Open data and innovation in the federal government are critical topics in today's digital environment.

Bryan Sivak, Chief Technology Officer of the US Department of Health & Human Services, will discuss sustainable innovation in government and "challenging bureaucracy to escape the status quo.” Previously, he was Chief Innovation Officer for the state of Maryland, where he helped create the state's health information exchanges to connect various electronic health record (EHR) platforms. Sivak holds BS in Computer Science from the University of Chicago.

This episode will include discussion of important topics related to innovation and business transformation in the federal government.

Innovation in the federal government

Any effort to change the status quo requires detailed understanding of the relationship between process, technology, and business goals. Although culture plays a significant role in all change initiatives, the government's sheer size creates inertia that inhibits change. Under Sivak's leadership, Health and Human Services developed the IDEA Lab to foster innovation and entrepreneurial thinking.

Digital transformation

Open data and analytics are key components of any digital strategy for the government. Sivak will share his experience and lessons on how to make data accessible and the value of doing so. At the same time, Sivak will describe the organizational challenges and how to overcome them.

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Innovation, Data, and Technology in the Federal Government: Bryan Sivak, Chief Technology Officer, Dept of Health & Human Services

Michael:         

(00:04) Innovation and the Federal Government are these words that we often hear together? Not often, but today, on CXO-Talk we’re going to be talking a lot about the combination of Federal Government, the department of Health and Human Services and interesting things happening. This is episode number 106 of CXO-Talk. I’m Michael Krigsman and as always I’m here with the glorious the fabulous Vala Afshar, Vala how are you?

Vala:   

(00:46) Michael I’m doing great. This is my favorite time of the week for me because I get to learn from best and brightest and today is no exception. I just don’t understand why you don’t ever want to buy an Apple watch but we can talk about that later.

Michael:         

(01:03) You know we’ll talk about the Apple watch, but let’s first talk with our guest who is Bryan Sivak, who is the Chief Technology Officer for the Department of Health and Human Services in the United States Federal Government. Bryan how are you?

Bryan: 

(01:23) I’m fantastic, thanks so much for having me on the show.

Vala:   

(01:26) Bryan can you tell us briefly about your professional background and introduce yourself to our audience.

Bryan: 

(01:33) Sure. So it’s sort of an interesting story. I ‘m really a software entrepreneur by heart. I started a company in ’97 in San Francisco. Grew that for a while and moved over to London in 2005 to open up the European and Asian office for the company.

(01:51) And in 2009 was actually recruited by the City of Washington DC to be the CIO for the City. Kind of came out from nowhere but for a few different reasons it was the right time to make a move. And I had always been interested in public service. I always wanted to see what it was like and it was just an interesting role to step into.

(02:16)So the whole family moved back to the States. We moved to DC, took that job. And actually it turned out to be way more fun than I ever could have imagined.

(02:30) City level stuff just in general is incredible fun because it’s so tangible, and so fast moving. You’re doing things every day that affects people literally on a minute to minute basis. And I was lucky that I happened to be working for a Mayor who really understood that if you hire good people and then just left them do their jobs and don’t hold them back, they can accomplish incredible things.

(02:54)So we were working with a team that was incredible. We got amazing stuff done. A lot of those people that I worked with some are still some of my best friends and it was great.

(03:04) Unfortunately Mayor Fenti lost his reelection campaign and basically we were all out of a job at that point. I didn’t realize quite how it worked until that happened. But what happens when the Mayor or wheteverelected official who you happen to be working for loses an election and somebody new comes in, is that they ask you to write letters of resignation.

(03:28)And so we all wrote our letters of resignation which were then accepted, then we were all out of a job. After that I ended up being introduced to Governor Martin O’Malley in Maryland.

(03:41)We hit it off and basically invented a job called the Chief Innovation Officer for the state. To my knowledge it was the first time there had ever been a Chief Innovation Officer in any sort of jurisdiction in the states and maybe even globally. And we had fun with it.

(03:57) One of the really interesting things about  O’Malley is that he, over the course of 16 years, he ran Baltimore for eight years and then was then the Governor for Maryland for eight years. Really learned how to run  large bureaucratic organization and when he brought me in, basically what he said was, look, I’ve got these 15 goals – and this was his thing. He said look, the states a big state but I’m going to focus on these 15 things and they’re going to be very time bound and measurable.  And we’re going to be very public in how we achieve these goals.

(04:29) He was like, look, I want you to come in and I want you to help us accelerate our progress towards reaching these goals by leveraging you know the idea and doing things in different ways. Use technology, use data, use process change, use culture change. Use behavior change – all the things you could think of.

(04:44) So I had a great time there and I was actually planning so – this is kind of funny. So when I started that job myplan was basically work for him through the end of his term which is the beginning of this year and then go back to the private sector.

