Healthcare is moving to the cloud and in this episode of 4x4 Health we talk with Travis Good, MD, Chief Technology Officer of Datica; following their recent merger with Sansoro Health. Travis and the Datica team have deep expertise and experience in helping healthcare organizations deploy in cloud environments, integrate securely with EHRs, achieve HIPAA compliance, and pass HITRUST CSF assessments. Previous 4x4 Health guests have noted how important the cloud is becoming for data-driven healthcare and Dr. Good takes us through the compelling reasons for this shift as well as the associated integration and compliance challenges. You won’t want to miss this discussion about how cloud-based health IT is enabling the next wave of innovative technology to improve outcomes for patients, providers, and payers.
Dr. Dave Levin: Welcome to 4 x 4 Health sponsored by Datica. Datica, bringing healthcare to the cloud. Check them out at www.Datica.com. I’m your host doctor Dave Levin. Today Travis Good chief technology officer for Datica is here to talk about cloud computing for health care and the compelling reasons behind the recent merger of Sansoro health and Datica health. Travis is a co-founder Datica and prior to the merger served as chief executive officer. Since 2013 Datica has helped health care technology companies moved to the cloud. With a combination of technology and advisory services. Customers leverage Datica solutions to deploy in a cloud environment and integrate securely with hospitals and electronic health records while also achieving HIPAA compliance. The Datica team draws on a deep understanding of the exact policies and procedures required to turn HIPAA eligible services on the public cloud into architectures that can actually pass a high trust CSF assessment. Don’t worry we’ll get a lot deeper into what all that means during the podcast today. Sansoro health and Datica recently announced they’re merging to offer the most complete single platform available to mitigate the complexity and risk of using patient data in the cloud. The combined platform solves integration and compliance challenges created by health care regulations. While simplifying and speeding development processes. This accelerates innovation by letting developers focus their efforts on delivering great products rather than the details of cloud deployment compliance. Travis has devoted much of his professional career to these kinds of challenges. After securing his MBA and MS and prior to founding Datica. He analyzed security systems with pricewaterhousecoopers and Booz Allen Hamilton. As if having an MBA and a master’s is not enough, Travis add a Doctor of Medicine to his pedigree in 2011. He’s played a key role in the evolution of security and compliance and is a founding member of the high trust alliance business associates council. He’s also a thought leader with over 40 or 50 publications and recently released his first book, “complete cloud compliance.” given his diverse background in business and technology Travis is in an excellent position to help us explore the challenges and the potential of healthcare in the cloud. Welcome to 4 x 4 health Travis.
Dr. Good: Thanks for having me. So good to be here.
Dr. Dave Levin: So before we get into the meet of this today take a minute and tell us a little bit about yourself and some of the history of Datica.
Dr. Good: I definitely can. Though you may have done a better job than me with my intro. So you know as you highlighted my background is pretty varied, but I think uniquely varied kind of arrived at where I am today which is focused exclusively on healthcare and healthcare on the cloud. I spent about four years out of college focus on cybersecurity and that was really in the pre cloud days. That was like early 2000s and I actually did some very early, some of the initial HIPAA technology assessments for groups like HCA, some of the blue bands and others. So really started my professional career in specifically healthcare compliance and security again sort of pre cloud. Ultimately went back to school and thought I wanted to be a physician, practicing physician. And as you said went through, got my md, a combined MBA and while I was doing my MBA year I started interning actually for catholic health initiatives and then I did some work with Denver health as well and really started to get exposed to the technology side of healthcare. This was really early days of meaningful use. Things go sort of stage one where EHR adoption was slow not close to where it is today. But you know the writing was on the wall in terms of digitization of medical records and really the push of technology into clinical care. Ultimately at the end of medical school decided not to pursue a clinical career but focus exclusively on the intersection of technology and healthcare. And by that time we were a little bit later stage in meaningful use and certainly much further along in terms of adoption of electronic health records and really the push towards telemedicine and some new solutions that were coming into the market and ultimately decided to focus on really the intersection of those two things, technology and care delivery. And what I saw on the market at the time I was the editor for HISTALK [04:59 inaudible] or mobile, it had a couple different names and really spent a lot of time looking at the new technologies that were coming into the market around the EHR. So you know the last 20 years, 15 years have been about sort of installing one solution be it Cerner, be it epic, meditech, some EHR solutions it sort of does everything from a technology perspective for care delivery organizations. The site that I was editing was really focused on solutions that were starting to be bolted on around EHRs. So we were moving away from this best agreed model to more of unbundling if you will and you know ultimately what I saw was there were just more and more of these new solutions coming. More and more of these new solutions that needed to be on the cloud and we’ll get to that I think a little bit later and more and more of these solutions that need to integrate into the clinical workflow and into the clinical data which at that time and still today are going to be provided within the electronic health record. And so looked at the challenges that were unique to health care but faced by really anybody that was trying to build new technology in healthcare and ultimately arrived at you know how do we break down the barriers to enable healthcare technology and healthcare organizations to succeed on the cloud. And that’s really been that recognition since 2013 which I guess at this point has been about six years. And you know we can speak to kind of working with a lot of different organizations across all sectors in healthcare and really kind of an exciting time. Six years ago was probably too early. Today it’s a really exciting time and really excited to be talking about it with you.
