Las Vegas 2018
Enabling Business Transformation in Health Care
As health care evolves to a more "consumer" centric model, software delivery teams in these organizations are finding new and innovative ways to work to support the speed and experimentation expected by their business partners. Kaiser Permanente has built a DevOps practice to meet these needs, and is contributing to a larger transformation internally and externally with their members' experience.
As vice president, Digital Presence Technologies, Alice Raia is a leader in digital transformation at Kaiser Permanente. She drives the strategic direction for the software-development group that delivers Kaiser Permanente's digital channels including kp.org and mobile applications. Partnering with marketing, business, and clinical leaders, she also works to define and execute Kaiser Permanentes Consumer Digital Strategy and its laser focus on engaging consumers and members in their total health by delivering end-to-end digital experiences that are seamless, convenient, and personalized.
Alice also leads the DevOps transformation in IT, ensuring that the organization's development philosophy, platform, framework, and processes are set up to deliver into production efficiently, securely, and rapidly.
A veteran in the software delivery world, Alice cut her programming teeth in Silicon Valley with tech giants Apple and Hewlett Packard. More recently, she led web and mobile applications development for Blue Shield of California. She holds a master's degree in management from Purdue University.
AR
Alice Raia
Vice President, Digital Presence Technologies, Kaiser Permanente
LQ
Le Quach
Director, Strategic Design & Implementation, Kaiser Permanente
Transcript
So the next speaker is Alice Raya. She's VP of Digital Presence Technologies at Kaiser Permanente. Uh, last year, uh, at the conference, her talk was one of my favorites. It is this amazing experience report of how she's modernizing the technology organization and the healthcare industry where they deal with not only patients, but also the providers. That's doctors, nurses, pharmacists, in an integrated clinical setting of all the places where we want technology to work. It's there. She's going to talk about the continuation of the journey at Kaiser. Not only is she helping more and more parts of the organization, but she's also working with a group of physicians and staff in Southern California to totally reimagine what healthcare should look like for patients. Alrea raa.
Thank you. Good morning everyone. Um, I wanted to thank Jean and the programming committee for inviting me back to talk to you guys about the story of Kaiser Permanente's DevOps journey. It's a journey that not only is changing the way we work in it, but it's changing the way we work with our business partners, and it's actually contributing to a larger transformation in the way we deliver care to our members. So, I'd like to start off a little bit about talking about who Kaiser Permanente is. For those of you that are not familiar with us, we are the largest integrated healthcare system in the United States. We have 12.2 million members spread across eight regions. Um, we have 216,000 employees, about 22,000 physicians, 50 plus thousand nurses. We're a very large organization, but we're especially proud to be rated, um, in the top five of the top 50 companies being recognized for their diversity of their employee workforce.
And we're also very much invested in being a partner in health, not only to our members, but to the communities in which they live. So that's Kaiser permanent data glance. Now I wanna talk to you about who I am, um, and you'll see my business partner, Lee kpi. I wanna introduce her as well. Unfortunately, Lee Qua could not be here today. She's back, uh, at the home office working hard on transformation. But I do have a video where she's kind of talk a little bit about how, um, this new, uh, engagement model that we've got in partnership with business, it is really making a difference for us in moving the needle forward. So, as Jean said, I do, I'm the Vice vice President in IT of Digital Presence technologies that primarily is digital engagement with our consumers and our members. Um, I now only own kp.org and our mobile apps that are consumer facing.
We have a mobility center of excellence, and I also lead the DevOps practice for the organization as well as, um, I'm the owner of the Agile software delivery process. So, Lee Pictured here is a director in our newly formed office of transformation. This is a group that our CEO Bernard Tor Tyson has spun up that reports directly into him. And their major goal in life is to transform the way we deliver healthcare, offering new models to our members, meeting them where they want to be met, weaving health and wellness into their daily lives. So Lee's a director in that organization. Um, she is again, working with her team, um, to create these new models. And you're gonna see some of those models in a few videos that I've brought along with us today. Okay. But one of the things I really wanna stress here is that we are changing the way we work with our business partners.
