While at HIMSS 2018, I spoke with Lidia Fonseca, SVP and CIO of Quest Diagnostics about a broad range of issues: the evolving role of the CIO; design thinking; big data and analytics; and presenting information in meaningful ways to multiple audiences, including patients, providers and payors. Last year, Fonseca won a Forbes CIO Innovation Award in recognition of the QuestQuanum suite of information and analytics tools. She has previously served as CIO of LabCorp.
Over time, Lidia sees a shifting focus in her organization from provider-only to all users, including consumers, and from systems to experiences, in the context of the digital transformation happening across many industries — not just clinical laboratories or healthcare. Lidia said: “I spend 35-40% of my time with customers [in order] to provide effective solutions.”
She works closely with the customer experience staff at Quest and has a center of excellence focused on design thinking. She is focused on creating solutions built on empathy, on understanding the consumer experience. She asks, “How do we give them information and provide them services so they get to to what they need as quickly as possible?” The voice of the customer is built into the design sprints for her team. She defines “customer” as including a broad range of constituencies — patient, provider, payor. Each has specific needs, which makes life challenging, as Quest works to provide each of them with appropriate continuous service and a useful customer experience.
Fonseca described design thinking as the idea that solutions are designed based on empathy, based on needs including emotional needs. Built into the notion of design thinking is the need to iterate – test ideas as you go; test your riskier ideas first, and refrain from judgment. She observed
As technology folks, let’s face it: some of us think we know all the answers. Well, we don’t…. Let the emotional need drive what we need to do…. Tolerate failure…. Not everything is going to work. get the voice of the customer along the way … and change it so it works.
Analytics under the hood, including real-time analytics, for Quest’s varied audiences are consolidated under the QuestQuanum brand. Analytics are required by all of the company’s constituencies, but the needs vary by audience, leading to the development of half a dozen or so different offerings over the past couple of years. Here are a couple of examples:
- Provider analytics under the name Quanum Interactive Insights — not just test results but further context, including what’s happening with a patient over time. Results, context and recommendations help the provider make the decision with the patient about what comes next.
- Health systems, IDNs, with hundreds or thousands of providers require a different view: A tool enabling benchmarking, minimizing variation of practice, and tracking measures across the system in order to help with clinical, operational and reimbursment decisions
- Payors may wish to view test data in the context of coverage guidelines – Is this the right test for this patient at the right time? Can we tell that providers in the network are following guidelines?
Analytics are both longitudinal and real-time. The knowledge base underling the analytics comes from the 700 MDs and PhDs in the company, experts in laboratory medicine, routine and advanced. The data used in the analytics are drawn from Quest’s 50 year history in the business, with one of the most comprehensive test menus in the industry. Quest sees 1/3 of the U.S. population every year, 50% every 2-3 years. The company has ability to aggregate information — 10 years’ worth of data in its big data platform, including 40 billion test results across 170 million unique patient identities — and to mine all of these encounters in its big data platform in order to identify trends and patterns, to create national standards, to identify regional or disease-specific trends, and to use the knowledge base created over time, including through what Lidia termed “some pretty snazzy data visualizations.”
Quest lets individual providers compare their patients against a national database. For example: when a provider orders certain oncology tests, results are returned together with a sophisticated report prepared in conjunction with Memorial Sloan Kettering and IBM Watson, a report that can give more context around a test result. (As an aside: It is, of course, important to recognize the subjectivity inherent in these analyses; we sometimes think of these sorts of reports as being based on Science when in fact they may be filtered through an all-too-human lens. That’s not to say they are wrong, just that the information provided by IBM Watson must be taken not as gospel truth but as a human opinion, a perspective that weights certain research and information differently from other research and information.) Lidia described another aspect of leveraging research as well: incorporating information on relevant clinical trials together with the test result so that clinicians and patients have the opportunity to consider clinical trials they may not otherwise know about.
The overall goal of building tools like this (which exist for some other specialty services as well) is to put resources in hands of community providers. These and other partnerships with academic institutions, with payors and with patients make clear that “healthcare is a team sport.”
The company’s patient portal, MyQuest, has five million active patient users. Thirty percent of consumers are caregivers, caring for dependent child or parent, and folks can integrate family member data into a single account, with a single login. Patients can make appointments and pay bills, and can also access longitudinal views and reports similar to those available to clinicians. Context is provided for patients — more educational content, including videos, that are likely to be more helpful for consumers — and “expert patients” such as chronic condition patients can drill down as far as they want to go. Quest can see how deep patients go in “peeling the layers of the onion,” and additional resources are included as they go deeper.
When I asked Lidia to think about what she would hope or expect to find five years in the future, she couldn’t limit herself to one thing, so she offered three:
- Self-driving cars;
- Voice-based always-on connections, through intelligent assistants and chatbots, perhaps prying us free of our “iPhone prayer” devotions; and
- Blockchain-enabled easier use and exchange of personal data.
I spoke with Lidia as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.