TRANSCRIPCIÓN 🔗
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Hi everyone, this is Eddie Qureshi. I'm the founder and CEO at Rainfall Health and also the host of this podcast. Today on the podcast, we're joined by Cora Han, the Chief Health Data Officer at UC Health, one of the nation's largest and most complex academic health systems. In this role, she says that the intersection of law, data governance, and health system strategy, guiding how patient data is managed, shared, for example, in the past.
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managed, shared, protected, and leverage across a sprawling multi-entity care environment. So today, we're going to be talking everything from value-based models to how data sharing works across the care continuum. Cora's expertise in building responsible
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compliant and operationally effective data infrastructure has never been more relevant or needed. Welcome to the program, Cora.
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Thank you, Eddie. It is my pleasure to be here. Well, it's great to see you again. Well, for our audience, let's just start from the top. How did you get your current role and what does a chief health data officer do?
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Sure. So I had maybe a little bit of a different path coming here. I am a lawyer by training and spent by early years as an intellectual property lawyer.
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So I did trademark, copyright, and privacy litigation, and counseling. And then after that, I had a number of years at the Federal Trade Commission's Division of Privacy and Identity Protection.
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So there I did a number of different enforcement-related activities about technology, and then also spent a good portion of my time thinking about large data management and working with colleagues at HHS, the Office of the National Coordinator for Health IT, the Office for Civil Rights, and also the FDA.
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And I think that combination at sitting really at the center of technology and policy and regulation really gave me an appreciation for the two sides, I would say, of how to use health data.
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On the one hand, it is essential. I think it is really our duty to be able to use health data, to be able to improve care, to be able to improve people's lives.
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And we see in healthcare an opportunity that is apparent, and there may be advances in other industries as well, but in healthcare, the potential is really, is really obvious.
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On the other hand, I saw some of the harms that can really occur when there's a misuse of consumer and patient sensitive data, and how important it is to keep patients and consumers at the center.
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At the center of discussions about how to use and share their data.
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And so that is really what shaped my views and brought me to the University of California to take on this role, which really allowed me to build solutions to use data to improve care, while also making sure that we were doing it safely, safely and responsibly.
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Well, for those of us far less experienced than you in sort of the data privacy and use of data issues that could come up, give us a high level view on what you've seen.
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And, you know, you mentioned even how mismanagement can lead to issues.
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What does that actually look like sort of in practice or in the real world?
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So I say that I am often looking at different kinds of use cases that will take place either with our operational business partners or on the research side about what can we do with data?
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What are the data they problems that we need to solve?
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And how can we use data to solve those problems?
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How can we use data to improve the population of our communities?
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How can we use and leverage data to achieve efficiencies to actually learn about what might make our operations work better?
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And then we are also looking at things like the tremendous opportunity that exists in the research realm to utilize data to actually create new breakthroughs in treatments and then how to translate that into the clinical sphere.
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I feel very, very lucky that when I come in, it could be a whole bunch of different things that I am looking at.
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So, and that ranges from working with all sorts of different stakeholders across the system, whether they be clinicians or operational business leaders or privacy and security colleagues or people in IT, data scientists to trying to solve problems.
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And it can also be working with my team at the Center for Data Driven Insights and Innovation at University of California Health to build AI and analytics solutions to help support the work that's really going on locally all across the University of California Health.
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Well, Cora, you know, the audience might not know this, but you and I have known each other now for a couple of years, and I know how innovative you are in terms of healthcare, AI, technology, and what's, you know, what I want to go to is a little bit on our
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Rana-Rana Advisory Committee, where you sit along with another member, which is Paul Jourick, who also is a JD background, and also sits on top of innovation.
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I'm sometimes curious because I get executives that I talk to across the country, across different systems, and sometimes there's this sense that lawyers to disload things down.
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My
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experience has been quite the opposite. I think innovation has been happening from the policy lens, from while keeping an eye on legal, but really, how does it actually drive change and innovation?
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Do you find that the case as well, that there's almost a misperception of how your background actually comes in and flows and guides your innovation versus steamy as it from the healthcare lens?
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I do, and then I've also seen situations where, in fact, it can slow things down, and from my perspective, I think, and I think that Paul might agree with this, one of the key things is to get involved in difficult questions and projects early
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so that there can be guidance and thoughts about how to build it so that you don't end up with something that is almost ready to go, and then you realize you need to run it by legal and compliance, and then there are a host of issues that you never realized existed.