You'll hear that referenced quite often in the talk. I'm gonna be, um, going into here as well as some examples that Lee will be giving, um, in her videos. Before I dive into kind of what we've done and how it's making a difference, I'd like to talk about our journey. So everyone's got a little different path on how they got to DevOps, but ours was a little bit unique and even more important than the how is the why. So let me start off with where we've come from. Back in 2015, um, our reality for our digital consumer assets was, you know, that we didn't have a lot of investment in them. I mean, they were kind of cool. It was a nice website, nice, nice mobile apps, but we were faced with the fact that we had problems and struggles releasing. It was hard. We could get code out about once every quarter, large bra batch.
I mean, I'm not telling any of you anything that you probably haven't heard here already, but it was difficult. And then we had an aha moment, an uhoh moment. I've, I've heard other people refer to it my, um, a little bit differently here. But, um, our moment was we were tasked with a strategy on changing the way we engage with consumers. The organization was willing to invest a large sum of money to do so, so that we could change the face of healthcare in this country. In order to do that, we were faced with rising expectations of our business partners, predictability, quality and time to market were going to be critical in our ability to innovate and experiment with new care models. So this was our moment where we decided we must do something differently. So we decided to embark on building a modern engineering practice.
Okay? Um, again, with those goals in mind changing mindsets to ensure that we could deliver quicker d to market with predictability and high quality every single time. So how did we explicitly get there? Well, we started in 2016. When it was born, the idea was born and the idea being born means I beg the CIO. Um, we, we executed a series of value stream mappings against our specific release process for kp.org. Um, and it was actually very eye-opening. We all kind of knew there was inefficiencies in waste in the model, but this specifically pointed out to us where we needed to focus and concentrate. I then went back to, said CIO after he agreed, uh, to that this was the right way to go and asked for an investment. So that investment was granted. And the way we operated, we actually sequestered the DevOps team that was going to build our practice. We wanted a little separation away from the daily goings on of the work and allowed those folks to start with a clean sheet of paper. So very smart people in a room pulling together best practice and trying to understand how we could build this so that it would work in a highly regulated healthcare environment, but also press on the status quo and the norms, the cultural norms that we face every day.
We activated the practice when it was 80% done. So this is a really interesting construct. Um, for those of you who may also work in highly regulated industries, we're not big fans of doing, taking one step forward until everything is done, signed off, blah, blah, okay? We intentionally started when it was 80% done because we knew we'd have to iterate. We knew there were things that we who were putting the practice together we're gonna have to accommodate for. Once teams started using the practice, and then we iterated and we iterated and we iterated. We have a few very, um, uh, good teams who are willing to sign up to be early adopters, and they helped us to mature this practice. As of today, we've got 30 squads on the practice. I'll show you some statistics, um, in a late, uh, later on, how many people that means and how many pipelines, et cetera.
But 30 teams are now starting to leverage the practice in these digital assets, and the intent is to spread this all to the rest of it. So this is how we got where we are today. Okay. I talked about how this is changing the way we engage with our business partners and changing care models. So I've got a couple videos I wanna show you. Um, oh, I jumped ahead, I'm sorry. Um, the way, this is some specific ways in which it is changing the way we work. Okay. So I talked a little bit about our DevOps practice. You know, we are, um, engaging, we've got 30 teams on it. Um, it also helps us with some innovation and some experimentation. We're intro introducing a new site, reliability engineering function within our organization, pulling ops more into dev. And, and quite frankly, honestly, we have a, we had a development problem to solve first.
So we started with dev and now we're going into ops. Um, we're moving to the cloud, we're refactoring, we're making sure we're following microservices patterns. So there's a lot of change here in modernizing this enterprise, um, practice and, and engineering practice. But it's also involving a cultural transformation. There are absolutely new mindsets that are necessary. There are new ways of behaving that we're asking our teams to accommodate. Um, and we're adopting things like design thinking, um, empathy, um, you know, co-creating with our business partners, which you'll hear a little bit more about in a couple of minutes. And this collective approach, DevOps, new ways of operating new des new, um, places to put our code, cloud microservices, all of this comes as a package. It's not one of these things that's making a difference. It's all of them that are contributing to that transformation and helping us to be able to enable our business in these new paths that they wanna go down. So now I'd like to introduce the video, um, in this first video you're going to see is actually a day in the life of a care delivery team and a few of our members at Kaiser Permanente. Um, and showcases some of the technologies and approaches that we've put in place that are differentiating us. And I'll come back and talk a little bit about them after we see the video. Can you roll the video please?
