How Karen Xie Challenges the Status Quo at Blue Shield of California

Karen Xie’s scientific training and patient-centered strategies are strengthening healthcare innovation at Blue Shield of California

Meaningful change always meets resistance, but it can be a particularly tough sell in healthcare, says Karen Xie, vice president of enterprise architecture and health innovation technology at Blue Shield of California, a nonprofit health plan that has more than four million members. “When you push for innovation, you are disrupting things,” she says. “You are challenging the status quo, trying to get people out of comfort zones and toward out-of-the-box thinking. It’s not comfortable. It’s a huge barrier.”

Xie speaks from experience: she climbed the IT ladder, growing from a tenure as database administrator to VP at Trinity Health over sixteen years, and then joined Blue Shield in 2014. Blue Shield’s mission immediately attracted her; the company is committed to ensuring its members are provided the highest-value, highest-quality care that is readily accessible and affordable. She was also struck by the company’s focus on learning.

“I could see how highly the company valued learning,” says Xie, who earned a PhD in physics from Worcester Polytechnic Institute. “In any organization, success is the result of learning. If not, you won’t be able to run and grow the business. That is something I value highly about the organization.”

Xie runs enterprise architecture, quality assurance (QA) testing, and health innovation technology at Blue Shield. When Blue Shield hired her, the company needed someone who actually had the experience of building these separate domains from the ground up. Her role and responsibilities are complex, but Xie breaks them down into constituent parts.

Enterprise architecture at Blue Shield consists of five segments: business capability architecture, information integration architecture, application solutions architecture, and infrastructure technology architecture. All of these categories fall under the umbrella of security architecture.

Meanwhile, software QA involves the entire software development process. Xie cites software design, coding and code reviews, unit testing, functional testing, regression testing, integration testing, configuration management, and release management as associated steps.

Then, there is the health innovation technology (HIT) facet of Xie’s purview. She added this function to her responsibilities in the spring of 2016, and the former Columbia University scientist is excited to tackle the subject.

The HIT organization faced many challenges in its first couple of years leading up to Xie’s arrival. However, it now consists of three effectual teams: innovation strategy development, product delivery, and an open innovation lab, a place where creative ideas are brought to the experimentation level.

Recently, the delivery team diligently transferred comprehensive patient information into an integrated platform known as the California Integrated Data Exchange (Cal INDEX). The interface allows doctors, hospitals, and other care providers to securely review, analyze, and share medical information across the healthcare system. Cal INDEX is being merged with Inland Empire Health Information Exchange. The union will create one of the largest repositories of patient records in California, and together, they will have insurance claims and medical records of 16.7 million people.

The merger also happens to be a passion project for Xie, who considers fragmentation to be one of healthcare’s biggest problems right now. It disperses a patient’s history through different systems that don’t communicate with one another, even contributing to the eighth leading cause of patient death: medical error.

Xie sees the problems of fragmentation not only from the vantage point of her work, but also from personal experience. At one point, her mother needed to have surgery. Prior to the surgery, she needed a blood test and an x-ray. She had already completed both procedures elsewhere two months before, but she was required to do it again because the hospital had no access to the results. This kind of redundancy is common, expensive, and even deadly.

“As a result of fragmentation, nobody can have a complete picture,” she says. “It ends up being very costly, requiring all kinds of testing, a longer path to diagnosis, and delayed treatment. Providing a comprehensive picture will directly contribute to the lower cost and higher quality of health care.”

While leading HIT, Xie has instituted sweeping changes. The main challenge is the lack of a systematic innovation methodology, which contributes to how dreams and big ideas will be stillborn, she says. To remedy this, she created an operating model with four aspects: an innovation counsel for governance, an end-to-end process for innovation initiatives, an ideation platform for generating and managing ideas, and an open innovation lab for bringing ideas to the market and promoting the culture of innovation.

“The cultural aspect is so critical to what we are doing, especially in a healthcare organization with its long history of doing things in a certain way,” Xie says. “We try to encourage those people in the company who have contributed to innovation initiatives even though they might not be a part of my team. We do work in awareness and education. We hold workshops where people can talk about design thinking and customer-centric thinking. I always stress that many innovative concepts didn’t have popular support at the beginning.”

Looking toward the future, Xie is focusing on how to transform data into insights that can make a strong impact on healthcare transformation. Some organizations are only at the level of descriptive and diagnostic analytics, using data only to see what happened and why it happened. Yet, Xie wants to push the envelope to the point of transformation, she says, because now the available information is more comprehensive.

“We can actually go beyond the what and the why to predictive analytics and even prescriptive analytics,” Xie says, adding that it also requires more advanced expertise in data science. “Cognitive computing uses data mining, pattern recognition, and natural language processing to mimic the way the human brain works. A target in 2017 for us is to have a breakthrough in cognitive analytics that will help us better serve our members and our providers while we effectively run, grow, and transform our own business.”