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This can be hard work. I think this is part of what it means to do something in a multidisciplinary way, which is often easy to say, but actually hard to do in practice, because sometimes, particularly in big, complicated organizations, groups can work in silos, and they need to not only be able to come together and to create enough time and space to be able to do that, but also to be able to do that in a way that is streamlined
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and doesn't slow down the process. And then the last part of that is learning to have different groups, I would say, within a complicated organization, learn to be able to talk to each other.
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So learn to be able to speak each other's language enough so that there can be a level of trust that someone is not just, for example, using privacy to slow down a project that, for other reasons, they would rather not pursue.
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But to get everyone on the page about what is the problem we're trying to solve, what are the possibilities for solving that problem, who do we need to have in the room, and sometimes, and perhaps more often than people realize, it can be really helpful to have
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either your legal partners, your compliance partners, but your governance partners in the room a little bit earlier than sometimes business leaders may realize.
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Well, I think that's usually we have an advice section for the podcast that usually comes near the end, but I think this is such an important one that I think we should jump into, which is for our audience.
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Bring in legal compliance early so that we don't have to have conversations later on and said you have somebody who's helping you chart the path to success versus trying to now fit into possibly an imperfect path that's been laid out.
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And it can feel like things are slowing down when they were never done properly to begin with.
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If I am hearing you correctly, Cora, I agree with that.
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There we go.
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I think this is such a powerful piece because, again, in the current realm of AI, I see so many executives wanting to run and figuring out that balance on what is the right speed and who's the right person in the room.
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Again, we've had great luck with legal teams and really seeing them be at the forefront of innovation when they're involved at the right time.
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One of the things you've again been a leader in is how to use policy, including some of the new mandatory models that are coming out of CMS, such as team.
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And one of the biggest things for audience who's slightly unaware of the team model, it requires so much navigation in the acute care space, because those are the main facilities that have to participate.
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But a lot of the care happens in the post acute and that is data sharing.
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Ultimately, and even though interoperability has been a promise for the last 30 years, it's still not where it should be. So tell, tell us a little bit about how are you looking at where we are in terms of readiness as a health care sector as a whole.
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So I would say that when I look at the sector as a whole, I would describe the level of readiness as uneven.
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And I would say that most of that unevenness isn't due to a lack of desire. I think many, many organizations realize that it is important to be able to handle care navigation and care transitions well.
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And that in order to have that happen, the data need to flow as seamlessly as possible to enable that.
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I think where things get complicated is that there are many different types of entities within the ecosystem.
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And so you're really talking about entities that range anywhere from hospitals to community partners to skilled nursing facilities, and you're trying to ensure that a patient's journey across that navigation and that care journey is happening smoothly.
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And those organizations, they may have different ways of storing their data. They may have different processes. They likely have other kinds of challenges. Some may have lots of resources. Some may have more limited resources.
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And it may even be differences in, for example, how they capture their data and all of those things, I think, can make the goal that I think many, many people agree with happen as easily as people would like.
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So from, you know, taking this
really complex landscape, what do you think are the biggest challenges that exist? Because, you know, it's a little bit of different, like you said, different entities have different levels of resources.
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But that's also the reality for where we are. And that's not, doesn't seem like it's going to change. So what are the, then the biggest gaps that exist as a result?
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Then maybe we can wrap our minds around or have policies that started addressing those and meeting these different care providers where they are versus sort of a, an idealistic future space where they, we want them to be.
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Sure, sure. I think I will mention one and it's a broad word and I think it applies in different ways and I'll explain why. I think there is a trust gap.
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And I think this trust gap can exist in different, in different pains. One of the, one of the areas in which there's a trust gap and that is that there needs to be agreement.
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I think simple agreement about what data can and should be shared for patients to help them for their care.
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And I think that needs, there needs to be agreement about that, how it will happen and also who will be accountable if something goes wrong.
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And then there also needs to be almost at a higher level is some trust amongst the organizations that are involved, but also the patients that how their data are being shared is really limited to the purpose for which we want it to be shared.
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And that there are appropriate safeguards in place. And I think once all of the players in the ecosystem are feel confident about that and there are many, many efforts and successful efforts to get this done, then I think you can have the data flow more, more easily.
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But often when one is just starting out and trying to establish those relationships, there may not be a natural level of trust, even though there is a natural desire to do it.
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Wow, that's such a great point and kind of a nuanced way to approach such a complicated problem, where maybe we need to almost speak the same language and align on the frameworks and uphold ourselves to those frameworks rather than trying to necessarily beholden ourselves to just how perhaps one entity does things.