(05:01) I also promised myself that under any circumstances go work for the Federal Government because I’m pretty bad at bureaucracy and my experiences with the Federal Government from the DC and Maryland, jobs had been just a lot of bureaucracy. And so that all change really when they were calling for this particular job and recruited me to be the CTO.

(05:26)And I ended up taking it for a couple of reasons. Number one because when you think about the stuff what’s happening in Healthcare and Human Services right now, it is literally the most interesting times since probably 1965 when Medicare and Medicaid were created.

(05:43) You know, the universe is changing and this ecosystem is changing, and to be sort of in the middle of it at that point in time is just incredibly fascinating.

(05:51) Secondly, I’ve always had an interest in Healthcare. My dad’s a doc, his dad’s a doc, my uncle’s a doc. I was that close to being a doc at some point, and so it’s always been in my blood so to guess in a certain sense. And it’s pretty amazing and the people who work here are incredibly dedicated and the have all of the right motivations in mind. They’re trying to help people. They’re trying to help this universe. It’s just been great. So that’s the story in a nutshell.

Michael:         

(06:23) So very briefly, give us a sense of the size of the Department of HHS

Bryan: 

(06:37)So the size of the department is, and it’s actually an interesting question. The Department itself, I would say it’s roughly 90,000 employees if you look at – that’s just full time employees. If you look at contractors it’s probably two to three times that.

(06:53) The CMS, the center for Medicare and Medicaid services for example is 5,000 full time employees, but a 100,000 contractors. So it’s a pretty fascinating structure.

(07:05) HHS itselfyou can think of almost as a holding company for 11 of what we call operating divisions, and these are things some that you’ve heard of, The National Institutes of Health, The Center for Food and Drug Administration, The Center for Disease, Control, and Prevention, Medicare and Medicaid, and then maybe a bunch that you might not have heard of, Substance Abuse and Mental Health Services Administration, The Administration for Community Living, the Administration for Healthcare and Quality and things like that.

(07:34) So it’s a very interesting organizational structure. NIH for example is a very sort of the crown jewel of the American Healthcare and Health Research, so they are out there doing their thing. And it’s often an interesting challenge to kind of help all of these different divisions and different people work together to do interesting things. It’s really been quite fascinating.

Vala:   

(08:03) Can you just give a sense to our audience. We have digital marketers, information technology, chief technology and we also have startup founders. And it’s a mix of you know Fortune 500 as well as startups across different lines of the business. Can you explain to our audience of what you do as a CTO.Your job, your function as a CTO for the department.

Bryan: 

(08:28) Sure. So it’s a god question and I say that’s a good question, because I think the title CTO is a little bit vague and misleading in many cases when you look across the universe. One CTO especially in Government is not remotely the same as another CTO.

(08:47) In some cases, in government in particular we have CTO’s who report to CIO’s. those roles tend to be around looking at you know, sort of the near term future of technology and how that technology can be embedded into the enterprize to help it kind of move forward.

(09:03) In my case it’s a little different. I work directly for the secretary and the deputy secretary, and my remit is a little bit broader. Basically the job is to look at this generic thing we call innovation, which might be related to technology, which generally speaking, and more often related  to process change and behavior change, and getting a large organization and a culture to shift. And helping people figure out how to take advantage everything from new tools, and new processes, and new methodologies to you know kind of old stuff. Like figuring out how to actually talk together in a way that’s productive as opposed to nonproductive.

(09:47) So that’s really what I focus on. Some of it is related to technology specifically, some of it’s not. What we’ve really tried to do here in the three years or so that I’ve been around is to build a platform of other people to plug into both inside the Government and outside the Government to help them experiment with ideas. To take successful experiments and try to scale the both across the internal and external ecosystems, and to really king of move the ball forward in kind of new and unexpected ways.

(10:17) One of the ways I looked at it is that you know, as the pace of change continues to increase in the modern world, both technologically speaking and sort of otherwise, we as an institution need to be able to react faster. We need to be you know sort of immediately faster on it and hopefully proactive, so that we kind of get ahead of some of the things that we’re actually writings. And actually, what we’re thinking about is how can we help people prepare for that universe and how can we change the culture of HHS and the way things work around he so that the people are in that proactive mindset, rather than a sort of reactive mindset that takes a while to catchup.

Michael:         

(10:56) So is the focus of your work Bryan primarily on process and culture and creating the conditions for change and innovations as opposed to the technology itself?

Bryan: 

(11:12) Yeah, I would agree with that and one of the reasons for that is because, you know I’m a technologist by background and training. I’m a computer Science graduate and haven’t written code in a while and it’s probably a good idea probably that I’m not writing code anymore. But you know that’s my thing and I’m a huge geek and you know love all this stuff.

