Episode Transcript:

Frank Maddux: Health care’s use of digital technology has changed significantly in the past decade, from online patient records to telemedicine to connected health. As the health care industry evolves with new technology and legislation, identifying security threats and keeping patient data safe is a top priority. Today's guest is Anjana Harve, Fresenius Medical Care’s chief information officer. She talks about cybersecurity and the use of health information technology to improve the quality of care for patients. Anjana, thanks for joining me.

Anjana Harve: Thank you so much for having me here.

Frank Maddux: Let's talk a little bit about cybersecurity first. A lot of people hear in the public press about cyber events and other things. Give me your sense of cybersecurity in health care and sort of what its importance is and how you're addressing it.

Anjana Harve: I'd say definitely the importance of cybersecurity is increasing because, as you know, more and more of our business operations have become digitized. So as companies-- and certainly Fresenius Medical Care is no different. We're automating a lot of things, we're digitizing things. I think the exposure to cyber potential threat actors starts to increase, and so we're definitely feeling that as well, and the problem with cybersecurity, as you can imagine, is it can easily have an identity theft, and somebody can get access to your data, there can be loss of data that can happen, so lots of issues. There's ransomware that people can come in and kind of make a claim on the data that you've got and kind of hold you hostage, if you will. So lots of issues with cybersecurity if you do get into that, and so I think the importance of cybersecurity in today's world-- I cannot underscore how critical it is. And you talked about health care, Frank. I think it's even more critical because-- I was looking at some of the statistics, and I think more than 34 percent of the breaches actually happen in health care, so it's one of the most targeted, I would say, sectors, and we are part of that sector, and so doing everything we can is going to be important, and health care itself-- I think just as the evolution of the industry, lots of outdated technology, as you can imagine, that we've got within hospitals, within the health care system itself. Lots of different kinds of users that come in, so it's hard to really educate and get different people up to speed on having the right cyber hygiene, if you will, and making sure that we are taking care of the connected devices because more and more in our environment you've got all of the medical devices that are more connected, which is all great on one hand and gives us a lot of value, which we can talk about, but certainly it increases the exposure and the threat to cybersecurity.

Frank Maddux: I have spent many years interested in how health information technology can actually improve my work as a physician, but give me your perspective on what the opportunities are for IT to actually influence patient outcomes.

Anjana Harve: It all comes back to data and insights, Frank, and I think technology can play such a tremendous role, and that's what I'm passionate about is how do we take the information, the insights to better equip, provide the right information, the right recommendations, interventions? Ultimately, the clinician is important and super important and critical in all of this, but if you can aid and support that with the right decision support systems, with the right insights, I think the world opens up in what we can do from a data and analytics perspective, and so that's what I'm really excited about. It's all about, in my mind, kind of thinking about the truly 360-degree view of the patient. So all aspects of the data that relate to a patient, how do we curate it? How do we pull that together, draw some patterns and insights out of that, and then embed that into our systems that we have, our clinical information systems to kind of find the right relevant data that can be provided to our clinicians at the right time.  

Frank Maddux: One of the things that's changing in the environment right now is we've shifted our lens from being strictly on the beginning to the end of an individual dialysis treatment and historically predominantly a hemodialysis treatment. It's now widened out into the patient's home environment, into looking at things that we might sense otherwise in their environment, and this entire opportunity of connected health presents such a such an open field for us to actually have greater influence on good decision making by patients. How do you see connected health being structured in the company, and how do you see us actually embracing that?

Anjana Harve: It's absolutely critical, I would say. As you think of the patient in the center, which is what I'm really happy as a company we’re thinking about, for me, it starts with patient centricity. We've done a number of things from kind of keeping the patient at the center. What kind of communications do we want to give the patient seamlessly for them to communicate with us? How can they place orders for their supplies much easier? How can they go in and make sure that they're putting in all their flow sheets, and we can communicate back to them? So many, many aspects of kind of thinking about it from a patient perspective all the way to how do we equip the care teams and bring a truly integrated care team together with the right insights for that patient? Bringing that and then, ultimately, from a provider perspective, providing them the tools, and so that's really, as I think about our connected health, is patient at the center but everything around it to kind of really bring the right technology pieces in-- all in pursuit of one thing, which is really to improve the quality of our patient care.

Frank Maddux: To what degree is there a need for broad data governance as we collect through connected health much more data or potentially much more data than what we have today?