Hey sis, it's Dave. Yeah, I'm good. Yeah, no, I'm in front of her house right now. I absolutely, no. Well, she's been down since dad passed. Yeah, well, when she sees you, she's just going to light up. I have no doubt out.
Get your arm off to work. She's not doing too good. Okay. Buffy, you don't feel good. Lemme see. Let me know how it goes. Okay. Okay. You feel warm? Papay. Good morning, Lako here. Good morning Tanya. How are you? Fine. And you? I'm good, thank you. How's everybody's weekend? We doing great? We're good. Awesome. How's it going? It's good. How's your weekend buddy? Good. How about yours? That was good. Good. Just hung out with the family at home this weekend. How about yourself? I work Virginia chair. Wasn't bad. Not too bad. Very nervous. Very nervous.
It's gonna be okay. Mom.
Hi. Good morning. Yes, I'm looking for a video appointment with Dr. La. That'll be for Felipe Soli. How's
My schedule looking this
Morning? It's pretty good. But can we actually add in Monica Sise for a video appointment at 11:00 AM Oh sure. I'll say in the middle of it.
Okay. Thank you. You're welcome.
Oh great. We're gonna see the doctor at 11.
No. Hey, Dr. Edi y don't forget this afternoon. You have telehealth. Got it.
Alright, here we go. Here we go. Motion. Alright.
Hey man. Are you all right? It really hurts. I think you need to go to the emergency room. It just takes so long there. I don't wanna wait. Let me know if you want me to take you Nice time.
Hi
Ms. Rose.
Hi, how are
You? Hi Tracy. Good to see you.
Good to see you guys. Welcome. Great to see you again. You look amazing. Thank you
So much. She does, doesn't she? Oh yes,
She does.
I'm gonna get you all checked in for your visit today.
Hi Monica. Hi Felipe.
Hi Dr. Lacount.
Oh my goodness. He's getting bigger.
He sure is.
I was just going up for a rebound and I came down and I'm just in a lot of pain right now. I can hardly move it.
If you can try to reach up like how I'm doing and touch your opposite shoulder
Like this.
Good.
He's had a little bit of orange juice and a couple sips of water. He did eat dinner last night. Okay.
He, did he keep that down?
Yes, he did.
What I'm thinking when I'm looking at him, he looks very comfortable in your arms. I'm thinking he has a viral syndrome and with that we need to make sure that we keep him as comfortable as possible.
We don't have to worry about a separation of the shoulder.
So I can't play for a while.
I really don't want you playing him until you can do those full range of motion activities with the arm without any pain. Alright,
Sounds good. Thanks a lot doc, appreciate it. You're
Welcome, Andrew. Feel better soon.
She'll be with you guys in just a few minutes.
Surprise <laugh>. Hi.
Oh
My goodness. How are you? Wonderful. I'm feeling much better. Hi. Hey. Hi Ms. Frost. Good to see you. Nice to see you. Thank you so much for moving. Hey,
Is my pleasure. Thanks for joining us.
Nice to see you again. And hi Pam, I'm Jacque. Count. I'm taking care of your mother
Under the count. Hi Michelle. Hi. Can I please order that foot x-ray for Ms. Sarah?
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It for her left foot? She's still having left foot pain.
Yes. Can you order that for me please?
Thank you.
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Have
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Hello
London. Hi, it's mommy. I'm gonna be able to make your performance this evening.
It was good seeing Pam, huh?
Yes. It was really nice seeing her again. I think everything's gonna be fun.
You took care of us, so now we're gonna take care of you.
How
You killed? I'm all right. I just can't play for a couple weeks. Did you talk to a doctor? Yeah, I did. And you didn't have to go in. Nah, I didn't.