(11:30) But one of the things that I’ve kind of come to realize over the years is that technology is very rarely if ever, a direct solution to a problem. It can be a catalyst, it can be an enabler, it can be an accelerant. But it is very very unusual for a technology to actually come in and solve some problems.

(11:51)What tends to solve problems are people an culture and you know the ability for people to adjust to new ideas and new systems and to push new ideas. So we really try to focus onto enable other people to see different possibilities. And where tools can come in and technologies can come into help enable those changes and accelerate those changes, great. You know, we’ll be the first ones jumping up and down saying, hey have yu tried this thing.

(12:19)But there are plenty of times when new tools and new technologies actually have an opposite effect, right. You bring something in, it doesn’t get adopted, nobody uses it and you’re kind of back to square one. And so I think, you know a lot of people sort of associate this idea of innovation with technology. We’ve actually defined this word innovation in a bit of a different way.

(12:42)We define innovation as a direct result of the freedom to experiment. The idea being that we can teach people the scientific method right. We can teach people to experiment and develop by apotheosized and test that hypothesis to kind of look at the results that come back and fold those results into future iterations.

(13:03)We can also provide people with freedom, right. And we can give them the air cover they need to actually run these tests, and we believe that if we can both provide the freedom to run these tests, give the methodologies and the specific ideas, and trainings around how to actually go about experimenting, then this thing called innovation will result.

(13:24) And a nice little side effect of that by the way is that the word, experimentation by itself sort of encodes the idea of an unsuccessful test. And one of the things that Government is really bad at and it needs to get better at is figuring out how to embrace failure, right. And how to eat essentially say, look, we’re going to try something and it might not work and that’s okay, and we are going to learn from that from the things that didn’t work and forward those back into another iteration to into something that does work.

Vala:   

(13:54) You have said that your role at HHS is executing the department’s innovation agenda. Does executing the agenda – sounds like is it more cultural, process and people innovation and technologies last. Or can you explain in how you’re driving the innovation agenda.

Bryan:

(14:13)Yeah, so I guess the first thing I’ll say, even although I justified the word innovation as I kind of hate it. And I hate it because it’s become this word that kind of means everything and at the same time it means nothing, right. So we tried to define it to give it a little bit of immunity.

(14:32) I mean, really what we are trying to do is build out this platform that to me really has been focused on solving three big problems that we identified, both in the Department and in the ecosystem.

(14:43)Number one,we've got these 90,000 people, who for the most part are incredibly in dedicated, incredibly intelligent, focused on the mission, here for all the right reasons. I mean really, just subject matter experts in these incredibly complex areas but they find their hands tied by the bureaucracy and red tape, and something that challenges that a large organisation presents.

(15:10) So, the first problem we try to solve ishow can we enable these people to test out some of these ideas in a sort of a free way and really figure out how to make something go from an idea to a functional prototype that will provide some data that indicates in whether it is successful or not.

(15:26) The second problem that we tried to solve is really the idea that we have these 90,000 people that are all incredibly intelligent and they’ve got all these great skills, but at the same time we don’t have all the skills on the inside that we need in order to solve some of the most complex problems that we have. And so, we’ve devised some initiatives to kind of bring people in from the outside world on a time limited basis to help us solve some of these problems that we don’t have the internal skillsets to do.

(15:56) And then the third problem and anybody who works in a large organisation will probably recognise this, but maybe this actually propagates to organizations of even a smaller sizes, which you know in my experience it does. You get these silos of sort of expertise, or behavior or program functionality or what have you and they very rarely talk to each other. But one of the things that we know from looking at the history of sort of innovation and innovative thought is that new developments never come from the guy that has that eureka idea, right. The Apple doesn’t tend to fall on Newton’s head and all of a sudden some great theory of gravity comes out, right.

(16:41) All of these new ideas tend to come from groups of people working together, each of whom have different backgrounds, different ideas, different cultural histories etc. and so these silos that exist tend to prevent people from different backgrounds working together. That sort of architecturally in many cases in government. If you walk literally right outside my office into the hallway here, you’ll walk into a windowless corridor that is sort of cement lined and dark. And the only thing you’re going to collide with is air, I mean like people are stuffed in cubicles and they never really interact with each other and that’s exactly the wrong kind of thing.

(17:20)So the third issue that we try to solve is this issue of really getting people to work together in more effective and appropriate ways, so that we can actually get new ideas out on the table and try them and see what happens.

Michael:         

(17:32) We have a question from Twitter and Arsalon Khan and asks a really interesting one, and he knows that change requires people. And in the government there are many folks who are close to retirement or aim towards retirement, and how do you get that large group of people to change, and evolve, and adapt as you’re describing.

