53. Anshul Pande: "All of these changes brought about a new set of problems to solve and challenges as we implemented those technologies."

Episode 53 of the HIPAA Critical podcast features an interview with Anshul Pande, vice president and chief technology officer at Stanford Children's Health.

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Anshul Pande: In what has been a surprisingly interesting year for us, the last 18 months has seen a huge growth in our technology portfolios, in terms of how we have conducted business with more telehealth in place, but also in terms of how our employees have worked, as they have transitioned more to working from home. 

So all of these changes brought about a new set of problems to solve and a new set of challenges as we implemented those technologies. And then finally, from a patient perspective, their experience and how they experience healthcare from us changed as well. So an all-around interesting and exciting year from an innovation perspective that brought in a new set of challenges that we got to be in the middle of and solve

Anshul: Now, the cybersecurity risk part is front and center. Right. So we're seeing a lot more attacks happen not only in the U.S. but throughout the world. And healthcare has been a big target for attackers. And so from a stack assessment perspective, you're doing it continuously, looking at where we have vulnerabilities that we need to patch and install and update. 

We're also looking at our core products probably every one to two years to see, are the next generation products fundamentally better in terms of providing a stronger security posture? And if they are, how can we quickly migrate to them? So it's a continuous process. It's an ever-evolving one. And there are lots of vendors and partners that are coming into the mix as well. With cybersecurity being such a hot market to understand the new problems and then find solutions for them.

Anshul: Absolutely. So cybersecurity is ongoing. I think it starts from day one. When you join the organization as part of the orientation you get an update on our approach to cybersecurity, what is that steak, some of the regulations which are very specific to healthcare. 

There are obviously the annual cybersecurity requirements that are there, we do a ton of brown bag lunches for departments to get in-depth about specific topics. We do phishing, testing, many times a year for separate groups, in terms of getting them used to what a real phish could look like. 

Anshul: Absolutely. And our CISO has been keen on sending us news articles, as well as stories about how to ensure your own personal cyber hygiene. Those stories resonate well with our team members. But those same principles apply to what you need to do from a business perspective. 

So how do you do online shopping safely in the midst of, for example, the Christmas season? And then how does that relate to being smart about online purchases from a corporate perspective, kind of falls into the same outline?

Anshul: So we've talked a lot about, you know, Human-Centered Design for quite some time. And it's really about spending time with your end-users understanding their needs and then coming up with creative solutions to solve them. 

A lot of times the end-users may not be able to quite explain what they want out of the solution, but just hear the pieces together. But then how do they fit in together in a graceful and elegant manner has always been important. 

From a software design perspective, I think the impacting design piece adds another layer of nuance to it to say, not only do you have to make the product to be functional, but also to elicit positive emotion. 

And so as long as you provide these nuances that provide them with a working environment, that gives them a positive emotion, whatever that is, whether it's a slick way of doing what they were doing before or automation. 

All of those things can change the brain chemistry of an individual, using yourself, especially, if you're going to use it all day long. And I think that adds to, that adds to the experience, but it also adds to the stickiness of the software.

Anshul: Yeah, so it's, it's tricky, right? It comes at the design time, I think it's, a lot of it is around, again, understanding what the user is trying to do, getting into their mindset and understanding what is complex. Where is the heavy cognitive load? 

And then how do you change the heavy cognitive load? I think the gaming companies have done a better job of this than anybody else. Yeah, of keeping it engaged. I think social media has data to a degree to which is giving us continuous dopamine hits, whether it's through the likes or comments section.  

And so we have to take some of their best practices into play. And then, you know, some things just don't make sense in a corporate environment. So we’ve got to be cautious about that, that we don't over gamify.

Anshul: Yeah. So you know, for the longest time, we have been in an approach, which was very episodic. You came, got care from us, spent time with us in a hospital where we performed surgery or a key procedure on you. And then you left and you forgot about it, till the next time that event happened. 

Then over the last decade, we really started thinking about, “Hey, how do we longitudinally take care of the patients.” And what has happened in the last year is, because the direct face-to-face contacts became less frequent from all the things going on around us. 