So what you saw in that video is a very different way for our clinical staff to work. Um, a very different way for our members to engage with us immediately when they need us and on their terms. So a lot of, uh, those technologies that you saw were actually developed, um, and co-created with our Southern California business partners in the clinical setting. So what I'd like to do now is introduce my business partner, Lee kk, um, who has worked with our teams, again, extensively in Southern California to build these kind of experiences and is thinking about the future on how we're going to do things, um, to expand telehealth and to meet our members outside of a medical, uh, facility. So can we cue the next video with Lee, please?
Kaiser Permanente's new medical office buildings are an example of how we're leveraging technology to improve the care experience for our members and our providers. These new medical offices leverage cutting edge technology to create intuitive, convenient experiences for our members from before they arrive and extending beyond their visit. The check-in process is an example of where technology has transformed the member experience. Traditionally, when you check in, you come into the office, you wait in line, you get in front of a desk, you're processing paperwork. It's very unpersonal, it's very DMV like. Um, but we've introduced two technologies that have really enhanced the efficiency as well as the interpersonal interaction with our members. One, technology is express check-in. Uh, people can connect while they're still at home, make their payment, answer questionnaires, and check in in the comfort in of their own home. Another example of technology improving the care to our members is the tablets.
We've provided tablets to our receptionists and essentially untethered them from the long reception desk. Our receptionists are now free to roll around. When patients come in, uh, they are able to greet them, they're able to give them hugs, they're able to help those who need physical assistance. When paperwork is actually necessary, they sit down at a table or eye to eye, ask questions and do that work on a tablet, which makes for a much more interpersonal interaction. As a result, the receptionists love it. They're able to connect to the patients in a way that they've always wanted to. Uh, members also love it because they feel as if they're being cared for in a much more personal and less transactional way. The exam room visit with the doctor has also been transformed. Now, with digital technology and a monitor in the room, we can video in the family, friends, caregivers, and other people who are there to support our members in their health journey.
With the teleconsult, we can teleconsult and call in different specialists and providers to give a diversity of opinions and give a true care team approach. Being able to call in a teleconsult also helps our patients avoid having to go to additional visits with specialists. Technology has extended our ability to reach into the home and beyond the doctor's visit. We're able to send them home with video, with email and other resources to support, uh, their healthy lives. In addition, telehealth telemonitoring has allowed us to keep tabs on our members and monitor their health. And then further on in the future, we wanna create an infrastructure to support more self-care, more acute care in the home setting, nudges to support clinical adherence and healthy behaviors or ways of connecting people to people, because that's what matters most. Technology has changed the way that the care team collaborates with each other within the clinic because they are armed with tablets and mobile devices.
They're untethered from their computers and their offices, and that allows them to collaborate together, either planned or spontaneously, and really, really promote the idea of team-based care. To get this done, we embarked upon a process of co-creating technologies. This means taking a human-centered approach, design and immersion to understand the needs and to develop solutions to meet that need. That meant working in anti-disciplinary teams, mashing up technologists, clinicians, operations, facilities, and design, all towards accomplishing a shared vision of a better experience for our members and our providers. The result is what I call radical collaboration for on the spot solutioning and development in real time. It also meant easier adoption and integration into operations for these new clinics. We developed over 10 new technologies in the span of 18 months. Most importantly, this approach developed a deep mutual appreciation between business and it. And it's with this appreciation that I thank you for inviting me to share how technology has been used to enhance the very human interaction between getting care and being well. Thank you.
Thank you. So a couple of things I just, that resonate with me When Lee talks about how this radical collaboration has helped us, again in our mission to provide outstanding, affordable care and transform the healthcare system, the anti-disciplinary team concept is something that is really, really foreign. I mean, putting technologists, business folks, physicians, nurses, operation folks and pharmacists together is something that gives us a robust set of offerings but was never even considered. We're all for all in our own world. So a lot of this new way of working, um, has been tried and is now starting to permeate throughout the organization. So a couple of things, um, again, that I just wanted to touch on, on how the work we're doing, which is foundational with DevOps and the way we're changing the way it is engaging with our business members and, and maturing our engineering practices, making a difference.