Bryan: 

(17:58)So the way that I look at it is actually fairly simple. Let’s say you were to graph the propensity of any individual to want to actually change the way they do something, you know sort of versus the number of people that are out there. What you’ll get is a standard bell curve, right where on the left-hand side of that curve you’re going to h this ave people who really have zero desire or incentive to do anything differently that they want to do.

(18:29) And on the far right hand side of that curve you’ll have the number of people who are jumping up and down and you know raising their hands and saying, where have you been I’ve been looking to do all of this stuff.

(18:39)What we tend to do isfocus on the people on the right hand side of that curve. I could spend the rest of my life focusing on the people on the left-hand side of the curve and nothing would ever change. The people on the right hand side of the curve on the other hand are embracing it, they are ready to go.

(18:53) So, what we found is that if we can work with those people and make those people successful, that success then propagates down that adoption curve and allows us to actually engage with people who you would never would have thought would have be engaged in the past.

(19:07)What’s also interesting now is that, well I suppose it’s true that demographically the right hand side of that curve probably skews more towards the younger you know, the people that haven’t really been around as long. There are plenty of people that occupy that space of the curve who have been around for 35 years, and are you know still anxious and eager to do things in different ways.

(19:34) So, sure there are percentages of people out there especially in government who have been around for a long time, and who are close to retirement and are not interested in changing. I actually think that there are plenty of people out there who are in that same scenario that really do want to do things in different ways. Mainly because you know, part of it if you think about it most people who are in government are here for the mission, and if you can provide them with an opportunity to really execute on that mission, and to move the ball forward in some massively tangible way they are going to be all for it, because that’s why they are there. You know, even if maybe that’s why they came in 30 years ago and sort of forgot about it, you can reignite those fires and it’s pretty powerful when you do.

Vala:   

(20:19) How do you do that? How do you you know if you want to see the change, but how do you ignite the fire in someone’s belly to say, I’m going to fight through the bureaucracy, I’m going to sit in the windowless cube as long as I know that I’m walking towards the mission that I still strongly believe in. How do you do that as a leader?

Bryan:

(20:41) So, what I’m trying to do is – first of all, it’s important to recognize that you know I’m not necessarily a subject matter expert in anything that we do at HHS, right. We have you know people that are – I mean you know the craziest cancer researchers that you can imagine, right. And people who like literally know everything about child welfare programs and I mean there are all kinds of crazy people.

(21:05) So, the first thing that I do is that I absolutely do not go in and tell people how to do things because like that’s the wrong approach. That will not get you very far. What we try to do is offer assistance to help them achieve the goals that they are trying to achieve, right. Because even the most jaded, cynical, long term government employee is not going to say I don’t want to do that, right. I don’t want to go and help all these people that I’m here trying to help, or implement this program that I’m trying to implement.

(21:36) And, if you can give them an opportunity to jump in and actually say you know what, like if I try something you know and they’ve got my back you know so I don’t need to worry about it if it goes wrong. You know, may be something good can come with this, and that’s one of the ways to do it.

(21:51) You know, one of the things that we’ve seen in a number of different occasions is where you will get some of these old folks that have been around for a while, and they will have younger people in their teams who are actually trying to push the envelope in interesting ways. And so we will work with those younger folks, and all of a sudden they will be delivering on things that these guys have been around for a while who never thought were possible. And all of a sudden you know they are like, wait a minute this is kind of cool. What else can we do?

(22:21) And that’s that’s where we see just massive adoption and interesting things happen. So again like you know, a lot of people complain about the bureaucracy. A lot of people complain about you know folks who are blockers or who are saying no. But we just sort of try to get them on the same team, right. And to the extent that we have to go around, we go around.

(22:39) You know, sometimes we do have to use the authority in the secretary’s office that actually gets things done, and we try to use that authority in a relatively limited fashion.

Michael:         

(22:51) Soessentially then you’ve been describing how you overcome forces of inertia that tend to militate against innovation or change. And it sounds like your approach really consist of two things. Number one, is having the and I’m going to call it management finesse to magnetize and attract people onto your set of goals. But not specifying how they work, but rather supporting their objectives and then number two, is to accomplish that through demonstrating quick wins

Bryan: 

(23:37)That’s exactly right. I’ll give you a great example. One of the initiatives that we’ve spun up in this thing, and we have created this incentive called the HHS Idea Lab, which is really a wrapper for all of the hopeful solutions to those three problems that I described earlier.

(23:56)One of the solutions that in this entity is in an initiative called the HHS Ignite Accelerator. So think of it as a Silicon Valley accelerator. It’s a three month program, and teams from across the Department apply to be in this. We’ve done three rounds of it with three cohorts so far. We’ve probably gotten in the order of 200 or so applications and we’ve accepted about 35 teams into the accelerator.

