Bryan Sivak, Chief Technology Officer, Health and Human Services

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Mark Masse ll i: This is Conversations on Health Care . I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

th
Mark Masselli: Well Margaret, it's that nail - biting time of the year when 4 year
medical students find out which residenc y program they are being matched with.

Margaret Flinter: Well, that’s an exciting time for the US medical school grads,
and in total, th ere is a record number of physicians applying for residencies. And
a particularly good news Mark, more applications f or primary care residencies
this year than we have seen ; an increase by 400 to roughly 6400 who are
planning to have primary care careers.

Mark Masselli: Though estimates vary, projected short fall of primary care
physicians is looming large . And there a re provisions in the Affordable Care Act
a imed at addressing that short fall. I should no te one of them which is our own
Nurse Practitioner Residency Program , which you started , and we have eight
slots this year, and we are looking forward to a great crop of residents.

Margaret Flinter: That’s right. And it's going to be interesting to follow the trends
around primary care and who chooses to be a primary care provider and how we
adapt ou r training systems to meet their needs. But this is a good start se eing an
uptake in the number of medical students choosing primary care residency.

Mark Masselli: There is another trend that I think we are going to hear a lot more
about , and that’s the call for transparency in health care pricing. The lack of
pric ing transparency has been a big driver in increased health care cost.

Margaret Flinter: Recent report yield ed some pretty dismal findings . 29 states
around the country get an F for health care pricing policies that are supposed to
assist patients and famili es when making health care decisions.

Mark Masselli: That’s because in those states, there are laws allowing insurance
companies to keep their pricing hidden from patients until the patient gets the bill.
Can you imagine buying a car or going to a resta urant with that sort of policy?

Margaret Flinter: Well, that would be sticker sho ck to a significant degree. And
it's a problem that was very clearly elucidated in a recent article in Times
Magazine by Steven Brill , who found wildly v aried price quotes for the same
exact procedure across multiple hospitals in just one community. So I think Brill
has really shown the spotlight on the scope of the problem.

Mark Masselli: And the report card that was put out by the nonprofit Catalyst for
Payment Reform o nly showed two states that scored a n A , Massachusetts and

New Hampshire . Suffice to say when it comes to price transparency in health
care, we have a long way to go in this nation.

Margaret Flinter : And our guest today is seeking to improve transparency of
another kind, and that’s making more public health and medical data available
through Health Information Technology. Bryan Sivak is the Chief Technology
Officer for Health and Human Services , and he talks about the trend at HHS to
open source as much health data as possible.

Mark Masselli : Lori Robertson of FactCheck.org looks at claims that the health
care law is a tax burden on the middle class.

Margaret Flinter: And no matter what the topic, you can see all of our shows by
Googling CHC Radio.

M ark Masselli: And as always, if you have comments, email us at CHC Radio or
find us on Facebook or Twitter . We would love to hear from you.

Margaret Flinter: Now we will get to Bryan Sivak in just a moment.

Mark Masselli: But first, here is our produ cer Marianne O'Hare with this week’s
Headline News.

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M arianne O'Hare: I am Marianne O'Hare with the se Health Care Headlines. The
federal government will likely be playing the role of enforcer in several states .
Vocal, even vociferous opponents of the health care law are refusing to follow
direct ives in the law that e nsure changes are made to the state insurance
markets to adhere t o new ACA guidelines . Texas, Oklahoma, Wyoming, and
Missouri have refused to enact legislation that would set new pa rameters on the
insurance industry to align with insuring all Americans by 2014. This leaves
federal health officials no choice but to take measures to pick up th e s lack in
those states.

Meanwhile, 71 million Americans received some kind of free preventi ve
screening thanks to the Affordable Care Act . The report by the Kaiser Family
Foundation combined with US census data yielded the figure . Preventive
screening and early detection are the best known deterrents against expensive
and catastrophic illness.

The coming Tsunami of Alzheimer’s , it's the theme of this year’s TEDMED
Conference in April. It would appear the first waves have hit the shore. Study
shows the number of deaths from Alzheimer’s increased to 68% from 2000 to
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2010. It's now the 6 lea ding cause of death for which the re are few treatment

options and no known cure. I am Marianne O'Hare with these Health Care
Headlines.

