Digital Health Care: The Patient Will See You Now

Digital technology is empowering patients to participate in developing their own treatment plans, but only if the organization’s culture is ready and willing, says Kristin Darby, CIO of Cancer Treatment Centers of America. “We crave constructive disruption, so we are always challenging ourselves with the question, ‘how can technology positively impact our patients?’ If there’s value for the patient, we’re interested and we dig deeper.” Darby spoke with MIT Sloan Management Review guest editor Gerald C. Kane about how digital disruption has changed her company's leadership perspective.

What is Cancer Treatment Centers of America doing with respect to digital, and what are you most excited about going forward?
The approach at Cancer Treatment Centers of America (CTCA) is extremely patient-centric, and our strong focus on digital supports this commitment because technology does not forget that the patient comes first. This approach is vital because it provides different avenues for connecting with our patients in a non-traditional way. We see our relationships with patients as a series of different touch points along a continuum. As we move along that continuum, it’s very important to us to know that if a patient hears the words, “you have cancer,” they can rely on us as a trusted resource — either in person or digitally, based on the patient preference.

We have a core philosophy that patients should be active members of their care team, empowered with access to their own health information — lab tests, scan results, any of those types of things — at the same time as their care team. Our proprietary patient portal enables our patients to access the same information at the same time as their physicians. Currently, this portal has a utilization rate of approximately 85%, while most health care providers are aiming for a rate of 5%. This rate highlights the strength of the unique culture CTCA has created around digital concepts. Our patients understand that the choices they make in their care process can influence their outcomes in a positive way, so we try to provide the platforms that encourage strong connectivity and empowerment.

Has your decision to make the treatment data available to patients always been a part of your philosophy, or did something shift along the way?
This kind of transparency has always been fundamental to the philosophy of CTCA, but the shift to digital has made it easier for everyone — the organization, our health care providers, patients, and their caregivers — to access their information and to access it in real time.

As digital has made patient access to information easier, what has been the reaction from your doctors and other care providers? Were there any internal cultural challenges from them? Did they think you were maybe being too transparent, or that experts should be interpreting the data for patients?
Absolutely. I think some pushback to any new process is common at first. But our clinicians now realize the benefit of having a patient “at the table” with the care team, of having patients understand the pros and cons of a course of treatment, where they are in their treatment process, and what role they can play in contributing to their care plan.

Digital makes it very easy to involve our patients in that way. Traditionally, a patient might not see their care team for a few days, but technology now makes real-time connectivity possible, which allows our care teams to maintain an intimate relationship with their patients without a physical presence. I have found that to be an incredibly positive aspect of the technology.

Let’s talk about CTCA’s digital strategy. You use the word “we” a lot. Who is “we,” and who owns the strategy?
The digital strategy at CTCA has matured a lot in terms of our presence, growth, and our connection with patients. As chief information officer, I own the technology platform and strategy, but our chief growth officer, Dr. Peter Yesawich, and the president of CTCA Medicine & Science, Dr. Maurie Markman, are strong business partners, and we share a great deal of information. My focus is on business transformation and enabling different ways of moving our business model forward. I am honored to work with a talented technology team of invaluable thought leaders uniquely capable of taking clinical impact to new levels through the power of technology and collaboration.

And what’s your time horizon? When you’re thinking, okay, here’s our digital strategy, how far out are you thinking?
I try to look at a three- to five-year timeframe. Five years is pretty fuzzy in the digital world, but we certainly do scenario planning. As the demands and expectations of our patients and consumers change, we try to make sure that we develop agile and nimble architecture that enables the technology to evolve.

What do you see happening in your industry over the next three to five years? Which technologies are going to make the biggest impact, especially in terms of your business processes?
Two things come to mind immediately. Technology will enable clinical capabilities to rise to new levels of excellence in oncology, which is being done through precision medicine. The science of how we treat and understand cancer is evolving at a very rapid pace, in large part because of our understanding of the human genome and how different kinds of DNA align with different kinds of cancer. But science is working toward a better understanding of DNA through precision medicine at the molecular level. By understanding what goes on at that level, we have begun to identify individual therapies and regimens for specific patients. But the genomic information files are enormous, and physicians can’t analyze that amount of data without the assistance of technology and analysis of big data.