(24:28) When they get in there given three months of time, up to $5000 and a significant amount of training on things like centre design and design thinking, lean start-up, business model canvas, rapid iteration and prototyping techniques etc.

(24:46) And then, they spent those three months basically building out a prototype of whatever it is that their idea was coming in. The goal is to essentially build that prototype, to an extent where they have generated enough data to essentially validate a pitch that they will make at the end of that three months for additional time or resources, or whatever they need to scale that across the Department.

(25:16)And so it’s been fascinating to see the kind of things that come out of this. Some are technology related, some our business process related, some have been architectural. I mean it’s a fascinating kind of thing, and what we see is that not only of the quality of the projects that have been proposed and executed on continuously to increase throughout these three rounds. What’s really interesting is that people are taking the lessons that they have learned throughout this mentorship and bringing it back to their day jobs. So they are actually approaching their day jobs in completely different ways.

(25:52)A perfect example of this is if you look at a lean start-up right, one of the key elements of that is getting out of your office, right. Going to talk to your customers, trying to understand what your customers want and then rapidly building low res prototypes up through the higher resolution prototypes as you learn more.

(26:13)The word customers is very rarely used in government, right. So when you say to somebody, who is your customer they kind of look at you like what? But then once you explain it and once you put it in that context right, all of a sudden you know people light up and they go for it.

(26:29)So one of the things that we’ve been doing in the labs is trying to ignite the most recent round which is about to end and we are having a sort of shark tank day, kind of thing. At the end they do five-minute pitches and get some Q and A, and it’s fun and intensive at the same time.

(26:47)For this last cohort, we actually required a certain number of customer interviews before they really could progress to the next phase of their prototypes. And so it’s been fascinating to watch and how these prototypes have progressed and changed, based on the conversations that they had with these customers they never would have talked to before. They would have just been like delving in and building, so it’s been really fascinating to watch and that’s just one example.

Vala:   

(27:13) We had on our previous shows Keith Blanc and Alex Osterwalder, so it’s clearly great to have you talk about business model canvas innovation and lean principles and they were two fascinating guests. So is that a kind of a CEO of a founder of a startup and I had an appointment with a CTO of a 90,000 person of an organization, what advice do you have for me the founder CTO of a startup before I walk in the office and pitch to you, other than knowing the importance of what a customer is.

Bryan:

(27:53)So actually a big part of my job and we’ve talked a lot about of my internal part of my job. A big part of my external piece of my job is actually working with startups and entrepreneurs, but also great companies who are doing innovative things that have the potential to fundamentally reshape or disrupt Healthcare or Human services ecosystems.

(28:15) So I kind of  look at myself in my office as the entry point in HHS where if you’re doing something crazy that has like significant potential, but it’s difficult for you to get attention from anybody else, we’re the place to come, right. And it’s been fascinating, so actually I spent a lot of time talking to entrepreneurs and start-ups.

(20:35)So, actually this is a great question and I want to answer that in a couple of different ways. So first of all if you are going to write me an email, first of all don’t spell my name wrong. Secondly, don’t send me a generic template that talks about you know, how much money I’m going to save if I switch my Cisco rather – you know, figure out what it is that I’m interested in, and what it is that I care about you know in terms of moving the ball forward and make a very interesting recrafted pitch that I can’t ignore.

(29:13)Also, don’t make it too long. You know, I get thousands of emails a day and if you send me an email that’s you know more than a few paragraphs long then I’m probably not going to read it because I'm going to think it's a sales pitch. But try to capture my attention quickly, so that’s the first thing.

(29:30) I’ve been known to write back to people who have sent me really bad cold emails, and tell them what they could have corrected just because it drives me crazy. Anyway, so that’s the first thing.

(29:41) When you get here and we’re sitting down to talk, get to the point quickly because you know the chances are we only have half an hour, and if we spend too much time messing around we’re not going to get to the main point.

(29:52) But then secondly, tell me about not the features and functionality of what you do, tell me about the impact. Tell me about immediately of the bat what’s going to change if we do not either work with you if it’s something that HHS would end up buying, or if it’s something that we can help the market adopt like why is the market going to adopted over the other things that are out there. What’s the unique selling point, what’s the you know the thing, what’s the outcome and what are the goals. And too many people I think miss that and they start talking about features and functionality.

(30:24) I care less about features and functionality and more about what change you are engendering within the ecosystems that we deal with on a regular basis.

Michael:         

(30:34) So you have just described start-ups to enterprise marketing in a nutshell. So you say that you spend time with start-ups, but clearly you are inundated and you must have additional filters just because if someone send you an interesting pitch and expelled your name correctly, and the pitch is short and they are describing the outcome rather than the features and functions, and they get right to the point. Still, you have to have additional filtering mechanisms because otherwise you would be completely inundated. So can you describe a little bit more, what are the filtering mechanisms that will get somebody through the door?