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And that's where I feel like healthcare has always been, which is some of the larger players in whether it's in an area or in a particular specialty asking people to just conform to their way, but that doesn't sort of scale.
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And instead, sort of coming together and agreeing on standards, which we do really well in healthcare and maybe start off with aligning on those without bullying the ocean.
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And I think that is something that Medicare has done really well is starting off with just, hey, let's start off with a handful of service lines instead of trying to go for everything all at once.
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Does that seem like a good place to start?
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Yeah, maybe.
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I think so.
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I think that the CMS teams model really really makes that challenge very concrete and hopefully will lead to even more advancements, I think, in processes across the ecosystem.
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And I'll say that there is a lot of very effective data transfers and interoperability already already going on.
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There are frameworks that work well, and those things are things the whole industry I think could be proud of, but there are also just always challenges with trying to share data effectively.
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And so there always can be more to be done as we work to improve the care of patients.
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And I think one of the things that we're always thinking about is how do you enable the care, the data sharing as in for care transitions, for example, which is something everyone wants to happen from other kinds of data sharing that people may be more nervous about.
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How do you help the care that needs to happen really flow effectively while also mitigating some of the downside risk?
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And that is a problem.
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I think many entities are very familiar with dealing with.
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So there is a lot of, I think, promise that things will just continue to improve.
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Absolutely.
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Well, that leads me to one other point, which is, is that one of the reasons why health care is.
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Sort of stands out by itself on trying to do a lot more.
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Build versus by decisions. Is it because it's so complex and.
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There are specific needs of a large institution, which also tends to have.
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And, you know, a large amount of resources not proportionally where, you know, right now point 75% margins around the nation.
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But generally, when you're dealing with, you know, tens of thousands of employees and seeing millions of lives.
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It can feel like the governance problems and the data sharing problems are so insurmountable.
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That a lot of entities go out of their comfort zones and start to build technologies versus look for solutions that are off the market.
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Is that part of that trust gap that you're referencing?
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Well, I would say as I look at the ecosystem that.
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That large health care organizations are not necessarily building more than they're buying.
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There is a good amount of buying as well.
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So I don't know what the breakdown at one of our academic health centers might be,
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but I know that they look at what is on the market as well as consider other ways of meeting the needs that that they have.
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I will say that when we are looking at vendors and also when we're developing things,
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there are some some common questions that that we ask and they are things as simple as what is the need that this product is trying to serve.
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Is that a need that we acknowledge that we have and that we believe that this product will solve it in a better way than we have been solving it in the past.
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So it ranges from things like that all the way to, of course, very strong cyber security controls and everything in the middle.
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So a lot of data questions, what data will this product need?
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Ensuring that that only that data is is really within scope.
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What are the retention policies around that data?
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How do we ensure that that data isn't being shared downstream in ways that people wouldn't reasonably expect?
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And how are we going to learn about if it's a if it's a vendor?
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How are we going to learn about if the product is changing?
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And how are we going to determine overall monitoring and also accountability?
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So lots of lots of questions, but there is there are many vendors in the ecosystem and and we partner.
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I think we quite a few.
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Absolutely. Well, from a, you know, kind of zooming out for a moment.
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What do you as a hospital leader look for from a technology vendor?
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What can they do to make your job a little bit easier?
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Because like you said, there is this win-win, right?
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You do want the right solutions at the right time and it's you're working on this cross functional teams to drive impact and outcomes.
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And so how can technology vendor leaders come to hospital leaders and meet them where they are?
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And so that it's sort of a win-win on both sides of the table.
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I think one important aspect is recognizing that these tools
are really being deployed in complex workflows and the success of any tool will depend on those aspects.
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So being able to really be an effective partner in that regard is an important thing.
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And then I think it is very important to provide the information that health systems are looking for about how the product operates and whether or not it is, of course,
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safe, effective, not biased, all of those things that are important.
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And then I know I mentioned cybersecurity before, but that is always top of mind.
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So ensuring that the privacy and security safeguards that are very important to health system providers is adequately addressed.
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And those protections and those answers with those kinds of risk assessments are being done are coming as quickly and as fulsomely as people would like.
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Absolutely.
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Well, this has never been more pressing as it is now with AI being in the mix.
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Things are developing at unprecedented rates in some ways.
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But in the healthcare space, the margin for error doesn't really exist in the same way.
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So we need to be very mindful of how we do it, but at the same time, the healthcare system cannot afford to not engage either.
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So how do healthcare leaders stay ahead on this government and oversight of this technology that's rapidly developing?