So you saw the reimagined face-to-face experience. Um, you know, those interactions both with the clinical staff as well with our members. Um, we are now looking how, um, at ways that we can reach into the home and use technology to provide care. Um, we're tightening and, and blurring those lines between the business and it. We are co-located teams that are driving towards outcomes, not a hierarchical organization. And we're also broadening our member and community impact. So it's very important to us that we also provide ways to, um, increase health in the communities, which, with which we serve, whether those folks are our members or not. So we are at a DevOps conference. So I wanted to talk a little bit about DevOps, you guys, <laugh>. Um, one of the things I did talk about a little bit earlier was the fact that our digital assets are so important and so interwoven in our members' daily lives.
We often joke that kp.org and our mobile apps are kind of our ninth region, right? So if you look at some of the statistics and how people are self-serving, we have outstanding registration rates. They rival banking. We have 6.5 million registered users who regularly use our site in order to self care and self triage. So things like prescription refills, 28 million a year. That's 28 million people who did not have to go to a pharmacy. 51 million lab results reviewed online that did, that prevented a phone call or a doctor having to send something to someone. 28 million emails to physicians. All of this work is facilitated by our engineering practice on the teams that are building these capabilities. 59% of our encounters happened virtually. And that is the trend of the future. And the way we're gonna increase that is by leveraging technology, experimenting and innovating, which our engineering practice can support.
Our DevOps practice is actually doing pretty well for those 30, 30 teams that are aren't currently. So we've got about over a thousand developers leveraging five pipelines that we've built. Um, we have about, we average about 400 code commits per day. Um, and we are on pace to deliver 80 releases a year using these pipelines. So if you remember when I started the talk back in 20 15, 4 releases a year up to 82, and right now this is just the consumer facing digital teams. We are going to expand this practice to the rest of the organization. And we've got, I think, over 700 applications in our organization, and we fully expect those teams to be able to realize some of these benefits as well. Okay? But again, the largest transformation for us has been mindset. It does take a change in behavior to get here. Okay?
Um, we have become a learning organization. We are open and transparent with our content. We don't border or fence based on which team you're on. We share best practices. We go out and we evangelize. We help people understand the benefits because quite frankly, there's not always an NPV, but everything you've all been hearing about here at this conference around quality, time to market, innovation, leading and landing, leading and lagging indicators are all the case for this. We've also had to adopt a little bit of a, the developer's, the most important person in the cycle mentality. And that's a bit of a mind shift, right? Um, we think about producer, consumer, how can I, if I am not a developer, provide the most outstanding service to that developer so that we are all driving towards incredible outcomes for our members.
So what's next for us? I've alluded to the fact that we're going to spread this to the rest of it. Um, we've already started conversations with our, um, our IT partners across the organization in our pharmacy systems, in our electronic medical records system in some of the other, um, systems of engagement that we have with our brokers or, um, organizations, large organizations that are customers. So the spread will happen. We're also looking at how we accommodate data teams with a DevOps model. Um, we're looking at ChatOps, what is the next evolution of our pipelines? We're looking, we're really looking right now and are very focused on solidifying data SecOps so that we can bring applications that are held to stocks controls onto our practice. And then finally, again, it's always about mindsets, talents, skills, and making sure folks have what they need in the organization to be able to go here.
Um, we're even starting to think about certification programs for DevOps engineers. Um, can we have, uh, different belt, um, levels? How do we get our business partners trained in order to participate with us in this kind of model? It's been a journey for them as well. So we're really excited actually, about going here. Um, and I think one of, you know, I have to thank a number of my team who are all here this week. Um, we wake up every morning trying to figure out how we can improve this model, because again, what's really important for us is offering that affordable, high quality care to our members. And that is our North star. So everything we do, whether it be in our practice or what we deliver, is held up against that lens.
So finally, I'd like to thank all of you, um, for, again, inviting me here and, and, and, uh, having the program committee come out here. We think we have a very compelling story to tell. Um, we're excited about the work we're doing. Um, it's not always easy. Again, I, I talk about our teams pushing on cultural norms every day. But it can be done. It can be done when, um, the folks in the business realize that this is a way to enable a transformation. This is a way to enable adding whatever that value is that you want to add to your consumer base. And quite frankly, this ties all back again to our mission to provide high quality, affordable care to our members. So enjoy the rest of the afternoon you guys, and thank you for having me.