Bryan: 

(31:20)So first of all if I give you all of my secrets then I’m going to get inundated.

Michael:         

(31:26) I want you to be inundated with CXO-Talk just a few notes, so we’re going to cover our ears.

Bryan: 

(31:36) I’m kidding, so one of the most important things that I think people miss this relatively frequently is that it’s really important to try to figure out what the hot button issues are in any one point in time. And one of the ways to think about that, from the perspective of HHS, is to look at the strategic plan that is published on the web.

(31:59)You know, what are the different entities of HHS trying to accomplish and how can you help them accomplish those goals faster. Right so, one of the things that we are really pushing on is that the secretary made a speech about a month and a half ago, is this idea of reforming the health care delivery system.

(32:18)This is a massive topic, right and there are lots of different things that go into it. But one of the critical components that goes into that is this idea of data and information being shared between networks, and between systems of doctors and hospitals and these other things in a way that actually works that makes sense. And that’s something that we spend a lot of time thinking about.

(32:40) So if you can actually pitch whatever it is that you’re doing in those terms, right, what do I care about, what do I spent my day’s thinking about, and how is your thing going to help me take the stuff that I worry about and that I want to fix, and accelerate that even further, that’s what I want to know about.

(32:58)So here is an example, an interesting story. So in the United States of America, we do not have a unique national patient identifier. The story behind this is somewhat interesting, when there is this law called HIPAA, which is essentially designed to protect the privacy of your personal health information. When that law was passed, it was actually pass with a mandate for HHS to develop a national patient identifier. However, quickly after that law was passed in our funding bill Ron Paul, inserted a line that said, no dollars are appropriate into HHS shall ever be used to develop a national patient identifier.

(33:52)So, the law says we have to do it, but then the appropriations Bill that tells us how we spend our money, basically says that we can’t do it. Now this is actually a huge problem.

(34:03)If you think about any massive system, not being able to uniquely identify the participants in that system, you can understand where a lot of the challenges come in. And because we are prohibited by law from actually working on the problem and developing one of these you know national patient identifiers systems, one of the things that we’ve been thinking about is how can we help the ecosystem figure out how to match patients, much data in these dispersed systems in better ways.

(34:32) And so we actually have a guy right now in another one of our initiatives – and we have this innovator in residents program, where we partner with a non-profit to bring in somebody for two years to work on a problem. We actually have someone right now named Adam Cobergson, who is actually going to be presenting on his work to date, it’s a HIMSS partnership actually, where we are working on this idea of trying to help the ecosystem figure out how to better match patient data.

(35:01)So a super fascinating project, right. I mention that because if your organisation or your company has an algorithm that you’ve developed that actually match data, which by the way in this world happens all the time, we would love to know about that, right. And the next thing I’m going to do is put you in touch with Adam, because he needs to know about it, right.

(35:20)So that’s just like one simple example. But we talk about that on the website and you know all of this stuff that we are doing is very public, so if you do a tiny bit of research you can actually figure out what we care about and you know and make your pitch in that way. So, that would be the main filter that I suggest that I use that I suggest that other people pay attention to. You are always going to get an executive’s attention if you make a pitch on something that they care about.

Vala:   

(35:47) Now HIMSS is one of the largest technology conference and in Chicago it starts on Monday next week, and I believe that you’re presenting HIMSS at 1 o’clock local time, and is it okay to talk about the topic in what you’re going to talk about at HIMSS, if not we can go onto another question.

Bryan: 

(36:10) No, I can talk about that I don’t want to give too much away because then nobody will come and it will be that much fun. But basically it’s going to be a little bit of a retrospective of the last few years at HHS. It’s been a very interesting time as you might imagine, and one of the things that I want to be really able to do is give people who are outside of government that either need to interact with government, or should interact with government in a more frequent basis, a better understanding of how it actually works.

(36:43) I think most people think of government as this sort of big monolithic entity that like does things to people you know. And in reality it’s a big completely heterogeneous system made up of humans that do things, right. Humans who have their own interests, their own desire, they are owned biases, they’re all incentives and everything else.

(37:05) And it’s a much more complex system than I think most people really – I think they intellectually understand it, but I don’t think they necessarily internalize that understanding. And so I’m going to try and maybe give that perspective if I can.

Michael:         

(37:24) You know we only have a short time left, but we have not spoken too much about data and analytics and we kind of alluded to it, but maybe weave into this overall story and the importance of data. Talk about open government, which I know is a topic that is dear to your heart, and then let’s spend a little bit of time around that.

Bryan: 

(37:49)Sure, so let’s start with data. First of all we believe that data is literally the most critical element to reshaping the healthcare and human services ecosystems out there. We can’t do a lot of the work that we need to do if we don’t have the data to support it. So let’s take healthcare as a simple example or I should say a complex example.