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And a lot of it is being sort of brought to the system externally and some of their data is required to, you know, make it function and have it be as personalized in this experience as possible.
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I assume that, you know, that's something that solidly right now you spent a lot of time on.
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So would love to hear your perspective.
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There are indeed many, many solutions that are that are coming around.
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I'll mention a couple of things.
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I think what advantage of setting up governance committees and those exist across across you see and across you see health.
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One of the advantages is that it sets a set of replicable processes and that is not maybe the coolest thing to say and to talk about.
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But those kinds of processes can provide reassurance, I think, across the system as all of these incoming tools and products are being thrown about that there is a common way of looking at it.
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And a number of the things in those committees are come from longstanding other processes that exist so that there doesn't always need to be a recreation of the wheel.
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But I think that that strong processes are one good place to start.
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I will say it is a very, very quickly evolving ecosystem to put it mildly.
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And so everyone is really working to keep up.
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So another thing that happens within institutions that you see and also across institutions is a lot of information sharing about what needs might be able to be met with different sorts of products.
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And I think that that could also be very helpful. What pain points are you seeing? What advantages are you seeing?
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And so that is another thing that I would point to.
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And then one final, and this is very kind of pragmatic, but one of the things that I have been noticing across the industry is that because of the very quick pace of evolution, it might make sense with certain kinds of products.
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You enter into shorter term contracts.
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So instead of enterprise contract for five years, maybe it's sense to do a contract for a year or two and then reevaluate because the market is shifting and your needs might also be shifting.
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Does that also mean that maybe this is a chance to ask more of our vendors because the pace of which things are moving and things are being brought on?
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Like you said, along with the pace of the contracts and agreements, should healthcare leaders just be asking for a higher bar of work product and for accountability and transparency?
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I think we always try to be as direct with our contractors as as possible.
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I don't know if I would necessarily describe it as an opportunity to ask more as I would say an opportunity to evaluate and iterate on what are the most appropriate provisions.
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It may be that there should be, probably this is the case, that there should be additional provisions that come into play when it comes to AI and how we handle that in contracts.
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And I know that we have updated our standard terms and conditions to include some additional AI specific provisions.
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So I would expect that that is probably widespread and that I think is good.
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I think like everything else, things are not static and so it may be that the pace is even faster now than it was before.
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And that is something that entities have to push themselves, I think, to really accommodate.
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And in some ways that means we are asking more, but I would say that really what
is happening is that we are also evolving to a new marketplace.
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I love that. I feel like throughout this whole podcast, what's really to that to me is how hopeful you are actually about everything that's happening.
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I think there are sometimes the negative stories really take the headlines, but I think there is a lot of hope.
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So what are you most hopeful about where we are headed with healthcare with healthcare data, with technology?
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What's sort of the optimistic view as you look, you know, two, three, four years down the road?
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So I would say I think I am an optimist.
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I really do believe in the power of the technology to change lives.
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I think that there are many needs that this technology could serve in healthcare.
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And I think it is already starting to do that and I think it will continue.
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In order to do that, I think, as I said at the beginning, governance is an important part. It cannot fall by the wayside.
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And because of that, I think it is people just have to keep really working on it because it is not easy.
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And I think some of the discussions are some of the hardest ones where you have a bunch of people come into the room and many people are not agreeing or not quite understanding where someone else is coming from.
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And it's important to recognize that we have to keep working on it, that we have to have that come along just as the technology comes along so that we can actually create that level of trust, which is really needed to make big advances.
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And I guess the other thing I would say, and this is maybe a little bit more forward-looking, is that I think it's important to think about ways in which the technology might not just make the existence of technology.
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It's important to think about ways in which things go faster, but actually change the way that we are providing care.
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So I think that there is tremendous opportunity there to make some big strides, and that it definitely creates times of discomfort.
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But everyone will learn many things along the way, but I think it is really kind of our duty to think in the big picture about what the large-scale potential could be.
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I love that. It's a good perspective to have. At one point, when we don't have necessarily necessarily the data or even the vocabulary to describe where we're headed, it can be tough.
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And like you said, uncomfortable. But moving through it, we really can get to a great place. A car is not a fast horse.
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It's fundamentally a different way. But I guess at one point, you'd have to describe it as helping you get somewhere a little bit faster with the existing vocabulary until it takes a life of its own.
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Well, Cora, this has been such a pleasure, and it always is chatting with you. Thanks for providing us with your perspectives. It was great to have you on the podcast.
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Thank you, Edity. Like I said, I am delighted to be part of this conversation.
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Thank you.