Dr. Dave Levin: That was a really great summary, an introductory overview. I have to say I’m really curious there’s a million things in health care, in health care it to just to focus on. You clearly a bit drawn to this realm of privacy and security. What is it about that you were so compelling to you personally?
Dr. Good: That really is a fantastic question because there are a lot of different levers you can pull. The fundamental bet with Datica and this is fundamental that for myself since you know where I spent the last almost seven years of my life now is that really new technologies and access, ready access to data, existing and new data and healthcare is really going to fundamentally change the healthcare system and the experience of healthcare for patients for providers really for everybody. The ability to leverage that data, the ability to integrate that data and the ability to gain insights and informed decisions from that data really has to be run in the cloud. It’s not going to be an on-premise solution. It’s not going to be something that its departments and health organizations or even most payer or life sciences organizations are going to be able to do themselves. And so it’s kind of this first fundamental you know bet right on the cloud and healthcare and sort of a driving factor for this transformation. And then if you look at it and you look closely at it you come to realize that really what’s blocking the cloud in healthcare more than anything else today is really understanding the risk and being able to apply appropriate risk and responsibility models so that people aren’t exposed to breaches and reputational problems from having their data exposed, because they’re combining and trying to use it in a way to improve care.
Dr. Dave Levin: Part of what I find so interesting about that answer is if you substitute Dave Levin for Travis Good and you substitute interoperability and APIs for the cloud and security, I felt almost exactly the same way in 2014. So it’s again that you know they are sort of these really fundamental building blocks of the next generation of health vitality. So you’ve talked about this need to move to the cloud and we certainly hear that a lot. But I really want to drill into this and get to the compelling case and frankly I want to get beyond some of the buzzwords and jargon big data, ai, blah blah blah. I really want to get to you know sort of deeper to why there’s such a compelling case. If I’m a CIO and I got a lot of other things on my plate. I’ve got some, tried and true ways of doing things, I’ve done it on [09:21 inaudible] that seems to have worked pretty well. So take us deeper into this question. What is this compelling case, why do we have to move to the cloud and why is it such an imperative right now?
Dr. Good: Yeah, I get this question a lot.
Dr. Dave Levin: I imagine you do.