This actually accelerated the thought process behind “Hey, how do we better understand cohorts of the population that we need to care for? How do we ensure that we are monitoring them remotely as much as possible?” 

And then how do we do appropriate interventions based on the data that we're collecting from them remotely. 

So a good example is we have a diabetes management program, which includes continuous glucose monitoring at homes. And so all of a sudden, instead of seeing as every few months, with subsets of data based on your glucose levels in that particular day, we can actually get data at about five-minute intervals for all the time. 

Anshul: So all of this data is great. But if I send it in a spreadsheet to a doctor and say, “Okay, in your 15-minute appointment, interpret this gazillion data points and have a meaningful conversation with the child to give them what they should do or not do.” 

That just cannot happen. So definitely, work that has happened is not only collecting this data and bringing it in, but also visualizing it in a way that a physician has to spend less time interpreting the data, and more time using that data to have a meaningful conversation about it. 

I think that's just an example of things that are going to continue as we go on this digital journey, as well as collecting a lot more data and then making that useful in the entire life cycle. From a patient perspective.

Anshul: Yeah, so we're, we're super excited about telehealth. I think the example that I provided is one of probably hundreds of examples that we have seen successful use of telehealth, which we couldn't fathom 18 months ago, right? 

The right solution at the right time and then serendipity. In terms of successes with it. I think telehealth is here to stay, I think we'll see 20 to 30% of our visits being telehealth for a very long time. 

And frankly, at some point, we'll stop calling it telehealth. It is just health care being provided in another medium, right? We don't say clinic health. And we don't say hospital health. Yes. So I think our terminology will change, it'll just become that commonplace. And it has also given us a much wider view of who we can take care of. 

So previously, it would even take some families two to three years to get to us. And telehealth kind of removes that barrier. And we can see patients who really need our care at a much wider distance. But it is bringing a new set of problems as well. And we are seeing that the issue, which was historically around, “my neighborhood does not have a healthcare system that can take care of me”, is moving to “my neighborhood does not have the right broadband to start healthcare”. 

So the digital divide is going to become much more relevant for us. And there's a lot of work that we're doing from an advocacy perspective, to ensure that we are not leaving populations of Americans behind just because they don't have the right broadband to be able to access these kinds of novel services, which are extremely valuable, like you said, more, more comfortable, a lot more convenient, and not spending time on the road. And it makes sense for everybody, right, and it will actually reduce the overall cost of health care.

Anshul: Yeah, so that convenience doesn't go away. There's one thing written on the board, which always worries me whether at some point, convenience overcomes quality. And so we have to make sure that the experience is as easy and as seamless as possible. And you can continue to see your doc in your pajamas, if they don't have to physically touch. 

Our thesis is that that will continue. I think it's a better way to provide health care. So that fundamentally doesn't change. I think we'll see a lot more from a remote monitoring perspective. 

As more devices become available, and as well as more devices that are consumer-grade have the ability to collect more data on us. The trickier part will be how do we assimilate that data? 

How do we create the ML models, and the models to actually be able to hone in on what's relevant in datasets? And be able to provide the appropriate guidance at the patient's homes, with some intervention from clinicians at health systems to make this all work together. Especially for populations that have long-term chronic care that could really, really benefit from this ecosystem evolving and growing and maturing.

Anshul: Totally. And you know, the second opinion programs have been there for quite some time.

In fact, we have our own Second Opinion program at Stanford where anybody in the world can connect to the second opinion program for our specialists. And wow, that's incredible. So yeah, for a small fee, you can actually send your information on very specific areas that we provide that opinion, and we'll review all of the data for you. And then have a consultant answer your questions. 

And in a number of cases, the answer is simply, hey, what your local providers are doing is absolutely correct. This is the way to do it. On occasion, we will say, hey, this is what we know best about it. And here's the approach and tweaks you want to make. And, and on occasion, we will say, hey, come to us, because there's a novel approach that we're using that could benefit you. 

It's a super interesting program. It's, it's, it's well utilized, just for the use cases that you talked about. And definitely gives the opportunity for the entire world to be able to see what we're doing from a research perspective and how it goes.

Anshul: Thanks, and I had a great time answering your questions.