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Innovation Everywhere – A Chat about Cloud, Devops and Cyber Security with John D Halamka, MD, MS


So, here I am, Kim the intern, introducing John D. Halamka, MD, MS, Chief Information Officer of the Beth Israel Deaconess Medical Center, Chief Information Officer and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician. Oh, but wait. There’s more. He’s also Harvard’s Chair, Endowed Chair, as he might add, of Healthcare Innovation. Wondering what that means? So was I, and let me tell you, it’s certainly much more impressive than my groundbreaking title of “intern”. Keep reading and Halamka himself will further explain. In the very first of our interview series, we will also delve into a discussion surrounding some spectacular innovations, the cloud, cyber security, application development, and more. Enjoy!

K: What is something cool or unique that you’re working on as a CIO of Beth Israel Deaconess?

J: Beth Israel Deaconess is a very unusual organization in that it is the last hospital in the United States to self-build its own clinical applications. We don’t really depend upon a vendor, which means we have very agile development that is run by a DevOps crew, bringing the needs of the doctors, and nurses, and pharmacists to innovations with really rapid turnaround. So, for example, somebody had the idea, “Well, it’s pretty hard to schedule an appointment with your doctor, how about an Alexa app so that you could just be in your bunny slippers and say, “Alexa! Make an appointment with my doctor”?, and it happens. So, we have built a variety of Alexa interfaces for Beth Israel Deaconess. We are starting on the inpatient side, now on the outpatient side. We do a lot of mobile, we do a lot of cloud, we do a lot of machine learning. We’ve created something called the Center for IT Exploration, which focuses on these technologies that aren’t quite mainstream, but are likely to be revolutionary. So, the fun that I get to have beyond overseeing 22,000 employees, 7 petabytes of data, and 2 million patients, is the innovation that’s possible in healthcare with technology, often coming from outside healthcare.


K: What would you say is the most innovative thing that you have done, or what was your favorite project that you’ve ever worked on?

J: Wow, that’s just too hard a question. So, what happens, and I’ve written about this in my blog, is sometimes you get the perfect storm for innovation. That means there’s political will, there’s budget, and there’s a sense of urgency. Look at my thirty-year history in the field, there are certain things like when Harvard Medical School’s Dean said we want a digital curriculum and here’s a million dollars, and then we move the entire curriculum for Harvard Medical School from paper to digital and mobile in 2001! So, wow, okay that was pretty edgy for 2001. Or in 1997 when Beth Israel and Deaconess merged, and there was a sense that we should have records from both hospitals immediately available, we said, “I know! Let’s use the web!” In 1997! So, these are some fond memories, but literally not a day goes by when there isn’t some interesting breakthrough. The one that we’re working on right now is an app called Beth Israel Deaconess at Home. What that does is it takes the data from your bathroom scale, your blood pressure cuff, your sleep apnea monitor, any device in your home with your permission to share, and sends it to your doctor. It doesn’t just show data though, it shows insight. For instance, you forgot to take your medicine last night and look, your blood pressure went up today. You ate too many salty snacks over the weekend and look, your congestive heart failure is having a problem because of water weight gain. So, it’s the Internet of Things, subjective data, care planning, all communicated between doctor and patient with mobile applications. We finished that up and it’s rolled out in pilot, and that, I think, has the potential to change healthcare as we experience it.


K: That’s incredible. That could definitely help a lot of people at home stay on top of being healthy.

J: So, I’m guessing you’re younger than me, I’m 55. When you get to 55, you get to manage those above you and manage those below you. So, my mother is 80 and my daughter is 25. So, imagine if you’re put in the position of having to manage the healthcare of everyone in your family. Do you have the tools you need to do it? Building these mobile apps that are cloud hosted and Internet of Things connected, that really helps.


K: If I could circle back to application development, as you mentioned Beth Israel Deaconess is the only hospital that still does all of their own, why is that? Why don’t you outsource application development?