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Mark Masselli: We are speaking today with Bryan Sivak, Chief Technology
Officer for the Department of Health and Human Services . Mr. Sivak recently
served as the Chief Innovation Officer for the State of Maryland and wa s Chief
Technology Officer for the District of Columbia. He got a start in the private
sector as an IT entrepreneur and is co - founder of severa l successful startups
including Electric Knowledge , which created one of the world’s first natural
language speaking search engines. Mr. Sivak has also been a long time
promoter of co - chairing open source methods of expanding IT innovation. Bryan ,
welcom e to Conversations on Health Care.

Bryan Sivak : Thank you very much.

Mark Masselli: You know, your job at Health and Human Services is to harness
the power of data, technology and innovation to improve health and well - being of
our nation . And you took over from Todd Park who we like to say Todd’s middle
name is liberate data, who initiated that role , and you are monitoring everything
from health care options for m illions of Americans from keeping food safe to
infectious disease outbreaks at bay. The h ealth data management volume
seems to be pretty staggering. So tell us a little bit about the programs like
HealthData.gov as well as the health data warehouse and how they are helping
HHS shift to a more open and transparent government .

Bryan Sivak : Su re. One of the most amazing assets that we have here at the
Department of Health and Human Services is really the vast quantity of data that
our agencies create and maintain. And it's been realized for a while now that this asset really needs to be lever age d to a greater extent. And so as you mentioned
a few years ago, my predecessor Todd Park came in and really started focusing on getting this information out to the public, to the entities that could actually take

advantage of this . Entrepreneurs , insu rance companies, providers, anyone in
the system actually , consumers, I mean anybody who touches the health care
system at all can us e this information.
We , over the last few years, have undertaken a fairly significant program to
liberate this data, which really means changing the default setting inside HHS
from one of sort of protection of this asset to one of release of this asset. And we have done a great job I think to this point of really changing that default, getting people to realize that data is valuable, that it should be open by default with obvious protections in place for making sure that we don’t release personally
identifiable information. The I would say most recent manifestation of this is the
HealthData.gov website which is sort of the s econd version of our data
warehouse . And we are building this actually all on Open Source technology so

that anybody can use this for themselves , contribute code, improve the system
itself. But internally, the whole idea is that we are making a system th at should
be easy for people to interact with i n order to upload their datasets so that we
can make it available to just about anybody out there.

Margaret Flinter: Bryan , you have said that in the past you had a ton of fun
during your early days as an IT entrepreneur. But much of what spawned that
early innovation was collaboration with peers on how to build these better
platforms for data sharing. Now you have shifted your skills to the public sector
and you have an opportunity to help government, help innovators which you have
euphemistically called an interesting challenge . So tell us about these unique
and interesting chal lenges that you face in bringing public entities and bringing
st
government into this 21 Century exciting world of data sharing an d IT
innovation.

Bryan Sivak: So the first thing I will say is you should always beware when a
geek calls a problem interesting because that’s usually code for very, very
difficult. But as you mentioned, I started my career at a college basically writin g
code for a startup that I co - founded . And I am a tech entrepreneur at heart and I
kind of always self - identify as one. But one of the things that I think I realized in
this role , or in that world I should say , is that success is really all about being able
to accept risk and learn from mistakes . And I think that’s one of the biggest
challenges in the public sector is just the willingness to take on risk . If you think
about the idea of innovation, either in technology or in any sense, it requires
exper imentation. So I think if we want to innovate in the public sector , we need
to learn how to take some chances. If I look across the now three different jobs
that I have had in government at all different levels of government, really in order
to innovate, we need to take some of these chances, and my job is really to help
assume this risk. The other thing I would say is that governments in general are
sort of large somewhat ossified entities that have very established silos and walls
between various progr ams and entities . And there is a huge amount of value
that’s trapped up in those silos.

Mark Masselli: You have also been engaged maybe at Maryland when you
launched the program called Civic Commons which inspired by an attempt to get
more interconnecti vity between the states and the governments. It seems to me
it's sort of a virtual back - end for states if you will. Can you tell us more about
how Civic Commons Initiative works and sort of the policy behind it and what's
the funding mechanism moving for ward?

