Office Hours: I'm Kimber Lockhart, Chief Technology Officer at One Medical and former Senior Director of Engineering at Box.
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Office Hours: I'm Kimber Lockhart, Chief Technology Officer at One Medical and former Senior Director of Engineering at Box.Featured
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Hi Elpha! I'm Kimber Lockhart. I'm the Chief Technology Officer at One Medical, working to scale the technology innovations that underpin the reinvented doctor’s office and create a fully connected health engagement platform. At One Medical, I lead engineering (~100 engineers), product management, design, IT and security. Before that, I was the Co-founder and CEO of Increo Solutions which was acquired by Box. At Box, I served as Senior Director of Engineering, leading a number of engineering teams behind the growing commercial success of the company. I have a B.S. in Computer Science from Stanford University.Ask me about engineering leadership, product management, building diverse teams with purpose, goal setting, technology in healthcare or anything else!
kuan·Jul 28, 2019kuan·Jul 28, 2019Thanks so much for joining us, Kimber!Please ask your questions for Kimber here, and she will answer them before the end of the week. Note that she may not have time to answer all of them, so upvote the ones you're most interested in.
Do you have any frameworks you can share for organizing your teams. I'm particularly interested in how to align towards goals, how often you recalibrate the progress towards the goals, and how you keep the teams efficient but also motivated in their day to day work. thanks for sharing!
I did an interview on team structure and dynamics that you can check out here: https://blog.gitprime.com/calibrating-technical-teams-simple-shift. I also regularly write about team motivation and processes on Medium: https://medium.com/@kimber_lockhart.As I mentioned in a previous answer, we use a quarterly cadence for planning -- not because it's anything magical, but because monthly is too much overhead and one a year isn't enough. Then, we check in on the plan with each team every other week. It's important to me that representatives from each function on a team participate in that check-in: we're all working together to achieve our shared goals.
I'm curious to hear your thoughts about EHR. I think Epic/Cerner's market share, high switching costs for customers (hospitals) and long sales cycles make it challenging for startups. Where do you think the disruption would come from - hospitals/medical practices, insurance companies, government, google/other big tech companies?
Curious about this as well!PS Epic ☠️👽💀
Ah, EHRs. Nobody’s favorite software. Not only are legacy systems, well…legacy, but the market is very challenging for new entrants for the reasons you cite.One of the biggest issues in the design of EHRs today is that documentation is optimized for billing purposes, not for clinical purposes. On some level, this makes sense, doctors and hospitals need to bill in order to make money. On the other hand, all the complex logic of medical billing has resulted in tools that don’t serve their end users.Most of the promising disruption I see is in tools that surround the EHR and in “full stack” systems (like One Medical) that can innovate on EHR design without the overhead of long sales cycles. I hope these innovations from from all of the sources you cite. In an industry that keeps the fax machine alive, there’s a lot of room for improvement.
Yes! Totally agree. Epic is a billing tool first, patient care tool maybe third. 😂🤡
I would love to hear about your experience transitioning from an engineer to a CTO/Engineering leadership role. Do you still spend any time coding as a CTO?
Great question! I'd like to add to this as well. What are your recommendations for hiring a CTO? What sort of thought leadership should they bring to the table and how much are they involved in the weeds? Esp. for say a start up of 23 people and a dev. team of 2-3
In my CTO role, I don't contribute code to our production applications (though I participate in most hackathons and on occasion find myself writing a script to get something done!) I stopped regularly contributing to production code around the time I became a Director of Engineering (though that was fairly late for most engineering leaders). At some point the leverage I can provide in building teams, designing processes and prioritizing is much more valuable than then code I could write.On @AmanyK's question: CTO is an inconsistent title, and might mean the technical co-founder of a startup, a senior technology lead without direct reports, another title for a VP Engineering, you name it. That's why it's especially important to understand what type of technical leadership you need before you launch a search! The right kind of person for your organization is going to vary depending on how technical company leadership is, how quickly it's growing and a number of other factors. Generally, though, with a dev team that small, you'll want someone who can hire and manage people, but is still willing to write code most of the time.