Dr. Good: and I think that leaning ai and big data, I mean there’s a kind of promise with you know healthcare data and a bunch of other sources of data being combined and you know use in ways for things like drug discovery and genomics and even population health and interventional medicine all these different terms. So there is that, but yeah, you’re right. People talk about ai and big data in the cloud and it’s kind of become buzz worthy. And so I think if you kind of you know even step back to the more macro level and something I touched on in the introduction is the history of health it of the last 20 years has been pushing the EHR, the electronic health record as the hub of two things. I think this is really important. It’s the hub of clinical data. So that’s where the bulk of clinical data within you know care delivery organization resides. And it is the hub of clinical workflow. So it’s the place where physicians spend actually more time than they do actually caring for patients. And that’s great and that’s been pushed by a mix of carrots and sticks in meaningful use. But what we are now starting to see is that we’ve arrived at sort of a post EHR world where adoption is 98 percent plus whatever the number you want to use. It’s basically everywhere. And so we’d like to talk about it as being in this post EHR world. And now that we’ve arrived here, we’re now looking at okay what do we do now to actually improve the experience of health care? So I don’t think it’s cheesy to think we’re shooting for triple or quadruple and how do we want to view it. So we really do want improve outcomes. We do want to lower costs and ultimately, I think we want to improve the experience for patients and providers. Because I think both sides of the actual healthcare transaction, providers and patients aren’t really enjoying health care that much these days. And so you know I think ultimately we’re at a point where we’re doing that and in order to do that I think what we need to do now is really reimagine the care experience and in reimagining the care experience at a macro level you’re really unbundling and some of this information we can touch on. Clayton Christensen, when he talked about innovation in health care really, we’re starting to look at unbundling a lot of the behemoth institutions and processes that is within health care and move outside of the four walls and move outside of the interaction between patients and providers. Provide patients with access to data so that they can make more informed decision, provides patients with access to care where they are, where they need to be. Whether it’s on the phone or at their home or wherever it might be. And I think as we start to sort of unbundle and package these massive slow-moving organizations, what we’re going to need to do that is technology. So we’re essentially unbundling and unpacking our largest industries in the world and we’re doing it with technology. And so all of those technologies and there’s going to be tons of them. Are going to need a place to reside, are going to need to scale, are going to need to integrate both with on premise systems as well as with other cloud applications. And so ultimately the cloud is the enabler of that future and you can see it very clearly if you look at other industries. If you look at even more traditional industries like finance and education, you’re starting to see the cloud take hold and you’re starting to see really just fundamental shifts in how people bank right and the types of products that banks are allowed to offer and the types of financial institutions that even exist. Same with educating systems. And I think ultimately we’re starting to see that with health care and it’s driven by its unpacking and these heinous systems and the unpacking is tied to really the unbundling of the technology and that unbundling it’s going to be a lot of different types of technologies, types of solutions, types of data and really the only way to build and deploy those new technologies today is on the cloud. No one’s going to be doing that on prem. And I think that health systems that are doing it or trying to do it on prem are going to have a hard time competing with those that are moving more quickly by applying the advantages of the cloud. And ultimately I think by applying the advantage of the cloud, CIOs and executive technology leaders at healthcare organizations are going to move from being largely cost centers today into really strategic member of the board room where they’re helping to inform the rest of the executive team on how technology can actually improve care and ultimately achieve the triple or quadruple landmark like I said. So I think that’s really the promise of the cloud in healthcare.
Dr. Dave Levin: Yeah, boy there was a lot in there and I particularly want to pick up on that last point. But as you said if we look outside of healthcare and that’s often a good guide to where health care is going, this is the way it’s done and pretty much every other industry. And there’s real compelling reasons for that. I think many of our colleagues who are in the digital health space that are developing these applications they get it. I think it’s becoming clear to focus on the provider side as well. And to me there’s this other very interesting opportunity around this which is around focus and discipline. And if my organization has important priorities to achieve and this is sort of necessary infrastructure, I need cloud services they’ve got to be secured, I need to be able to integrate data. Those are sort of if you will necessary evils in achieving whatever the thing is that I really set out to do in the first place. If I can have trusted partners, if I can have more turnkey kinds of solutions for that, that lets me really focus my firepower, my capital, my thought leadership, my people on the real challenges in front of me creating these new business strategies and enabling them from a developer to round focusing on delivering a really great product. And so to me this is the other huge advantage in this approach. I was reflecting on this interview and I got to think out about an experience I had had about five years ago Travis. I was visiting with a very well-known very prominent health system and they took me on a tour on this beautiful new data center that they had just built and open. And I remember having this kind of mixed emotional reaction, almost the sort of paradoxical sense that yeah this was a really cool facility and it was clear they’d put enormous effort into the design and an enormous amount of capital into it. And I also remember thinking simultaneously this is probably one of the last of these that will be built. Health systems are not in the business in building and maintaining data centers. That’s not a core. And if they can find another way to meet those needs they should. So I’m just curious what you think about this issue of you know sort of focus and also my a little anecdote about my experience.
