Houston Methodist's Dr. Roberta Schwartz on the 'struggle' of balancing data privacy with innovation: 'It comes with friction'

Roberta Schwartz, PhD, is executive vice president and chief innovation officer of Houston Methodist and CEO of Houston Methodist Hospital — two complementary roles that she juggles with "way too much energy."

That sense of collaboration is reflected not only in the makeup of the other members of Houston Methodist's innovation team, all of whom boast similar combinations of operational and innovation roles, but also in Dr. Schwartz's overarching approach to innovation, which depends on ongoing collaboration with other hospitals and health systems, industry partners, technology companies — anyone who shares Houston Methodist's emphasis on rapid, forward-thinking innovation.

"What we're seeing is everyone just has a little bit of a different focus: Some are on building, and some are on buying," she said. "They're all going to make significant contributions, as long as we learn from each other and don't waste a huge amount of time reinventing the wheel over and over and over again. All of us who are dedicated to it are going to be a piece of what's going to help transform the industry."

Here, Dr. Schwartz explains how she has enabled her team to both succeed fast and fail fast, and discusses the murky way forward for maintaining data privacy in healthcare.

Editor's note: Responses have been lightly edited for length and clarity.

Question: How do your dual roles of academic hospital CEO and health system chief innovation officer fit together and inform one another?

Dr. Roberta Schwartz:
Well, my husband says I have way too much energy! I was listening to an interesting lecture from Ochsner today, and they were saying one of the keys for their success was that they have dedicated people who do nothing but innovation all day. But we would say one of our key reasons that we've been so successful in innovation is that almost everybody in our innovation shop shares an operational role and an innovation role.

The reason I love that is whatever we innovate, we have to live with. I know how a hospital works; I know how, culturally, my physicians work; I know what my employees are willing to adopt and what they're not. If I'm going to put in a system that makes them change, I then have to manage the cultural change that comes with it. I also have to inspire that group of people to make changes. If I'm going to put in something that's going to reduce working hours, I'm going to be the person who has to look those employees in the eyes and say, "I'm moving your cheese, and I have other jobs for you."

I also know key questions and problems that we are challenged with every day — from an employee level and from a patient level — that need, desperately, to be fixed, and I can look for innovations that help me fix this.

I was just talking to my boss today, saying I really feel like I've done what I said I was going to do, which is a couple of days a week are nothing but my innovation days, and a couple of days a week are my hospital days.

Q: So you have a few days dedicated to each, and you feel like they each continuously inform the other?

RS: Right. I was just in a meeting talking with one of my key faculty who's interested in asking both research and clinical business questions about radiosurgery and brain metastasis. From my operational hat, I know everything that's in my databases that we code from, because I'm very in tune with my coding data. When I then sit with my innovation hat, I can say to him that I also know what programs are coming down the pike that will do natural language processing that will take him to a different level of database. So I can help him from two different hats to get him where he wants to go.

Q: You come from a business-heavy background — how has that business perspective helped you make Houston Methodist's innovation strategy unique from other hospital innovation programs?

RS: I've been doing healthcare since I started candy striping when I was 13. I never wanted to do anything but healthcare, but I never wanted to be a clinician. And so, more than anything, I am a healthcare expert. I've gotten to do things from the medical school side and really understand the business of research and education. In my consulting role, I've gotten to work with pediatric hospitals, adult hospitals, academic hospitals, community hospitals — doing everything from improving operations to, one of the first things I got to do in my career, working in the Senate to write the GME sections of the single-payer bill.

What I've learned over the years of all of the different pieces and parts of my career is how the business of healthcare works, how clinicians interface with a hospital, how clinicians interface with their patients, how the patients want to seek care from different pieces and parts of an organization. I've gotten to see things through different lenses and, over a career that's now spanned 30 years, I've enjoyed seeing these multiple ways of looking at how to make healthcare better.

Q: How do you think that compares to innovation programs that are run by clinicians or people who came from outside of healthcare?

It's interesting —when you look across the country, if you've seen one innovation organization, you've seen one. Some are very focused on bringing in somebody from Google or Amazon, to say, "We're all doing things wrong. We need to look at it from a consumer perspective and stop focusing on changing what we've got, but just rip up what we've got and listen to what the consumers are saying." And I respect them completely.