I've read that interacting with unwieldy medical records software is a driving factor in physician burnout. From my experience as a patient of One Medical, you seem to be a company that takes design and user/patient experience very seriously. You also seem place a priority on creating an environment that allows physicians to focus on their patients. Has any part of your work as CTO involved creating physician-friendly medical software? If so, I'd be very curious to hear any insights that you're willing to share.
You’re absolutely right, physician burnout is a real issue in healthcare. One study by Kaiser/HRET found the percentage of family physicians experiencing burnout to be as high as 64%!At One Medical, we design and build the software our physicians and other providers use with the same intentionality we design our member experiences. To combat burnout, we focus on building thoughtful user experiences, reducing unnecessary tasks, and enabling a team of providers to coordinate each individual member’s care. My role is to create the type of environment where our technology team can be truly centered on the user experience. We do this through user research (technology team members regularly visit our offices and observe our provider and administrative teams in action), design sprints, user testing, and embedding stakeholders (like providers) on our project teams.
I HATE CLICKING THROUGH EPIC AND MOST EMRs. Would be happy to give input if you guys are looking for more providers — also selfishly interested in some of the One Medical design workflow for myself!
I'd love to learn more about goal setting as a CTO. You manage so many teams at One Medical, what's the goal setting process like for yourself, and the various teams you manage? Was the process noticeably different at Box as a Senior Dir of Eng, comparing to now?
For most of our product teams, we use and OKR-based approach. We charter teams based on our long term initiatives, and then each team designs their own quarterly OKRs, which we review together. From those OKRs, the team orders the major projects in their backlog, dividing up projects that are larger than ~10 weeks into smaller projects. We then draw a rough line for what is likely to complete in the quarter so we can communicate clearly with stakeholders, setting the expectation that in an agile process, things will change. Nothing is magic about a quarter for planning, but it's typically good to check in and realign priorities at least a few times a year in a fast-moving business.I'm also a huge proponent of personal goals, and my family goes on a retreat once a year to think through and set our goals for the following year. I always try to have one or two fun goals -- one year I learned the flying trapeze and another I read 50 books!
I also learned trapeze, as one of my goals one year. :D Thank you for sharing, Kimber! There really isn't magic about a quarter of planning.
I'd love to hear about your journey from co-founder and CEO of a cloud storage company to non-founding CTO at a healthcare provider. What have been the biggest changes in how you lead from CEO to Sr Dir of Eng to CTO? What were the biggest challenges / surprises when you transitioned into the healthcare industry? In my experience, healthcare is one of the more "you have to have experience to get a foot in the door" industries so I'm curious to hear your thoughts on how to approach that as a technical leader.(side note, having a major a fangirl moment!! elpha AMA guests are such an outstanding roster.)
Thank you! I think one of the biggest transitions in leadership is making the move from being a leader of a small team to thinking of yourself as co-leader of a broader organization. In many ways my early startup experience helped to cultivate this mindset, which helped immensely as I began to lead teams in larger organizations.I made the move to healthcare because I wanted to make a positive impact on the world with the hours I spent at work. One Medical was an opportunity to use the skills I had (building and growing technology teams) to address the macro-scale and human-scale issues in healthcare today.There certainly may be parts of healthcare that require direct industry experience to have a foot in the door, but this hasn’t been my experience. It’s helpful to do your research and have a baseline idea of how healthcare works, but I think the industry is starting to see the value of modern technology development practices and a modern technology stack.We’re certainly looking for talented people of all stripes, and find that sometimes the people without the built-in expectations of how healthcare has “always worked” are able to see opportunities to improve the system.
I completely agree with this. Interestingly enough, when I talk about working within MedTech, everyone’s concern is always the difficulty of finding physician partners and dealing with insurance companies; also, when physicians start companies, they usually think within the restraints of the medical field, therefore immediately limiting the amount of possible disruption. And so for my company, I do want some people who are almost completely healthcare naive — my hope and intention is that they can bring up problems and solutions that may not even occur to me as a provider.