Anjana Harve: I think data governance, data sharing, and kind of really systematizing that, which we don't have a lot of that today as well, right? So it's really-- we are slowly kind of opportunistically trying to figure these things out versus a scalable method, and as we get the explosion of data, that has to be scalable. It can’t be I’ll pick up the phone, call this person. Can I do A, B, and C? Which is a little bit of how we operate today. So it starts to embed all of those things.

Frank Maddux: How do you think the standards are evolving? Are they evolving swiftly enough to catch up with the technology?

Anjana Harve: Not as swiftly. I would definitely-- as an industry, if I think about where we are, what we need to do, how we start doing things, it's not as fast as we need to, so I think that is part of the whole interconnectivity and interoperability of things and why health care is such a challenge, especially in the US, but suddenly now there are other countries and regions as well. It's not keeping up at the pace at what we need to, but-- which means that industry needs to come together and start figuring out ways and means because without the right data sharing, you can't get the insights. So it's almost a premise of really how do you start to connect the data and exchange data to be able to unlock that? Otherwise, it becomes silos of information that sits in different pockets, and yes, you could share data, but it's very transactional based today versus really the power of what can be actually extrapolated.

Frank Maddux: One of the things that I've always thought we needed to become a little more facile with was the development of application programming interfaces, or APIs, that can access data from a lot of different points but through a single data call, essentially. Do you think that's still the model going forward, or do you think there's something else that's going to evolve?

Anjana Harve: We have now embarked on that with many parts of our teams coming together and really laying that foundation because then it becomes-- it's almost like-- the term we use is data supply chain. How do I take data from one to the other to the other as and when I need it and reuse data, make it available where it's needed? And so really having that sort of an integrated supply chain of data, if you will, and having that pipe is really what we're starting to work on.

Frank Maddux: Study it.

Anjana Harve: Exactly. Yes. Go procure it, whereas it's part of the record itself that I'm able to pull and make some relevant sort of comparisons, etc. So we're definitely doing that both with external data, Frank, but also internally kind of setting up the right architecture, a modular way of kind of thinking about data, about applications, about interconnectivity because that's what it's all about. It's all about integration, so if I think about what is technology or an IT role anymore, it's all about how you integrate and facilitate and bring all of this information is more valuable than I’m just going to go build 35 different applications and systems and getting it done.

Frank Maddux: It strikes me that a lot of our data is sort of single-purpose use right now and the ability to create a way in which we syndicate that content or syndicate that knowledge into several pathways that are more pertinent for whoever the receiver is, whether it's to a mobile channel versus a fixed channel or whether it's different information that needs to go to different categories of people. Your description that we are multiple industries all together in one manufacturing and R&D and communications and health IT-- it is pretty amazing that if we can in fact find a way to syndicate certain content to the right audience, that would be a much more extensible system.

Anjana Harve: Exactly. And doing it-- and we can do that with the right context with making sure the right data sharing systematically, that we can kind of do it versus I pick up the phone and figure out what-- I can take this data and syndicate and give it to you versus it's available in a shared environment that is protected, rightfully protected, encrypted, anonymized in the right manner but can be shared. So absolutely, Frank. I think that's where it opens up, and you start to really get the multiple values, as you said, multiple pathways of using it versus single use. So it's very transactional based today, and the journey we're embarking on is really getting us to really open up the doors between this but in the right manner, of course, with making sure the right rules are followed, the right regulations are in place.

Frank Maddux: The privacy rules across different parts of the world are quite different.

Anjana Harve: Absolutely. But there are technologies that can actually help us make sure we're still compliant, if you will, to all of those but open up the doors versus today it's a little bit of very, very opportunistic sharing versus a more systematic way, so..

Frank Maddux: How do we get to the point where our time is spent in its most valuable way and get to the most efficient systems that can put us in an environment that we don't put the company at risk or ourselves at risk?

Anjana Harve: I would definitely say the way we're trying to approach it is really-- How do we look at it from a persona-based, role-centric experience of what's needed? And then we can have the right workflows, the right systems to string it all together so we don't go in and cause more confusion.  What I'm excited about is really taking that sort of experience-based view of what is needed to make that person do their job really well, whoever that person may be. And how do we then stitch systems and information that actually enables that person? And that if we can start doing things like that, then it won't come in the way but, hopefully, make it easier for them to do their job.