And then you've got clinicians coming in who are saying, "I think there's a lot that we can do to change the lens that the physicians are working with our patients on." What I find in those shops is they're a little bit more predictive analytics-, artificial intelligence-focused, while someone who comes into it from the industry side is looking at it like, "How do you get an appointment? How do you access the system? How do you get the patient's information?"

What we're seeing is everyone just has a little bit of a different focus: Some are on building, and some are on buying. I think what we have to respect is they're all going to make significant contributions, as long as we learn from each other and don't waste a huge amount of time reinventing the wheel over and over and over again. All of us who are dedicated to it are going to be a piece of what's going to help transform the industry.

Q: That seems to be the prevailing message when it comes to healthcare innovation — that collaboration is key.

Right, and it's really interesting because there's so much to do. I look at Stanford Health Care and I'm constantly listening to what they're talking about in predictive analytics. And I listen to Penn Medicine because they are so interesting in behavioral health design. But I also listen to Livongo, because Livongo's messages make a huge amount of sense. I'm listening to Twitter, because they have a whole different sense of where the market is coming from.

We're integrating all of these messages. Everyone's trying things, and those who are really being forward in innovation are saying it's OK to fail. If I'm saying it's OK to fail, that means so is [Penn Medicine Chief Innovation Officer] Roy Rosin and so is Tom Maddox [executive director of BJC HealthCare's Healthcare Innovation Lab] and so is [Cedars-Sinai Medical Center CIO] Darren Dworkin. I can learn not to do what they've said fails, and I can also learn that, if Darren says it really works, it really works, and I can adopt that. And when I'm trying things and failing, I tell them, "Hey, don't do that. I went down that road and it's a dead end."

Q: Your team operates under a "succeed fast, fail fast" mentality. What support and what safeguards do you have in place at Houston Methodist to allow the team to fail fast and then pick up and keep going?

What we do is we give people leverage within a certain cost structure and a certain amount of time. Every one of my contracts has an out. There is no contract we will sign at this organization that I don't have an out in a year. And that is because we don't pilot — we assume it's going to succeed. But if it doesn't, we want to be able to walk away from the table.

Q: Since the Project Nightingale news broke, much of the conversation has been about how data sharing is so important to healthcare innovation, but only if the right privacy structures are in place. How is your team getting over that barrier and adapting to these constantly changing and evolving privacy issues and other issues related to how quickly technology is evolving?

I'll tell you, it really is very hard. Once our patients leave us and go to a different organization or have a test at a different place, we want to have that information so we can have a comprehensive picture of the patient, but if you don't need it for clinical reasons, you can't touch that information. So putting a comprehensive picture together of a patient is pretty hard.

Privacy versus being able to move faster is going to be a struggle. Are all of us doing it and making it work? Yes, we do it a lot faster and with less clunkiness. But here's an example of where we struggle with this: In your daily routine, if you're going to get information on library books that are overdue or where your friends are going to meet you for dinner, whatever it is, most of that information you get in your texts. But if we want to send you a piece of information, you may have to go through six levels of security to get there. You may get a piece of information that says you have a text, then you have to log on. Then, you may have to put in a two-security identification to be able to get the information from your healthcare system to ensure that we have the level of security you need.

You don't require that from anybody else who's sending you information, and because of the fact that you have to jump through some of these hoops to ensure that the privacy's there, you may be less likely to engage. So as we think about this, when we're trying to get compliance on remote monitoring or to make sure that you showed up for your appointment, if I'm trying to get in touch with you and you have to jump through three hoops because of all of these rules and regulations and privacy, you may be less likely to do it.

Think about your 80-year-old grandmother or someone who may have depression or three comorbid conditions — this is who I'm trying to reach. I want to do it with the least friction possible, but ensuring security and privacy of your information comes with friction. And so I appreciate the struggle, I respect it very much.

Another problem is that many of us are still learning tech speak. We have partners that are amazing partners, but sometimes it takes me a little bit longer to understand what they're saying. That's why having all the right people around the table is absolutely necessary.

Q: So, would you say there's not really a clear way forward yet?

RS: In all my years of history, I haven't gained that level of intelligence to be able to figure it out yet. But I'm working on it.

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