Dr. Good: Yes. So I think I laugh because I’ve had similar experience with the health care organization and this was, I think it was probably early two thousand, maybe two thousand five ish. Where they had built, and they intentionally built their own brand new super sophisticated data center with the goal of actually using it and leasing it out to other health care systems. This was eight years you know after it had been open, and I think 10 percent of it was occupied. And the reality was, it was just bad timing. Because they were using the cloud, but they just weren’t using somebody’s private data center cloud. And so I hate to think about the investment that went into that. But maybe Microsoft or google or amazon will buy it. But I mean it’s just, you can’t do what they do. Our system is full of similar antidotes to that and to the one you mentioned. And I do think to your point about focus. And the cloud really has fundamentally changed the barriers to getting into or building a business that almost every business today is built either as a product and as a software business or with software as a core part of that business. And really the cloud is broken down the barriers to doing that. You don’t have to employ people who know how to stand up and configure windows or Linux systems. You don’t have to as you said build a data center right. And so it enables you to focus on really your core value and that could be you know you’re a developer building a new product or telemedicine or maybe something related to ai and analytics or your health system that’s looking to really focus on delivering better care and better outcomes and reducing costs and all those pieces and enables you to focus on that and not employ people to run data centers and not have to figure out how to scale or update to the newest versions of windows or Linux or whatever it might be. The cloud really enables you to focus on what you do best. I think what’s interesting about that is that ability to focus and the value that you get from using cloud technologies is also one of the things that presents you know sort of a key challenge for security and compliance because really health systems and just large enterprises in general sometimes aren’t as comfortable giving up some of their responsibility for what they consider to be you know sort of core infrastructure. And so you know there is sort of the unique model of shared responsibility on the cloud which is something that we talked to health system executives often, where they’re kind of struggling to kind of figure out what that actually means when you practically apply it to who’s accountable and who’s responsible for what. So that same sort of value of focus is also what puts up one of those kind of initial roadblocks to doing anything on the cloud. It’s okay if somebody else is taking these pieces on, are they actually taking on the accountability for that. How am I ensuring that these systems that somebody else is setting up and managing or securing compliance. Those are actually kind of flip side of the focus point and those are some of the challenges that we adopted to try to solve and I think really the market has to kind of solve if we’re going to succeed in using the cloud in healthcare.
Dr. Dave Levin: Well you went right where I hoped you would go. And to reiterate the point, people and healthcare were well intended and built these data centers. They probably didn’t realize at the time they were going to end up competing head to head with the likes of amazon and google and Microsoft. But they are and they are. So we have this public cloud. I don’t know if I’d go so far as to say it’s a commodity yet, but it’s certainly headed in that direction. But then as you point out we’re talking about the cloud for health care and health care is different. And so it’s great that we’ve got a choice when it comes to public cloud and they’re competing on price and service and those are all really great things. But it’s not like you can just drop your healthcare application onto amazon web services and go to town and you know as I’ve learned from talking with you and others you know when we moved to the cloud you know privacy and security are always concerns. They’re really big concerns here. There is technical issues, there sort of cultural historic issues as you’ve alluded to. You know you’ve taught me a framework that I’ve found really helpful. You talk about this in terms of privacy, security and controls as kind of related concepts. So take a moment and sort of take us through that you know specifically as they apply to cloud environments. And again let me be really concrete, I’m interested in putting some stuff on the cloud. I got my app, I am going to have some data that I’m going to move in and out. Probably going to use you know amazon or google. But I got to make sure that the stuff’s okay for health care. So how do I think about these related concepts of privacy, security and controls?