Frank Maddux: What do you think the culture should be five years from now?

Anjana Harve: As we think of the future-- for me, it's all about collaboration tools, and we're definitely doing a lot more with Teams, but even that, as you know, we've got different fragmented environments. Doesn't enable the-- sort of the true thriving and collaborative environment that we need. The one thing I miss is kind of going and collaborating together on a whiteboard, but there are many tools that we're evaluating now to start to stitch all of that in the same seamless environment, not 35 different systems to go to but bring it all into one environment that you can get in. I really see that-- that's where knowledge can be, knowledge management tools and the ability to share information across regions. So we definitely have that in the strategy of really bringing collaboration and knowledge management, which I think will be foundational for us to start to collaborate together.

Frank Maddux: I know that both of our major clinical systems are going to get to their end of their life in the professional lifetimes of many of us.

Anjana Harve: Yeah.

Frank Maddux: Do you think that we will linearly move to the next level of technological sophistication, or do you think we'll be able to jump over some of that?

Anjana Harve: I would say a little bit of both, Frank. So absolutely, without a doubt -- in my mind, when we're investing a dollar or a euro, we've got to-- let's try to see if we can leapfrog that amount into the right place. A general philosophy. Having said that, I think we'll need to make some choices and kind of-- is it too big a leap, and is it too much, and do we need to prioritize our method? I think the future where we have to get to is much more facial ID, fingerprints. There's so many more technologies that have come through, voice recognition. There's a number of different secure technologies. So I think my answer would be we'll do our best where we can. Absolutely the mindset is let's leapfrog, but given all the constraints in place, in some cases I think we might have to take a two-step process, rather than taking our legacy and trying to take the best of A, B, and C to create what we need to create, let's take this opportunity. So that's the mindset.

Frank Maddux: Telehealth and telemedicine are evolving fairly quickly, and one of the thought arguments that have been made is could we in fact enhance what's happening at a clinic anywhere in the world by creating sort of a centralized cockpit of information and visibility on the treatments as they're happening? do you think we're headed in that direction or not?

Anjana Harve: I think where we're trying to take this is truly taking telehealth as an embedded part of everything we do. To your point, it becomes a channel through which we can communicate and interact with our patients, but how do you put the right information around it so that when you're having that discussion dialogue, you can actually have the relevant information that comes along with this sort of video channel, that you can actually meet and talk to your patients? That's really where we've embarked on and really a truly integrated telehealth, which is kind of the version two of where we're headed, and really making some great progress there, and I do see it's going to continue even more as we-- it is certainly-- it’s never going to replace sort of an in-person visit and things like that, but it can be a huge augmentation, I would say, in providing the right care.

Frank Maddux: I think augmenting our ability to keep our eyes on critical information and things that might have impact the patient are really important. One of the things that I wonder about is to what degree-- you've told me we have many petabytes of information today, and I imagine with some of the projects, like our genomics project and others, that's going to expand rather dramatically.

Anjana Harve: Right.

Frank Maddux: How do you manage the infrastructure? And talk a little bit about the cloud, cloud security, and to what degree are we going to be obligated to participate in some of these more novel sort of infrastructural areas as opposed to having IT physically located in one of our shops?

Anjana Harve: We have definitely embarked on a large sort of cloud transformation because to your point, we have-- we're sitting on a wealth of data, I would say, but the wealth of data can only be-- if you capitalize on it and you can actually garner insights, only then is it of value, and there's a lot of things-- rather than reinventing the wheel ourselves and infrastructure that we've got, it is so much easier to leverage the cloud and be able to use native tools that are available, security sort of built in from day, one encryption built in from day one, a lot of things that we don't have to really reinvent the wheel, I would say. So we're starting to embark on that, really the cloud journey pretty significantly, I would say, in bringing all of these multiple data sources, and it's a wealth of data and information that we're starting to collect from our dialysis machine, from our treatment data, as you talked about, the genomics data, maybe Fitbits and Apple Watch, and all of these kinds of data that are starting to now-- for us to really collate the vital information, all of this together, but you can do that only in a manner that can scale pretty fast. And being in the industry we are in, Frank, I think the other thing that's really key is how do we ensure the right sort of data sharing from an anonymization of the data to kind of really get the full value of this? So we're trying to incorporate some of those principles as we set up the right foundation and take the data that used to be legacy, if you will, or historical that we've collected but start to establish it in the right manner. So it's an exciting front as I think about kind of where this can explode and kind of take us as we move forward.