Individuals are also using digital to become more educated about their health. They’re focusing on prevention and understanding their bodies better so that they can detect when something is off. Technology gets us the measurements and metrics that let us know when something has changed and when there might be a reason for seeing a physician.

I see a dynamic change coming in the next five years. The technology is here today; it just has to be wrapped up in a way that it reaches consumers. I think the younger generations will trust the information immediately, but for older generations, it’s going to be a gradual shift toward understanding and trust.

In addition, there will have to be a big shift on the clinician side. Health care providers are not typically used to functioning from a consumer-demand perspective, and I think that’s going to be a big disrupter in the way we deliver health care in the U.S.

That’s going to be a huge cultural shift for doctors. How do you get them from here to there?
I think it’s twofold. First, the data itself will tell the story in a way that can’t be refuted. Physicians are very responsive to scientifically investigated and validated information. That’s core to how they’re trained, so they’re already poised to be receptive if presented with this type of information.

Another way in which we can help physicians with this shift is through relationship-building. For example, a key relationship for me at CTCA is with Dr. Maurie Markman. As health care and IT evolve simultaneously at CTCA, our close alignment and open sharing of information is essential. We both understand the importance of that partnership. At another health care system, the focus might need to be on the relationship between the CIO and chief medical officer.

Looking toward your three- to five-year horizon, what skills are your employees going to need to work in this increasingly digitized environment?
At CTCA, all of our employees are called “Stakeholders,” because each one is committed to making every patient experience as pleasant and positive as possible. We look first for a cultural fit, the ability to understand our business model and the patient journey. In IT, we seek out people who understand and who can articulate how technology affects our business and most importantly, our patients. When people understand our patient-centered approach at a deep cultural level and have a vision consistent with ours, we feel confident investing in them long term — even if the individual’s technology skills are not exactly what are needed at the time.

We’ve talked a lot about your success in realizing your vision of health care, but you have faced difficult challenges along the way. Can you tell us about some of those?
One challenge we have faced was with one of our customer relationship management (CRM) applications. We use it to manage patient relationships in a way that’s critical to our organization. The system in place when I moved into this role had a history of unsuccessful upgrades and poor documentation around customization. It was not designed in a way that aligned with how our business operated. Our customer service was not meeting the needs of the organization, and our ability to provide solutions was seriously impaired. Because it was not well documented and because we were doing reverse engineering instead of proactively addressing the issue based on the logical functioning of that application, our recovery efforts were delayed.

Compounding the technical problem was the CRM’s visiblity in the organization because it supported one of our core functions. That problem gave our department a black eye, all the way up to the board level, and forced us to ask, “Do we have the right technology platform and skill sets to develop these systems? Are we able to do this in a way that’s reliable? Can the business rely on us to remediate the problem and also use technology to transform and mature this core function within our organization?”

By bringing in external specialists — essentially a SWAT team to revamp and stabilize — and adding skill sets for special projects, we have now stabilized that system. Our partnership with our internal customers has improved, and we are working together to design a new system.

Do you think similar challenges will keep cropping up, or will you have a different set of challenges in the future?
One of the biggest challenges is understanding how things are developing in the rapidly evolving digital space. You have to make sure that you’re investing in the right things and that you have enough of a window to realize those gains to justify your investment before things shift again.

I want to circle back to something you mentioned earlier. You spoke about the importance of your relationship with the president of CTCA Medicine & Science in realizing your vision. Do you have any recommendations for how other leaders can foster stronger relationships with each other?
Get out of your office. You’ve got to be connecting with your customers and interacting with people who are important to you so that you can understand what’s important to them. Go to other department meetings, even if it’s just to hear the conversation. Think about what’s driving them and what’s important to them. When you start to understand all of your customers on their level, you can start to build much tighter relationships.

It is also important to gain an external perspective of the industry and understand how technology is evolving and affecting your market in order to determine how to maximize your technology investment based on the organization’s strategic and operating objectives. Often, IT is seen as a “black box,” an area that other departments don’t always understand. You’ve got to get out and change the perception that IT isn’t just a desktop support organization. IT is a business transformation organization and a necessary enabler of an organization’s strategic evolution.