Bryan Sivak: Yeah. So the first thing I will say is that was an idea we hatched
back in DC with Code for America . Not just within organizations but across
jurisdictions, people are working on pretty much the same thing over and over
and over agai n. So if you look at cities, almost every city has to have a certain
set of infrastructure that they need to create in order to operate that city
effectively , and we end up not doing a good job of sharing some of those things.

And you see t his repeated o ver and over again as you go up the jurisdictional
ladder. And so really what Civic Commons was , it's an attempt to provide a
relatively frictionless platform for sharing not just code or applications but also
ideas or policies or funding methodologies or what have you in order to reduce
the initial cost of development, reduce the cost of maintenance going forward,
spread good ideas. That was really the intention behind it.

Margaret Flinter: Bryan, it seems as we look back, the Obama Administration
made a pledge to continue to work on making government more open and more
transparent. And one of the initiatives in keeping with this goal is a partnership
between Health and Human Services and the Institute of Medicine to launch the
Community Health Data Ini tiative making the data more available to innovators
and entrepreneurs. HHS recently participated in the Health Datapalooza Forum
in Washington DC. Tell us about some promising innovations that are growing
out of those efforts that were unveiled there.

B ryan Sivak: Sure. So the Datapalooza , as we affectionately call it here, it was
actually the third iteration of this event which started roughly two and a half or
three years ago. And I think it’s pretty amazing when you look at the path that it’s
taken . It started like I said a couple of years ago with 40 people sitting in a room
in a pile of data and a challenge to come back 90 days later with some
interesting applications. It turned out that 90 days later, over 2000 people
showed up or 2000 differen t applications were presented that showed us the
potential for utilizing this data that we have. And it's grown ever since. The
second iteration was somewhere around 600 people. The Datapalooza III had
1600 people; there were over 200 apps that applied to present. I mean it’s really
been quite phenomenal.

You know, a couple of good examples that have come out of this, there is a
c ompany called iTriage that we talk about a lot. This is an entity that was started
by an ER doc basically trying to use mob ile applications to diagnose individuals
based on certain symptoms that they were presenting and then they leveraged
some of our data in order to help drive people to the right provider at the right
time based on the diagnosis of th os e symptoms. They were actually bought by
Aetna recently. They have got 80 people ; they are growing ; they are doing really
well . And so that’s a great example. Another good example is a company called
Humetrix , which for those folks out there who have heard of this I think c alled
Blue Button, basically there is this technology that we have been working on in
conjunction with the Veterans Administration for the last couple of years which
allows people to click a little blue button on a website and get their personal
health rec ord. This version of it doesn’t have any specific structure associated
with it and so what Humetrix did was created an application called iBlueButton
which essentially takes this download of personal health data and translates it
into a visual representat ion that’s useful for the patient and for the doctor and for
whoever else needs to see it. So that’s another great example of an entity that
has come out on this.

Mark Masselli: We are speaking today with Bryan Sivak, Chief Technology
Officer f o r the De partment of Health and Human Services. Mr. Sivak recently
served as the Chief Innovation Officer for the State of Maryland. He was Chief
Technology Officer for the District of Columbia . Let’s talk a little bit about
innovation and it seems to be central to the new paradigm at HHS , and in fact ,
th
the department just announced its 5 round of winners in the HHSinnovates
Program , which is intended to facilitate the exchange of innovative ideas that will
enhance health and well - being for Americans . And so fo r the first time, you had
a people’s choice winner and allowed the public to vote on this. So can you
share with us some of the more exciting innovations that came out of this
program and also how much participation did you get from the public on this?

B ryan Sivak: Sure. So as you said, this round, we had the first iteration of the
people’s choice awards , which was pretty exciting. We let the world basically
vote on the finalists.

Mark Masselli: By Twitter or how did they vote?

Bryan Sivak: No, the y voted on the Internet .

Mark Masselli: O n the Internet .