Frank Maddux: I know you're in the middle of a fairly substantive transformation in DTI, and I've described our systems a bit as being a bit of a Gordian knot that-- trying to untangle and understand where we have opportunities. Just speak for a moment about the transformation and your thoughts about how you anticipate us stepping through creating an environment that’s sort of a One Fresenius Medical Care environment.

Anjana Harve: I think we've ended up with a lot of-- a little bit of a fragmentation over the history, over the course of the years as we've grown organically, and now we've got a fantastic chance to bring this all together and multiply the power of what we have, and so that's the journey. So the way we've started it, Frank, is really first start with let's define the strategy of what we want to do, and then we can kind of think of the path and where we want to go. So spent a lot a lot of time over the last several months really putting together, crafting our overall information technology strategy for the company itself to say where and how does technology play a role in a competitive advantage perspective, from a patient care perspective? What are the kinds of things that we need? And so we've laid out a pretty large and overarching roadmap of the things that we need to do, and now organizationally we're coming together because we can only achieve things if we come together as a team, as an overall group together, and so that's the next step of the evolution we're doing is changing our operating model, bringing teams together, and I think everyone's excited, I will genuinely say, as I think about the opportunity ahead of us. People see it because you can-- it is so much easier to multiply things when you come together than each of us trying to solve things in one single way with limited resources, limited ability to do things, and so I think huge openness within the organization to-- and excitement, actually, I would say, of coming together as a global team to now start to execute on that overall strategy. So we're going to see a lot more, I think, systems that come together and to capitalize on that sort of data that we were just talking about.

Frank Maddux: You have one of the greatest challenges in managing expectations of all of the rest of us that this is not a simple journey. It's a journey.

Anjana Harve: Yeah. Mm-hmm. Yeah.

Frank Maddux: How would you articulate sort of the greatest opportunity, the greatest challenge, and how you're prioritizing what to do first, second, third?

Anjana Harve: It's a huge challenge because there's so much to get done and so much of pent-up demand, and so then it becomes a question of what's the right choices to make.  The way I would describe it, I would say the opportunity I had for us is let's use the dollars we have wisely where it makes sense as in standardized-- where it-- there is no need for differentiation. Let's not waste our time and debate and kind of standardize and harmonize things, and let's focus all our energy, our people, our dollars, on things that truly matter and make a difference with where we need to go. As a company itself, I tell a lot of people I’m bringing on board is multiple industries rolled into one with very diverse set of technology needs, and so how do you bring it all together and make sense of what's the right map? For me, I think we've put together the overall strategy. I think sitting down and having a reasonable discussion with each of our stakeholders, being transparent, communicating, and readjusting the strategy as needed because the business moves and changes. We can't be just stuck with this is my perfect way of doing it. I think that's what I've seen in my previous experiences as well is what makes a transformation successful versus where it can be a drag. I think it's that open dialogue discussion, healthy discussions on where do we invest our time, effort, and money I think is the right thing. So looking forward to all of your support. I mean, each function and each group has a lot of pent-up demand, but we're trying our best to sequence it, Frank, on making sure where we do, and also figuring out how we split our time. So some of it, I think, is foundational things that we have to get done where it's a long-term play, not a short-term play, but some portion of the portfolio and our investment and our efforts are going to be towards the more near-term, short wins that we can do, and hopefully, we're trying to craft the right balance, Frank, on kind of let's not all focus on the near term or just focus on the long term, because we're going to get by otherwise, and having the right balance, I think, is important.

Frank Maddux: As we've seen in the Medical Office, globalizing activity brings a lot of new voices into play, and there's great benefit in hearing those voices and recognizing both what's the same and what's different in different parts of the world. I can only imagine you're going through a similar process in recognizing that there are a lot of good ideas out there, and yet, on some things, we don't need two or three versions of the same thing. We need to pick a version and choose that. You've brought on a variety of new folks to the organization. You've got some people that have great institutional knowledge involved. Where do you see the timeline, and how are you approaching trying to figure out what do we do next?