(38:16)Basically, the healthcare in this country today is primarily fee for service. It’s a transactional. You get sick and you walk into your doctor’s office. They do a bunch of stuff to you. That stuff gets built to you on a line item basis. You pay some of it and your insurance company may pay some of it, and that’s the end of it.

(30:32)The problem is that essentially incentivizes the entire ecosystem to do more things to you, right rather than keeping you healthy and out of the hospital and out of the doctor’s office. So a lot of the work that we are doing in various parts of HHS is to try to change in how we pay for healthcare, instead of paying transactional, we really want to pay with what we call, pay for value. We want to pay to keep people healthy and keep them out of the hospitals as opposed to treating them there in the hospital.

(39:02) In order to do that the right way, we need data, we need information, and if we don’t have that data and we don’t have that information then there is no chance that we have that to reshape that ecosystem at all.

(39:14)And so about five years ago we kicked off this thing called the Health Data Initiative. What we realised basically was that we have all of this data at the Department that you never really exploited. You know, we kind of kept it locked up in silos and we might have published it in literally in a physical book and shipped it off somewhere, but we never really thought about what the uses of that data might be, and how that data might be leverage by other people in the ecosystem.

(39:45)So about five years ago we tested the theory by gathering about this 30 datasets that we thought might be interesting, and giving them to 45 people who you know had some skills with data and said what can you do with these things and come back in 30 days. 30 days later they came back with 24 applications in things that they had written based on this data that had never been used. Not all of them were great, some of them you know were whatever.

(40:11) But what it proves to us was that there was value here, and so for the last five years we’ve really built this thing out called the Health Data Initiative, which is focused on looking at all the different categories of data that we have at HHS. Statistical data, administrative data clinical data (to a certain extent), and trying to figure out how to responsibly get that data out into the ecosystem so that people can take advantage of it and build into tools and applications and things that have some potential to actually change the way things work.

(40:45) I should actually plug here that basically one of the outcomes of this is a big conference that we do every year at DC. It’s called the Health Datapalooza. This will be the sixth iteration of it. The first iteration was really those 45 people in a room back on day one. But this iteration is now has gone from those 45 people to about 2500 people showing up at Washington DC, and everybody from you know economists, academics, entrepreneurs, developers, to data scientists, to VC’s to government people, they are all there and interested in this topic.

(41:21) So you know, one of the coolest things I’ve seen over the last few years are all of these companies, from start-ups to big companies that are using this data that we’ve put out out there to actually do things in different ways. Giving you an example of how all this stuff happens.

(41:38) It’s just been incredibly fascinating to see, and we are still literally scratching the tip of the iceberg I should say, and there’s a long way to go. One of the new projects that we’ve been working on is something that we are calling demand driven open data. The idea is that you know we have these thousands of datasets, many of which are not in machinery form and many which are not API enabled.

(42:05)The question is how do we know which ones we should be putting our priorities and efforts into making machineryable and making API enabled. And so we were asking the ecosystem out there to help us prioritize in where we put our efforts in a workflow and a process, by which we are going to communicate our progress along that front.

(42:25) If you go to and I think the URL is a mouthful it’s demand-driven-open-data.github.io, but if you go there, it’s all in Github and you’ll find everything that you need to find. I think we’ve blogged about it on our website, so if you go to www.hhs.gov/idealab and the blog there you’ll see it. But I encourage everybody who is listening to kind of go and check that out, and if there is a dataset that you particularly are big fan of, or one that you think we need to work on let us know there.

Vala:   

(42:55) Giving the fact that we only have a few minutes and your experience in government Bryan, what advice would you give to people inside of government who are trying to drive positive change. What would be your one or two or three words of wisdom to give them?

Bryan: 

(43:11) So one of my favorite words that somebody said to me the other day and used in my presence the other day was the word courage, right. Or to have courage. We need people that are not afraid to try new things and don’t worry too much about what the negative consequences of an action might be, versus what the positive outcomes of something. So that’s one thing.

(43:40) The second thing is I would say leverage, leveraged the word ‘why’ quite a bit. So it turns out that quite often you try to do something and somebody will tell you no. And what usually happens is that whoever asked that question takes that no as the final answer and walks away. When in fact it turns out that that was actually not the right response and if you just ask ‘why’ a couple of times, then what you will quickly come to the conclusion of is that you know the law that that person was supposedly quoting actually doesn’t say a thing that they thought they said. It just happens to be the way that we have done it forever.

(44:22) Right, so raise the question why, it’s hugely valuable and maybe the best tool that you possibly have in government.

