Quest Diagnostics is a $7.5 billion provider of diagnostic testing information services. It collects vast amounts of data: twenty billion test results, one hundred fifty million medical test requisitions in 2014, and testing services that touch about one third of the adults in the US. It is up to Lidia Fonseca, Quest Diagnostics’ CIO to organize, tag, and structure the data so that the company can turn information into insights and insights into actions. By effectively categorizing and partitioning the data, the big data conundrum has turned into a massive opportunity for the company, and it has also made that data much more secure.
Fonseca’s depth of experience in data analytics, security, and developing innovations that are leading to revenue augmentation have brought her to the attention of those who need that experience at the board level. In July of 2014, she joined the board of Gannett, a $2.9 billion international media and marketing solutions company. In this interview, she discusses all the above and more, and toward the end of the interview, provides insights into how she successfully became a board-level CIO.
(To listen to an unabridged audio version of this interview, please visit this link. This is the 16th interview in the “Board-Level CIO” series. To read past interviews with CIOs from P&G, Biogen, Kroger, Cardinal Health, and the World Bank Group, among others, please visit this link. To read future articles in the series, please click the “Follow” link above.)
Peter High: I thought we would begin with your role. You are the Chief Information Officer of Quest Diagnostics. I wonder if you could provide a description of the organization as well as your role within the organization.
Lidia Fonseca: We are a leading provider of diagnostic information services. That is both clinical laboratory services as well as diagnostic information services. 2014 revenues were $7.4 Billion, and we are growing at four percent. Interestingly for us, we see about one third of US adults, and we connect with half of all physicians and hospitals in the country. We are touching the samples of five hundred thousand patients per day. We have an expansive test menu, and thousands of tests ranging from ones for cholesterol and diabetic testing, to advanced genetic, cancer, and neurology testing. We run the full gamut of medical testing.
We count on the services of forty-five thousand employees. We have about seven hundred PhDs and MDs across the company, which is great because harvesting and leveraging that knowledge is pretty significant, as we think about leveraging innovation, both on the medical side, but also on the diagnostic and data side. We operate two thousand two hundred patient service centers around the country. That is a little bit of the scale and scope of Quest.
On the data and technology front, we have the largest private clinical database. We have over twenty billion laboratory testing data points. We have more than fifty thousand providers and hospitals that are leveraging our Care360 connectivity platform. From an interaction and reach standpoint, it has been phenomenal coming here. We integrate with more than four hundred EMR providers. We are integrated with pretty much any EMR that you can think of. If our customer is using it, we are connected with them. We have a patient portal so that patients can access our services directly. We have had more than two million patients access our MyQuest patient portal. We have a significant Big Data and analytics platform that enables population health and gaps in care types of analytics. It is leveraged by partners, including the CDC and Memorial Sloan Kettering Cancer Center, to name a few.
We have partnered with Inovalon, and we will talk more about that later. By bringing that together, we have a rich data backbone and dataset brought together with what Inovalon has. It is enriching what is already one of the most expansive clinical databases around.
As CIO, in addition to the typical things you would expect a CIO to be responsible for, I have a couple of other responsibilities. One of the things I am responsible for is all of our client-facing products. It is my team that develops those. We also develop the analytics products, whether it is sophisticated reporting or population health tools. Now that is in partnership with other providers as well, bringing a new capability that maybe neither of us could bring on our own. That is a key part of our thinking is that by combining datasets, can you offer something novel to the marketplace.
The other thing that I am responsible for at Quest is that I am the executive sponsor of our business transformation program. One of the things that we are doing as a company is that we are transforming our business model. There are three key goals to that business transformation program.
- One is that we are focused on delivering a superior customer experience – personalized digital experiences.
- The second goal is operational excellence. We are standardizing and streamlining our operations end to end. We inject automation where it makes sense. We also speed up our time-to-market for new products and tests.
- The third piece of that transformation program is the platform for growth. We focus on innovative powerful analytics.
Our brand’s unifying idea is action from insight, so this is how we bring this idea of action from insight to life. These powerful analytics and informatics help providers and patients make better decisions about their care.
High: It strikes me, as you are going through that description that you have a lot that is non-traditional. As I think about the patient portal, population health tools, the fact that your team is getting involved in customer experience, and the Inovalon offering, these all suggest a higher level of value than is typical of a lot of IT departments. Could you talk about the way in which you and your team structure customer-centric aspects of all that you described? Do you have a cordoned off analytics team that you have developed? How have you thought about staffing and org structure to do the multiple things you described?
Fonseca: We have a set of people that we call the “frontline folks.” I always think of these groups as team members who can work interrupted. At some point, once we go into development, I want my developers and test engineers to be doing the work, and making sure that the release and capabilities are on-time. The way we structure it is that we have, on the front line, technical product managers. They manage the various families of products that we have. That includes analytics, informatics, customer portals, as well as portals to hospitals and payers because we want to make sure those portals provide the specific services and insights that they are looking for.