Anjana Harve: Once we had this sort of overarching maybe 50,000-foot level strategy, if you will, which is what we define, then kind of worked on kind of really what's the right purpose-built operating model? For me, you can create an org chart in many different ways, but what's right for the journey we have to embark on was very critical to kind of think through. So we did that, and now, as you said, been bringing on definitely a good balance, I would say, of internal talent where-- we've got some great talent, great people. I tell everyone it’s the commitment of this organization that I'm truly, truly surprised but also very, very proud of when I think about how much of commitment there is in the overall IT organization, but we're balancing it with some outside-in thinking as well because we don't need to do this all by ourselves. There's others who have done it, and let's bring the right balance of that thinking. So that's been the next step of kind of bringing the right talent, getting them up to speed, understanding because a lot of this is listening, understanding sort of where we are, what are the thoughts and feedback from the team to kind of then take the next step? As I look ahead, to your point, on what's next and how do we do it, we're now pulling the teams together to start to take that sort of 50,000-foot level strategy into more very, very detailed plans that we can start to make, and that's where some of the difficult choices we'll have to make, So I would say in the next several months for us to start to share all of those details and get your feedback on kind of where things are and how do we move it forward.

Frank Maddux: It's clear there isn't a part of the company that doesn't rely on either our digital framework or IT framework to be able to either do the work logistically and operationally or in fact, in our case in the Medical Office, not only operationally support the work that's being done but also gain new knowledge and have the chance to do that. I'm curious whether you think there's anything individually that every employee can do that helps support the strength of the system. We started our conversation around cybersecurity. I'd like to end it back with what would you be asking of each of us in trying to help us keep our systems safe and allow us to safely go along this journey that you've described for DTI?

Anjana Harve: Definitely I think each one of us plays a role because each one of us is a touch point to how you can enter the company. So while we're spending a lot of time, effort and-- to kind of really advance our defenses, if you will, from a technology perspective, how do we protect the company, the assets, the information, each and every one of us is the open door that can potentially have the pathway into coming, and so I call it the human firewall that we also need to build along with the technology firewalls that we build and can protect the company, and so each one of us plays a role because we might get an email that could be an innocent email but could open up the door to-- for somebody to kind of make their way in. Could be a phone call, socially engineered calls that come in and may pretend to be someone else, and they try to get some-- elicit some feedback from each of us. So my ask, I think-- as you said, each one of us has a role to play, an active role to play in supporting and protecting the company. A couple of simple tips to kind of keep in mind and remember as we go through it. Certainly encrypt all of the data. If it's sensitive data that you're sending in, be sure to encrypt it and make sure-- use MFA, which is multi-factorial authentication. That's a simple way but a very-- at least it's multiple ways of kind of making sure security is strengthened, and so that's another one, I would say. Let's definitely please keep in mind and kind of use the tools that we've supplied and done. The other one I would recommend is be slow and think hard because some of these are pretty sophisticated sort of methods to getting us, and so there's a quick reaction you might have when you look at it, especially if it's your boss or someone else who’s sending it or someone high up who's sending an email. An immediate knee jerk reaction is what ends up causing all of this, but if you take some time, you really review it, look at where the email address from where it's come from, little simple tips I think can go a long way. Err on the side of caution rather than the other side, and if God forbid-- sometimes when-- we all do that. We're human. You click on something. Immediately at least call and tell us so we can kind of react quickly because it's not a question of-- we can't prevent everything, but I think we're also in the same time trying to employ the right defenses to say if things do happen, how do we react quickly? How do we contain it? How do we ensure that doesn't spread across. So lots of communication, being vigilant, open, and kind of taking the right sort of security trainings that we're providing. All of that goes a long way in strengthening us as a company.

Frank Maddux: I think the analogy for many of us that have been clinicians or involved directly in patient care is for many of our chronic diseases, we employ what I call active surveillance. We're constantly trying to look at whether the condition’s stable or it's getting worse and how we might respond to that. I think our personal cybersecurity journey is to try to also make sure we are actively surveilling ourselves as being potential sources of threat that could come through our portal.

Anjana Harve: Yes, exactly. Just keeping that in mind, and you said it, a beautiful analogy, but I think you're exactly right, Frank. Each one of us know that we could be the conduit and being cautious and vigilant about it and monitoring what we're doing. I think it goes a huge way in really protecting us as a company.

Frank Maddux: Anjana Harve, who is our global chief information officer, has been with me today talking a little bit about the journey we're on and the challenge and opportunities involved in ever-improving health information technology environment. Anjana, thanks for joining me.

Anjana Harve: Thank you so much for having me again.