(44:34) And then, I think the third thing I would say is recognise or assume that there is a solution to every problem. There is no such thing as an it intractable problem especially in government. Just keep pushing and keep trying to find the people that you need to find to help you make your idea and your vision a reality because you can do that, you really can.

Michael:         

(44:54) Okay you know we are almost done, but now we come to what is everybody’s favorite part of CXO-Talk, and that’s the gadget lightning round. Actually, we have never spoken about gadgets.

Vala:   

(45:07) I’ve never heard that before.

Michael:         

(45:08) We’ve never had a gadget lightning round.

Vala:   

(45:11) Thanks for inventing a whole new ending.

Michael:         

(45:14) Okay, Apple watch.

Bryan: 

(45:20) Okay, what I supposed to be saying, whether I am going to get one or not.

Michael:         

(45:22) Yeah, are you going to buy an Apple watch

Bryan: 

(45:26) I don’t know, this is a much longer answer than yes or no. So I’m a total gadget nerd right and like that’s just my thing. I’m also like an Apple guy, so my entire ecosystem is Apple, and I’m a quantified (self?) Guy, right so I like all the data and all that other stuff. So when I tell you those things you would think he’s totally going to buy an Apple watch.

Michael:         

(45:51) Oh yeah, you’re going to buy the $10,000 Apple watch.

Bryan: 

(45:54) I am totally not going to buy the $10,000 Apple watch, that is off the table. No, first of all my wife would slaughter me if I did so. Secondly, I just feel weird wearing something like that on my wrist. I mean I’m not a watch guy and that’s the problem.

Michael:         

(46:07) Okay, so you’re the Apple sport watch guy.

Bryan: 

(46:09) I mean I don’t know. I’m not a watch guy so who knows what I am. But anyway the thing that I hesitate is that with a phone I was okay buying the first-generation stuff because I use the phone all the time right and I want to play with a new toy and things like that. With a watch, everything that the watch can do I have kind of in other gadgets or other functions and I have not necessarily been upset about them not being integrated, right. So the short answer is that I don’t know. The slightly longer answer is that my birthday is coming up and if members of my family they’ll probably end up ever suggesting that maybe they will get me one, so.

Vala:   

(46:56) Bryan, family member, he’s asking for a watch.

Bryan: 

(47:02) Well that’s the thing like I just don’t know.

Michael:         

(47:04) As a lawyer friend of mine once said the most interesting phrase is, the fore going notwithstanding.

Vala:   

(47:18) I know that my father watches the show all the time, so dad if you’re watching I wouldn’t mind a watch.

Michael:         

(47:24) And I’m totally on the fence, but you know I have an iPhone, an iPhone six. And the other day I bought an iPhone 6+, the big one and then I realised that I tend to drop things and it was almost $1000 and so I got this big thick case.

Vala:   

(47:48) So you carry a laptop now.

Michael:         

(47:49) Right, so the question is, and this is the second question in our lightning round. Do I keep the six big thick phone, or do I go back to the nice compact iPhone six?

Bryan:

(48:05)So personally I feel that the 6+ is just too big. Like it’s just a massive piece of hardware is not and it doesn’t do it for me right. I have a six and I like the six a lot. I also thought it was a little too big at first and I got used to it and I like it now. But see, I think that is a good size for a phone. I think the 6+ is just way too big.

Vala:   

(48:30) Here’s a rule of thumb, if you’re talking and someone can’t see your head, you’ve gone over the edge.

Bryan: 

(48:39) I would agree on that. Unless you like six eight and you’re sitting down so I can’t really tell, but if you like six eight, maybe.

Vala:   

(48:48) If you’re a starter for the cell six or an NBA team I suppose the plus would work.

Michael:         

(48:55) Okay I like Vala’s rule, if you can’t see your head when you’re on the phone, the phone is too big. And with that, Vala and Bryan I think our time has come to a close.

Vala:   

(49:11) That was a fast 50 minutes. Thank you Bryan a tremendous insight and look forward to seeing you at HIMMS, I’ll be at your talk and tweeting away your controversial speech.

Bryan: 

(49:24)Well come and say hi afterwards I would love to meet you in person. Alright guys, well thanks for the time that was a lot of fun.

 Michael:        

(49:30) Thank you. You have been watching Bryan Sivak, who is the Chief Technology Officer for the Department of Health and Human Services, which employs 90,000 full-time people. I am Michael Krigsman and my glorious fabulous co-host Vala Afshar and I hope you’ll come back next time. Bryan, thank you for joining us Vala, may the force be with you and we’ll see you next week.

 

Companies mentioned in the show:

Department of Health and Human Services        www.hhs.gov

Healthdatapalooza                                                   www.healthdatapalooza.org

Demand driven data                                                demand-driven-open-data.github.io/

Apple                                                                           www.apple.com