to learn some of those skills.  We give them a little bit of money.  But the most important thing is that we give them some air cover so that they get permission from their supervisor to work on something new and to essentially try and create a minimum viable product that they then put in front of their customers.

It’s very accelerated. Our demo day is kind of the graduating class of the current crop.  One of the projects has been so successful that it actually has already launched because they created something that their supervisor and colleagues were so in favor of that they said, “We’re not going to wait for your graduation from this program.  This is fantastic, we’re doing this.”

The other thing that we do is we have a Ventures Fund where we seed projects that might not get noticed otherwise but we have a little fund that we try our hand in a little venture capital within HHS.  We also hold award ceremonies, the Innovates Awards.

The second area that we look at is leveraging external innovation.  And this is wonderful.  We bring in external entrepreneurs and innovators into the federal government for short sprints, either one or two years, again, to tackle a specific problem.  If you’ve heard about the Presidential Innovation Fellows program at the White House, that actually is based on our entrepreneur in residence program.  It’s something that Todd started here and then brought with him when he became the White House CTO.  What that does is it first of all brings in outside skills that maybe people within government don’t have, and there are some really fantastic examples which I can talk about.  But what we also really want to do, part of the ulterior motive is to infect people with this idea that innovation can happen in the federal government.

And so, half of our EIRs and IIRs have been asked to stay on and many of them do.  That’s a way for us to build the talent within the federal government to attract people who never really thought they would do federal service, like me.  They bring them in and show what great impact you can have working here.

The third area that the Idea Lab looks at is building collaborative communities.  With that, the Health Data Initiative is the most well-established of those programs.  We’ve really created a community around open health data.  Not only a community, but a marketplace where there is so much interesting development going on around the data that the government releases about healthcare.

We also have something called “Buyers Club” which is about something that I really honestly didn’t know anything about before I started here which is government acquisition.  But we really, really need to modernize it.

Matthew Holt: “Buyers Club,” you said?

Susannah Fox: “Buyers Club,” isn’t that a great name?

Matthew Holt: It’s like the Dallas Buyers Club, yeah, illicit distribution of medication in HHS?  No, you’d better deny that part.

Susannah Fox: One of the themes across all of these is that we need to have interdisciplinary teams.  That’s something that we promote across all the areas that we work on.  And it’s true for Buyers Club as well.  It’s something that you need to bring in, for example, a contracting officer as soon as you have an idea for a new government program because that person can help you design a contract that, for example, is agile instead of waterfall design understanding that anything having to do with digital or software these days, you need to have a different kind of acquisition of that kind of service. Now, what I’m really interested in is that all of these programs point towards democratizing and opening access to information data and tools.

And you’ll notice, Matthew, but the thing that I’m currently obsessed with is the “Maker Movement.”  Do you know about the Maker Movement?

Matthew Holt: Of course, yeah.  In fact, years ago, Health 2.0 had a booth at the Maker Faire.

Susannah Fox: Really?

Matthew Holt: It was really funny.  Health 2.0 actually had a whole pavilion, we worked on this together with Maker Fair.  It was on a county fair ground, and because they had to have the same vendors as any other fair in the county fair ground, immediately outside the Health 2.0 sign was the funnel cake, right there.

For those of you who don’t know, the Maker Movement is the modern-day tinkerers, people who are building things with their hands and technology and the physical embodiments of technology.  So then you’ve got the got the backyard building rockets and building robots and building stuff.  There are applications all over the place.  It’s really quite fascinating.

Susannah Fox: Yeah.  And it’s our answer to sort of the homebrew computing club.  What’s built in garages is now coming out for show and tell at Maker Fairs and other places.  I started picking up signals about this about five years ago in my fieldwork where I would be talking to people with diabetes or rare disease.  I would be asking them about access to information, access to data, and access to crowdsourcing techniques.  And they would say, “Yes, yes, I can tell you about that.  But let me show you what I made.  Let me show you this device that I had to create for my kid.”  Or, “I’m a caregiver for someone and this is the way that I had to create something to prevent, for example, my loved one who has dementia from flushing her adult diaper down the toilet.”

You might remember that I talked about this onstage during the unmentionables panel one year.  This is something that I’m very, very interested in.  I think that the Maker Movement will have as significant an effect on health and healthcare as we’ve seen for data particularly as the costs of manufacturing go down and 3D printers and other technology start to become very, very common.  Just like cloud computing with the accelerants that got poured on the fire for big data, the lowering cost of manufacturing is the accelerant that’s going to get poured on the fire of what I’m calling the “inventing health” or “health maker ecosystem.”

Matthew Holt: That’s very cool.  Actually, Indu and I were talking about this, how to describe what I was starting to call — I call it the democratization of diagnosis, that’s one thing, and then the sort of lowering and upstreaming of treatment.  And then you’re talking now about all the other pieces that go around that including, like you said, flushing the adult diaper down the toilet, what kind of tools can prevent that and what can be built openly?  And this is happening obviously not just in health but in energy and in manufacturing, across the board.  But it’s fascinating.

Susannah Fox: Yeah, absolutely.  And in joining the federal government, there actually is already an interest group of people who are interested in the Maker Movement.  There are people at, actually, FDA and NIH as well as USAID and the VA.  There are all kinds of people who are already interested in this in all sorts of sectors of healthcare.  So drawing that together and understanding what we in government can do to understand this ecosystem and to, frankly, get out of the way sometimes.  That sometimes is the best role for government.  To, again, open up doors and windows so that people can see in and so that we can learn from people who are really on the front lines of healthcare.

Matthew Holt: Fabulous.  Okay.  Well, let me say thank you very much to my guest, Susannah Fox, CTO of HHS.  We’re looking forward to seeing Susannah onstage.  She’s on a panel, as she ought to be, on the patient experience, the new patient experience and outcomes which is coming on Monday afternoon.  We are on just after Chelsea Clinton.  Well, after Chelsea Clinton and Indu herself which is a very, very impressive line up.

And there is going to be a lot of great technology on that panel showing a lot of the things that may impact patient experience.  We’ll have a patient, Kym Martin who you know well, who has had more bouts of cancer than most people can imagine, and Sachin Jain who is now the CMIO down at CareMore.  But it’s going to be a great panel and I’m looking forward to chatting with you there and seeing you then.  So, Susan, I thank you so much for your time today.

Susannah Fox: Thank you.

Deepa Mistry is a Marketing & Operations Associate at Health 2.0

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