Bryan Sivak: Yeah. We had a webpage up on our site. But Twitter is a good
idea; maybe we will do that next time. We actually had remarkable participation ;
it was kind of cool. Tens of thousan ds of votes were cast . And one of the
winners actually of this round I think the story is pretty awesome. The National
Institute of Allergy and Infectious Diseases basically came out with this
application they call FreeStuff and it's a really simple idea I think but it's a
powerful idea. Basically in the past, you would have a bunch of stuff within the
organization that people had bought overtime they didn’t need anymore. And
typically, these things , whether it's like a piece of lab equipment or a piece of
furniture, would go back into some warehouse in the middle of Maryland to sit
there for a while until some government process actually took care of it. Nobody
really knows how that works or what happen s to it. These guys realized that just
because I d on’t need this centrifuge anymore somebody else might be able to
use it. And so they put together essentially think of it as Craigslist for
government equipment , a website that internal employees can actually look at.

Mark Masselli: Is there actually a big room like Raiders of the Lost Ark at the end
where they find the Holy Grail, is that -- ?

Bryan Sivak: In my imagination, yes. And I hope that somewhere on one of
those shelves is an ark. But yes, I mean this story to me is pretty cool because
basi cally the idea for this came up literally when this employee of this agency
was out for a run one day . She goes back to the office, recruits a couple of

people and in their spare time they put it together . And a little while later, now it's
being nominat ed for the HHSinnovates Program and it wins and it's great. So
that’s a great example. Another great example I think is the Center for Disease
Control’s Zombie Apocalypse story; I don’t know if you guys have heard of that.
But basically they used this m arketing campaign of a zombie apocalypse for
disaster readiness. And it won because I think it was very unique and different
for governments to start marketing from this perspective . But the coolest thing
happened to me the other day. I was on an airpla ne back from San Francisco to
DC and I was sitting there the whole flight working, putting my stuff away at the
end and the guy sitting next to me, he had seen me kind of working this whole
time and asked me what I did. I told him my job. And he looked a t me and says I
have one question. I said what’s that? He said, what are you guys doing about
the zombie apocalypse ? It blew my mind right because there is a random guy
kind of on this airplane who had heard about this stuff and knew some of what
we had been doing which probably wouldn’t have gotten out there had we not
done a program like HHSinnovates . So I think these things really have some
very significant effect.

Margaret Flinter: Well Bryan, I have to tell you the zombie apocalypse was a
little bit like the Martian Invasion in some communities where people did take it
kind of seriously. And one of the words that keeps coming up over and over in
various manifestations is “connect ”, and this is sort of central to the work that you
are doing. It s eems connecting such disparate data that is stored and managed
by HHS. And when you go to your www.healthdata.gov website, as our listerners
are probably doing, there is a nice visual there that links all these p rograms into a
constellation, Medicare, Medicaid, the Center for Disease Control , and anybody
can access the site and find all kinds of significant health data on numerous topics. So the question to me is who is using the site and who is mining the data? Is it public health officials, people working on community transformation,
clinicians ? Are you able to glean some intelligence on who is using the data in
the public?
Bryan Sivak: We have ton of anecdotal evidence that people across the
spectrum are ac tually using

www.healthdata.gov and accessing the datasets ,
doing interesting things with the information. But we are constantly working on engagement and trying to get other folks and different communities invol ved. In
fact, one of the big efforts that we are undertaking right now is really one of kind of connecting different groups of people that don’t typically think about health data and kind of bringing them into the fold. So I think in the past you really needed to be a subject matter expert to understand a lot of this stuff. We are going to try to make some of these pieces of information more accessible . We
are going to try to reach out to developer communities, to entrepreneurs, to venture capitalists, to any doctor out there . I mean all of these different
communities that we want to get involved , we are going to try to broaden the tent a little bit and get more and more folks involved.

The neat thing is that since we launched HealthData.gov, I mean we have had
hundreds of thousands of visits on the site and we are constantly improving the
functionality. I would stress one thing is that this is sort of -- I would slap a beta
label on this in a lot of ways because we are constantly looking at different things
that we can do to make it more usable and more functional . And we are going to
be doing some stuff around that in the near future so keep your eyes on it.