Dr. Dave Levin: In my simple mind they’re sort of two, well several but two big points in there. One was when I go and adopt a cloud from one of these typical providers there’s sort of a base of privacy and security controls there. They’re not specific to health care. The demands of health care are typically significantly greater. And so what’s really needed is something that can sit on top of that and allow me to set that up to meet the standards that I want to meet for health care. The other and please feel free to take me to task on this. In fact let me remind you it’s not only allowed but we encourage guests to call bs on the things that aren’t accurate or that they disagree with. But you know one of the sorts of simple things I’ve taken away from my work with you is this idea of privacy is the goal, security is sort of the approach to achieve that goal. Controls are sort of how we hardwire that but also how we measure and prove that we are in compliance with those regimes. And I just find that to be really helpful. You very often I’ll cop to this myself. We sort of mash privacy and security together. I find this a really useful way to think about these three things as a separate but interrelated that I do that in a way that is least respectful for what you’ve tried to teach us.
Dr. Good: No i think that’s a great summary. And you know it’s one of those things where, as a privacy security compliance on the cloud is a pretty specific niche. I mean it’s obviously becoming a larger niche, but it’s pretty specific. And so it’s helpful to actually have a translated sometimes for people who don’t spend all their time there. And I think the way you summarize it is really spot on.
Dr. Dave Levin: Well that’s my specialty is dumbing things down so that I can understand. So thanks for that backhanded compliment. If you’re just joined us, you’re listening to 4 x 4 health, we’re talking with Travis Good chief technology officer of Datica. So Travis now, Sansoro and Datica coming together we’re going to go forward under the Datica name and this is going to combine secure cloud hosting and robust integration technology you know as we’ve talked about it seems like a really natural pairing it solves two really fundamental problems for innovation and health care. You’re going to be moving into the role of chief technology officer in this new company, this new combined company. From that vantage point what do you see as the most important needs in health it right now when it comes to these kinds of capabilities?
Dr. Good: I’m really super excited about the coming together or the merger Sansoro and Datica and particular excited about my role in getting myself closer to customers, that closer really specifically to a product. Because there’s a lot of exciting things happening today, and the market has moved. I think from when we founded the company in 2013 and I’m sure from day when you and funding team of Sansoro founded the company you know the market is really fundamentally shifted. I think what makes me most excited about this opportunity and is just really the clear alignment so we see from our customers as sort of pre-merger is you know companies that are trying to one, do more things on the cloud but I think, really the thing that’s really exciting to us is they’re really trying to do more with clinical data and have access to a richer set of clinical data to increase the value of their products and ultimately the value that they deliver to their customers. And doing that with sort of access to a richer and richer healthcare data. And so that’s something that’s Sansoro with emissary and its integration product really clearly is able to deliver. It’s a really unique and incredibly valuable as I’ve learned more through this process and coming together in a merger, just an incredibly valuable approach to data integration that goes beyond the typical data that is available to developers or really anybody trying to integrate any EHR. So you know from that perspective it really fits perfectly and putting on my new sort of merged hat here, I think what’s also very exciting from the other side. So I think there are just such clear synergies around delivering cloud-based platform and really a rich experience from a data access perspective, bringing these two organizations together and ultimately forming a new Datica is really really super exciting. Because I think that really the market has moved, and I think I’ve mentioned this before know six years ago I think we were early into the market. But now really the cloud and healthcare data on the cloud is really become like a number one priority for some of the larger entities in the world. And I think that it's this combined entity is really kind of super exciting to help enable that change in that shift in the market.
Dr. Dave Levin: Well it’s really, I see here you described that and of course timing is everything. And I think it’s a really interesting and fair observation that both of these companies started, and they probably were a little bit ahead of the curve on the Datica side around the move to the cloud, on the Sansoro side around the adoption of API as a core technology for interoperability. But the wave has caught up with us. I’ll cite two things, on the API side, I remember going out five years ago and talking about this and would often be greeted with you know sort of blank stares, what are you talking about? Well five years later the federal government is on the cusp of mandating the adoption and use of APIs. So we’ve clearly come a long way out of that respect. The other thing I was talking with a colleague about recently is we’ve got a bunch of proposed rules coming down now from ONC and CMS that are going to affect how payers, insurance companies and providers exchange data. And as we’ve looked at these requirements and they’re pretty extensive and they’re coming in real short order. I mean there’s deadlines in January or 2020 and July at 20. We looked at this and said you know you probably can’t even begin to think about meeting these requirements without a combination of secure cloud and API technology. It’s just the only way to quickly stand something up, know that you can secure that data, scale it and exchange it in the ways that are going to be required. So to your point and just to pile on I think these are both really complementary and the demand is rapidly escalating. And so hopefully the result will be you know really nice solutions that as we were talking about at the beginning allow the folks that are working really hard to deliver health care and pay for it and for patients to be engaged in new ways and to focus on that and be less concerned about some of these core infrastructure questions. All right I know I got up on the soapbox there and gave a little rant. But hopefully and I’m pretty sure you’d agree with most of that.