We have a front line of product managers, and we also have product managers for our lab and billing. We also have business relationship managers who work both internally, working with our marketing team, and spend a lot of time with clients making sure that we understand requirements. They are helping us design requirements, identify demand, understand the customer needs. When we get requests, they work with the business partners, both internal and external, to take those requests and make the right investments. They make sure that the business cases are put together for the investments that we want to make in technology. Those two groups are on the demand side, making sure we understand demand, both near-term, and over longer periods of time.
Then we have the design and architecture team. Once we approve where we want to go, then our design and architecture team starts working on the design, both from a user experience as well as from a technical design standpoint. They make sure that the solution is going to fit with our overall architecture and that it is going to integrate well and advance and support the architectural principles that we operate in. From there, it goes to our business analysis team. They are the ones who translate the need into a technical specification. Then it goes into our centers of excellence. We have development, analytics, informatics, and business intelligence teams. They are the ones who either develop or integrate solutions that are related to data, informatics, and analytics. We have some good expertise with Big Data, investigative reporting, developing algorithms, both clinical as well as informatics driven algorithms. That team handles all of that demand.
We have a software engineering team, for any application development. Those applications are across the board – client facing, middleware, and stack. The reason we do that is because we want to make sure that our developers are not only following good principles of developing good quality code, but also operate in both waterfall and agile methodologies, depending on where that solution is. We have our software engineering team in one place, and they support the various products, whether they are industrial strength laboratory platforms, or portals, or third party platforms.
We also have a PMO because at the end of the day, we want to make sure that we deliver projects on time, according to the budget, and with the scope that we agreed to. We have an infrastructure team. They handle all the infrastructure needs, datacenters, desktop, and connectivity that we need. That group supports both the company and our various patient service centers, but they also make sure that we have the infrastructure in place to support the business.
We also have a connectivity team. They work on specific client projects. Once we win an account, there are a number of things that we need to do, and we need to interface with the client. They focus on setting up the connectivity and the services and the menu that we are going to be offering to every customer.
As you can see, we have a number of centers of excellence, the front line that helps us on the demand side, the architecture to make sure the design and architecture make sense, our business analysts get the requirements and document it properly so that our developers and test engineers can take that spec and deliver and exceed the expectations of the client. That is the setup. To me, organizations are not right or wrong, they are about how you deliver for customers and the business, so that we deliver on the operational, financial, and client goals that we have.
High: You mentioned earlier that you have vast amounts of data – twenty billion test results, one hundred fifty million medical test requisitions in 2014, and testing services that touch about one third of the adults in the US. Structuring that and doing something with that sounds like it is well within the bailiwick of your team. I know that real-time analytics at the point of care with Inovalon, as you mentioned is taking some of that data and trying to use it at the point of care. Could you take a moment to describe that?
Fonseca: As soon you step in the door to a new role, it is a perfect time to do a walk through because you want to understand where you are. When you think about your information assets, number one, they need to be housed in a way that they can then be leveraged. Many companies have a lot of data in data marts all over the company. I call those data cemeteries. People go and bury the data in those data marts to never be seen again. I am a big believer that you first need to bring your information in, organize it, tag it, and structure it in a place where it can then be leveraged. We have done that step. That was one of the first things that we set in motion.
Categorizing and partitioning it is important, especially in this day and age where we need to be mindful of protecting our data assets. The next step that we have done is look at the views that our customers are looking for. How do they want to see that information? How do you want to visualize it so you can leverage it and have it be useful? We have layered, on top of our repository, these visualization tools. There are technologies available now where you can move information in large sizes in a much more efficient and fast way, and still keep it well tagged and protected so that you are unlocking that information and making it available. There is a lot of thought behind not just how it is structured, but also how it is accessed, inside or outside the company. A lot of thought went into that whole process to ensure that the right information is viewed by the right individual. All of that was put into place. That is one of the major efforts that we have undertaken.
When you think about Inovalon, we have our data set, and they have additional data. They have medication information, claim information, etc. We are rich in laboratory information. By combining that together, we are able to create a number of different views, or data diagnostics. The way to think about that is a suite of hundreds of patient specific data analyses or views that can be ordered individually, on demand, by the clinician at the point of care, and it fits within their existing workflow. The other thing that we did is try to integrate the phenomenal suite of diagnostics into the workflow so that the provider does not have to learn something new.
That is one of the beauties of Inovalon and Quest coming together. We have our menu, and we added these data diagnostics to our menu. The doctors already know how to order it. It fits into the workflow, so the combination of easy ordering from a menu that you already know and providing real-time on demand data diagnostics is a novel approach. We are leveraging our information assets, our workflow tools that physicians are used to interacting with, and more context to the results that we deliver through the combination of our data set and the Inovalon data set for patients. It is a foundational step of bringing information in, structuring and tagging, combining with their information set, and then using an existing portal and workflow to add these new services. We can go to market pretty fast, which is one of the goals of our transformation program.
