By Katlyn Nemani, MD

Bryan Sivak is the chief technology officer (CTO) at the US Department of Health and Human Services. Reporting to Secretary of Health and Human Services (HHS) Kathleen Sebelius, he is only the second incumbent of that position. In his role, Mr. Sivak has been a national advocate for advanced uses of health care data to improve health care.

What was your path to becoming CTO of the Department of HHS?

It's been fairly accidental, actually. I'm really a software entrepreneur at heart—I co-founded an enterprise software company in 1997 in San Francisco, and in 2005 moved to the United Kingdom to open up the European and Asian operations. In 2009, I was recruited by Mayor Adrian Fenty to be the chief information officer for the city of Washington, DC. Although I had never really thought about public service, it was an intriguing opportunity and I ended up accepting the offer and moving back to the United States.

The job with the city was a blast, but about 1 ½ years after I started, Mayor Fenty lost his re-election bid. I met Governor Martin O'Malley of Maryland around that time, and as we began talking, we realized that there was a great opportunity to bring innovation to the state of Maryland, and so we created the position of Chief Innovation Officer.

I had no intention of leaving this job until the end of the Governor's term in 2014, but when Todd Park moved from HHS over to the White House, we began talking and he asked if I would consider taking over his old role. I thought long and hard about the role and eventually came to the conclusion that, as someone who likes disruption and bringing new ideas into existing organizations and industries, there was no better time or place to get involved in health, health care, and the delivery of human services. That was almost exactly a year ago at this point, and the job has been amazing so far.

What is the role of the CTO?

I actually have two titles in the department: CTO and entrepreneur-in-residence. I mention this because it's important to note that, while technology has a large impact on the work we do, we look at technology more as an enabler, catalyst, or accelerant rather than something that will solve problems on its own. Therefore, our role really is to identify and leverage underutilized departmental assets to encourage the transformation of public health, health care, and the delivery of human services, and in doing so, build the foundation for a next-generation government.

The first asset we targeted starting 3 years ago was the vast treasure trove of data locked up within the walls of the department. We are continuing our data efforts, but have added a new asset to the target list—specifically, allowing the potential of the 90,000 employees of the department to be fully realized.

You have spoken extensively about data liberation—what does that idea mean in this context?

When we talk about data liberation, we are referring to the idea of taking data that has been locked up in government silos and making it publicly available, or transforming already publicly available data into useful formats. It means changing the culture on how we use and value data in the department. It means enhancing the value of data by allowing developers, entrepreneurs, and others to use the data to create interesting applications, services, and products that have the potential to solve some of health care's biggest problems.

Prior to releasing data we ensure quality levels are met, and we ensure that privacy and security are taken into account. We are very careful stewards of the personal data that the department holds. In cases where there are legitimate uses of data containing personally identifiable information, data liberation means making it easy for qualified entities to fulfill the requirements necessary to execute data use agreements that will then provide access to protected public data.

In general, the point is that we are taking government data that has traditionally not been available to the public and making it accessible so folks outside the department can help us solve some of the largest problems in our space.

Why is the present time a special time for use of data in health care?

Health care is in a state of radical transformation. Regardless of your political leanings, everyone realizes the current system we have is broken and that things need to change.

There is one common denominator across all aspects of this transformation, and that's data. Data are changing how health care is administered, by allowing us to focus on the quality of care and outcomes versus simply paying for services. Data are changing how people interact with health care— through sensors and their own personal data, which allows them to make and manage their own health care decisions. And data are helping people purchase health insurance, via the new Health Insurance Marketplaces that will be launching in October.

What do you see as the greatest opportunities to enhance health through data and technology?

There are a number of opportunities in this area, but I think some of the most interesting involve the intersection of personal health data and personalized medicine. As sensors become less costly and more ubiquitous, we are beginning to see personal health data being collected on a regular and massive scale. At this point the uses of these data are very basic, but we're beginning to see some interesting applications of proactive and/or predictive algorithms that are designed to influence behavior in real time. As we get more sophisticated in these analyses, and start to pull in clinical data along with a deeper understanding of genomics, proteomics, and other related fields, we'll begin to see a sea change in the way that medicine is practiced and patients become engaged in their own health.

What do you see as some of the biggest obstacles to enhancing clinical care through technology? How can we overcome these?

I believe the biggest obstacle to enhanced clinical care through technology is completely based in the culture and process of our current system. The majority of players in the health care ecosystem operate in a fee-for-service environment, and the support systems and processes in use have been designed for this mode. As a result, doctors have extremely limited time to spend with patients, and the current state and design of our health technology tends to take more time, not less, which significantly limits the possibility of adoption and use—even though we know that outcomes will improve once these systems are used appropriately and interoperably.

These barriers can be overcome, but we need to focus intensely on a few areas: fixing the design and implementations of the systems themselves to make them more user friendly and helpful to practitioners and patients alike, solving the problems created by fee-for-service incentive structures by building new mechanisms of reimbursement based on outcomes and wellness, and making pathways for new technology less burdensome while still ensuring safety.

What do you see as the key achievements of your term as HHS CTO? What will be your legacy?

It's only been a year, but so far we have made some significant progress in a couple of areas. First, we've continued to focus on the idea of data liberation and use, represented most visibly by our annual conference, the Health Datapalooza IV in early June, which attracted 2,000 people to Washington, DC, for a 2 ½-day celebration of all things related to health data. We are expanding our efforts in this area significantly, so watch for many more activities over the next year.

Second, we have really started to move the needle on bringing the concepts of innovation—which we define as the direct result of the freedom to experiment—to the massive bureaucracy that is the Department of HHS. We see this in the number of people who are engaged in status quo–challenging activities, some very significant breaking down of existing silos with partnerships and collaborations that haven't happened in the past, and a general willingness to experiment even when success is not guaranteed.

Legacy questions are pretty difficult to answer, but I'm hopeful that we can put the foundations of a new model for government in place that will continue long past this administration. We are at a significant inflection point in both the way health care is provided as well as how government is executed, and if we can execute successfully, we can leverage this moment in time to improve both systems dramatically.

Katlyn Nemani, MD, is from Tufts University School of Medicine in Boston.

Keywords: Public Health, Delivery of Health Care, Medicine, Software, Proteomics, United States

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