J: Well, we have. What we have done is we will buy services, cloud hosted services, Amazon, Google, of course I’ve looked up the company you’re interning at, you know all those sorts of things, but the core applications we develop because most healthcare IT applications are horrible! They are state of the art for 1995. Right? And so, you are probably not old enough to have programmed in visual basic, because it went out in 1998, but a whole lot of the most popular applications in healthcare are written in visual basic. Everything we do is HTML 5, and hosted on Amazon, and works on your iPhone, so that’s why. We’ll buy what we can, but we will build what we must.


K: When you’re doing this for thirty years, how do you manage to keep up with new technology news and trends and not sort of fall behind or get stuck in older technology?

J: So, I am Harvard’s Chair, Endowed Chair, of Healthcare Innovation. Doesn’t that sound impressive? It’s title in lieu of pay. So, I am supposed to invent the future as opposed to learn about it once it’s already there. I tell you this, of course, smiling. The expectation is, “Why does John have to copy somebody else? He’s inventing the future!”


K: What are some things that you’ve invented that you’re particularly proud of or something you’re working on right now?

J: Have you ever sent an electronic greeting card? I invented that. I have a patent to all electronic greeting cards, e-cards, and things of that nature worldwide. So, Steve Wozniak’s mom in 1983, said that Jobs and Wozniak were going to have a birthday party for Woz’s 33rd birthday and she wanted something special. So, I invented the electronic greeting card in 1983 and I patented it in 1984. And I got paid exactly what you pay for your electronic greeting card, nothing! But, I’m happy. When I say invent the future, I’m talking about embrace mobile and cloud, analytics says we’re talking about such things as Amazon machine learning services or what are those novel things we could do with Alexa and ambient listening? I am constantly looking outside of healthcare for technologies that have promise to then apply them in healthcare. I obviously don’t invent the future, but William Gibson said, “the future is already here, it’s just unevenly distributed,” and my job is to take the future as we’re already getting it, Facebook, Google, Amazon, and the like, and move it to healthcare.


K: Sounds like a challenging job, but lots of fun.

J: Well, here I am responsible for the security and privacy of millions of patients and all the day to day care and feeding of thousands of people as well and I am still smiling.


K: What is the biggest risk for data security that you’re hoping to combat?

J: Oh, it’s so different than it used to be. In 1997-98, it was MIT or Brandeis students who decided they would try to get into Harvard networks. Today, it’s organized crime, state sponsored organized terrorism, and hacktivism. It’s anonymous. It’s people from China and from the Soviet Union or Russia, so the nature of my attacks requires that I am constantly vigilant and constantly innovative. Knowing again what your company does, the idea of moving away from locally hosted enterprise licensed software to services in the cloud that are procured is one way to mitigate risk.


K: What are some other ideas you may have about why the cloud is a good idea for other organizations?

J: Sure, so I write extensively about this topic. How many servers do I have? Oh, about 600 and that sort of represents about 2000 virtual machines, but 600 physical servers. In three years, how many do I expect to have? None. I really don’t want to be in the business of buying hardware every five years, managing Microsoft licenses and dealing with heating, and cooling, and power, and all that other stuff. I would much rather buy a result that is software as a service, or outcome as a service, or platform as a service, where someone else is worried about all that stuff. My budgets go down every year, not up. My expectations of performance go up every year, the tolerance for downtime goes down every year, the need for innovation goes up every year. So, imagine constant innovation, complete reliability, and total security simultaneously. That’s pretty much impossible. The way to think about it is what I’m being asked to do every year is change the wings on a 747 while it’s flying. Constant change!

Wow.  John provided some great insights into the future of IT and his perspectives into the evolution of technology are eye opening and apply to companies of all sizes and in all industries.  Heck, since my day job is a student, it has got me wondering about how my university is evolving!  I want to close with a big thank you to John Halamka for the wonderful insights and encourage you to share this interview.

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