High: How do you think about security? Does it fall under your purview as well? How do you think about balancing innovation and the innovative uses of technology that you just described with safeguarding the information as well?
Fonseca: Security falls under my purview, and we have a strong security team. My philosophy on that is that it is a balance between how you drive innovation in a speedy way, but also knowing that we are protecting some important assets. One of my mantras is that when you develop solutions, do not make security an afterthought. You have to develop the solutions with security baked in as part of the design. When I talked earlier about our design and architecture team, we have a common and stringent process. Any solution that we are thinking about, we also look at from a security standpoint. That is why I spend time talking about the authentication, access, and who can view the information.
We are baking security into our design. To me, that is not only the responsible thing to do, but also it is much better when you think that way and design it up front than when it is an afterthought. Then, you could miss something or there could be vulnerabilities. We have a security team that is experienced, and they review every solution. That review process, when we are making a determination of what the solution is, there is a discussion of what the security elements are of that. In the approval process, we make sure that the security aspects are in the design and are a part of the project plan. I am a big stickler about that because what we are protecting is sensitive. As you have seen, there have been a number of incidents in our industry, so we are cognizant and focused on that.
High: You are a board level CIO, as you are on the board of [$3 billion media and marketing solutions company] Gannett. I wanted to talk a bit about the genesis of that experience. Having spoken with a great number of your peers, many of them have the goal of following in your footsteps. Could you talk a bit about the process of gaining access, the realization of something that was a goal of yours, the process of engaging with the board, and how the opportunity arose?
Fonseca: It is something that I felt would be a good development opportunity for me. I was fortunate enough that one of the board members of a company that I worked with in the past felt that it would be a good development experience for me. She raised it to my boss at the time, and said that it could be a good experience. That is how it started. I had the introduction to the person at this company that was doing sourcing for boards. We met, discussed the background, and it was one of those things where you have the interest and then you are then thinking about how it has to be the right fit. You do not recognize it as a pearl of wisdom at the time, but it is about the fit. I think that there are a lot of smart knowledgeable technology executives out there. The interest has to be there, and having the opportunity to meet with those companies, and seeing if it is a good fit.
I would say that the advice I would offer is to get involved. One of the things I did before I joined a public board was to serve as an advisory board member for a data company. It was a private company, but it was a great opportunity to gain that experience. When you are in a line job, you operate a certain way, are always on the go, and are responsible for strategy, and its execution. One of the important shifts, whether it is on an advisory board or board of a public company, is that you are in an advisory role. That means it is management’s strategy, their plan, and our job is to ask whether they have thought about this or that and looking at whether it all ties together and makes sense. It is a different kind of role than being in a management role. I would definitely recommend serving on a private setting, or non-profit board. It is good to have those kinds of experiences before taking the step to a public board.
I thought that sequence of being on the advisory board first helped to prepare me for not only the conversations I had going through the interview process, but also the mindset that has to shift because you are in an advisory role. The tendency as a line leader is hearing somebody’s plan, and saying that you need to do this and that. It is a different role when you are an advisor where you bring something different. It is a critical view, in a good way. You look at the business plan, the strategy, and anticipate what the response is going to be from the market. You get the chance to do that because you are not in the day to day. You have an opportunity to step back and evaluate the responses. That is a great opportunity. Typically, we are in the day to day and marching to our own execution plan. Having the ability to look out, but be in enough, is an enriching experience. I have learned a lot through my experience on the board.
High: It is no wonder that you have been asked to join a public board, as I know that many companies, both public and private, are thinking about the opportunity that technology can provide. Both the analytics and security that you already mentioned represent opportunities for a strong technologist to lend advice in a time of great opportunity and complication in each of these areas. Do you think that companies are going to be looking for more technologists to join boards?
Fonseca: I think so. It is good to think about that. My feeling on boards is that you bring perspective, both on a specialized front, and from bringing together different perspectives. I think that there are two kinds of companies. There are companies that are born digital, and there are companies that are trying to become digital. You need that perspective as a board, especially from a cyber security standpoint. There is technology providing, and the rate of change and innovation is so fast-paced that it is important to have that perspective. To ensure that, the board, as a whole, has to have at least one expert that can speak to those topics and bring that perspective from having that experience, implementing those solutions, and living that. I expect more and more boards are going to be wanting that expertise.
I think it comes from different dimensions. One is the fast pace of innovation and technology. Technology is an enabler, more and more. One of the things that I joke about a little bit is that we have been a Big Data company for longer than the term “Big Data” came into being. I do see, just from the interest that I see from being contacted quite a bit, just from the calls coming across. It used to just be technology companies, but not anymore. It is more the classical companies, the non-technology companies where I am seeing that interest more as they recognize that technology is such an enabler, whether for supply chain, logistics, client interaction, retail, or B2B businesses. I am glad for that because I believe that there are still opportunities. I think that CIOs will see more of that.