Mark Masselli: Is that part of the government’s new digital strategy? I know it's
focusing on three things making content more accurate, available and secure,
and you have been promoting Application Programming Interfaces or APIs which
are tools for building software applications as an important part of that process.
So tell us about these API s and why they are so important in securing meaningful
use of government health data.

Bryan Sivak: Sure. So basically what an API does is it allows a developer to
access content and data in a machine readable but more importantly a
predictable way . So they can make a functional call to a service and actually get
a piece of data back that they expect in a certain format and then they can do
something with it because it's in a certain format. You know, in the past,
developers have had to resort to techni ques for example like screen scraping
where they literally tried using a program read what’s on a screen. And that’s
obviously a very brittle way to do something because if the format of the display
changes then we obviously have a challenge with having t o update the program.
So there are some great examples out there. I think one really quick one is an
app called Healthline that was built basically using APIs that the National Library
of Medicine puts out and that’s all about basically providing informa tion to
consumers, beneficiaries about diseases and conditions and all kinds of stuff like
that. And that’s just one example ; I mean there are plenty of other ones. And
one of the components of the digital strategy is actually to API enable as much
conte nt and data as we possibly can to make this even easier for everybody.

Margaret Masselli: We have been speaking today with Bryan Sivak, Chief
Technology Officer for the Department of Health and Human Services. You can
find out more about these innovatio n initiatives by going to HealthData.gov.
Bryan, thank you so much for joining us on Conversations on Health Care today.

Bryan Sivak: My pleasure. Thanks for having me.

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Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org , a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well, Mark and Margaret, we recently heard competing claims
about the amount of taxes in the Affordable Care Act . Senator Ron Johnson, a
Republican from Wisconsin , said that there were “$1 trillion in middle income tax
increases,” and Democratic Representative Debbie Wasserman Schultz said that
there are not $1 trillion in taxes. So what’s the truth? Well, the law will cost $1
trillion over 10 years that includes taxes , fees, penalties for not having insurance
and associated revenue e ffects which occur when employees receive higher
wages w hich are taxed if they drop or lose their health insurance which is not.

But Johnson exaggerates when he says all of these taxes and fees would be
middle income tax increases. And he ignores the fact that the law will help millions of middle income folks by insurance. The taxes and fees in the law fall

heavily on upper income tax payers and business es. More money comes from
fees on busines ses in the health care field and penalties on busines ses that do
not offer insurance to their employees. Some will be subject to a penalty for not
having health insurance. But less than half of the penalty revenue will come from
those earning less than $120,000 a year. And that’s my fact check for this week.
I am Lori Robertson, Managing Editor of FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the An nenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at www.chcradio.com . We will have FactCheck.org ’s Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Mark Masselli: Each week, Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. The nation is battling an obesity epidemic and it's hitting our children especially hard. Turns
out the very thing perceived to be one of the causes, the sedentary pass time of sitting in front of a screen playing video games , could provide a great solution.
The folks at HopeLab have cooked up another video game aimed at impr oving
kids’ health. Now comes Zamzee, a competitive vide o game designed to get
kids moving. HopeLab’s VP and Communications Director Richard Tate says it's a pretty simple concept, equip kids with a movement monitor which they plug into their computer at the end of the day and compete against other kids on how
much they moved that day and there are rewards for each kid based on their level of activity.
Richard Tate: The Zamezee website uses sound principles of motivational science to get kids moving mor e where they experience success and feel
competence and mastery and that kind of positive experience keeps kids moving
overtime.

Mark Masselli: And as with their game Re - Mission, when kids compete with a
large r population, they are more inclined to want to succeed.

Richard Tate: And there is a sense of discovery and excitement to see how
many points you have earned, you see how many points you are racking up
overtime , and then with Zamzee, those points actually power your online
experience and allows yo u to compare and compete with others on the site.

Mark Masselli: HopeLab has been investing in Zamzee and the results are
significant. Kids playing the Zamzee video game moved i n average 60% more
per day than kids in the control group that didn’t have t he game at their disposal.
A simple movement monitor connected to a competitive video game that could
motivate millions of kids to move more during the day, improving their health,
well - being and longevity, now that’s a bright idea.

(Music)

Margaret Fli nter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org , and brought to you by
the Community Health Center.