Dr. Good: Yeah, I would agree with that 110 percent. I mean I think that the thing that I’m probably most excited about in this merger is the timing. Because I think that you know over the last probably and probably 18 months we’ve just seen a huge shift in the types of engagements that our customers are working on becoming much more core to their business as opposed to sort of periphery sort of innovation type stuff and just really the types of entities that we are working with and the types of entities that are coming to us for help in getting out of the cloud. And I know that you know this is more of the Sansoro side. So you know I’m incredibly excited and I think that the timing of it is what makes me really the most excited.
Dr. Dave Levin: Well I share that, and I know that our combined team does, and our board and our investors were all pretty amped up about this right now. To close out our discussion today, you are one of the best people to answer this question. So as a last question what’s your most sage advice about all of this?
Dr. Good: I’m not sure how much this applies anymore or how accurate this is. But my experience and I don’t, it’s probably going to continue to be consistent, my experience in health care and trying to build a you know a business and a product within healthcare is to be patient. Because I think that the market is slow to adopt new technologies. I think the market is widely widely varied. So you know one health system, every health system thinks there are somewhat unique, and they are and it’s similar even with payers to some extent. But because of that really you know it just requires a good amount of patience. You can use examples all the time in health care. I mean I think a fire as a big one. We’ve been talking about fire forever and fire is starting you know finally take hold as a standard. But practically speaking it’s not really widely available. I’ve been talking about it for years and years and years. Whereas you know during that timeframe there’s been like I don’t even know 100 new cryptocurrency launched and social networks and everything else and so I think having you know a good amount of patience and really you know I think the flip side of patients is conviction about what you’re doing is really incredibly valuable if you want to do anything in care.
Dr. Dave Levin: Well I think that’s truly sage advice. We’ve heard that advice before on this podcast. So you’re in a really good company and offering it. You made a point in there that I think is worth elaborating on just a little bit which is you know there are these common issues that all of us face in health care regardless of your stakeholder role. There’s commonalities within those. There’s also a lot of variation, a lot of that just reflects the market that you’re operating in the sort of regional local market and your priorities. You know as I like to say for one health system, the top priority is patient engagement and for the next one it’s genomics and personalized medicine. The next one’s into telehealth part of what I think is so exciting about these times is we’ve got great technology that can enable these different things. And you know as you’ve described very well today the platforms that we’re bringing together for core infrastructure can really support this variety. And it allows these organizations to go back to focusing on what is strategically important and what are the parts that they need to do to enable the technology and where can partners do those things better and I know it’s been your experience, it’s been mine as well that when we can get the conversation there and get the right people around the table it’s pretty amazing what we can do. Yeah it still requires patience, but we can really move the needle when we take that approach.
Dr. Good: Yeah, I would agree 100%. I think that like we have seen a share of Datica over the last six years where the pace is picked up a lot. So yeah, I would agree.
Dr. Dave Levin: Well that’s terrific. We’ve been talking with Travis Good, chief technology officer for Datica. Travis thanks so much for joining us today.
Dr. Good: Thanks for having me Dave. I really enjoyed it.
Dr. Dave Levin: You’ve been listening to 4 x 4 Health sponsored by Datica. Datica, Bringing health care to the cloud. Check them out at www.Datica.com. I hope you’ll join us next time for another 4 x 4 discussion with health care innovators. Until then I’m your host Dr. Dave Levin. Thanks for listening.