As a healthcare company how does your team manage the competing interests of keeping your engineering velocity high while ensuring your code does no harm and is high quality? Have you seen health tech companies start thinking about this differently as the Theranos case unfolded?
Writing thoughtful, testable, high quality code might take a little longer than hacking something together, but in my experience, there's not as much of a difference as people think. My favorite metaphor is rushing to get out of the house, only to discover you've forgotten your keys, and need to go back to get them. Hurrying didn't save you time!I often talk about maximizing velocity over the long term, which I think also aligns nicely with applying the appropriate level of caution for healthcare.
I have 2 questions:1. Do you host mentorship groups for women who are early and mid career? (like myself?) It would be really helpful to connect and have someone to talk to about career growth. How did you find mentors and sponsors at Box, and One Medical?2. I see you spent long-ish stretches at each company and was promoted internally. Did you have to deal with getting a smaller raise over time? The market price for a new hire has been going higher over time in Sillicon Valley. I see it as a tradeoff - having an existing network and knowledge of the company which is a great foundation to grow your career, vs sacraficing top comp. Do you think it is a tradeoff? How did you handle it?
What advice would you have for prospective engineers from unconventional backgrounds (coding bootcamps, self-taught, career switchers, etc.)? In your career, have you worked with any that really stood out? What made them awesome? For context: I used to work in tech (at Stripe) in a nontechnical role, am going through a 9 month bootcamp now, and am so intimidated by the job hunt coming up.
Hang in there. As an industry, we're adapting to all the new ways to become an engineer. That means you're going to find prospective employers are fairly inconsistent on what they are looking for and what kind of support they have to provide. Try to stay persistent! Keep an eye out for opportunities that offer training or mentorship.After a few years of industry experience, few people can tell the difference: self-taught, bootcamp, college grad or master's degree. You may not land your dream job right out of bootcamp (or you may!), but the experience you gain as a professional engineer will help set you up for your next job search.
Thank you so much for the encouragement, this is so helpful!
As a provider, I’m really impressed with the workflow at One Medical — it is currently my PCP network of choice.A few questions: How does One Medical handle PHI protection? Do you build out healthcare screening software (e.g hey, you’re due for your Tdap!) within One Medical or partner with other MedTech companies?
We build many things internally (like our reminders to get a vaccine or take a mental health questionnaire), and on occasion partner with other companies for more niche offerings.
Very cool!!! Sounds like there’s a ton of flexibility for coming up with and then building out all sorts of neat features :)
I wanted to how important you feel Data Scientist are to health tech companies? Also, how does one ensure that they’re operating within ethical parameters? (E.g. not like Cambridge Analytica)
I'm curious what life is like for you day-to-day... Lots of high level discussions that you strategize and work with your Directors/Senior Leaders in Engineering? Or do you ever get involved in the weeds occasionally? If so, what are some of the technical weeds you get involved with?
I would love to learn more about some resources you use as a CTO to:1. navigate all regulations and privacy constraints in the healthcare industry (PHR, EMRs)2. find info about the best templates for patient-generated data (PHR)3. integrations with third-ârties in healthcare: what are the best success factors and biggest challenges to make that happen? (I am working on integrating with health providers to have PHR or EMR integration but feel a bit naive about the process :))
Also curious about #1!
Being on the biotech/informatics side - does One Medical allow for large datasets to be accessed for physicians and in-house academics to conduct research? Do you know how these tools compare to Epic or other similar programs that currently allow access? Additionally, does One Medical do any partnering with hospitals to collect and use data and if so are there any big picture plans with the data? (All of this is under the assumption that data is de-identified)
Where do you see the challenges of health aggregators/marketplaces trying to create a more seamless and customer focused experience.
How important is creating a culture in the teams you have built and how did you establish that culture?
Thank you so much for having me! We're hiring across One Medical, particularly technology roles and providers: https://www.onemedical.com/careers. If you are excited about impacting healthcare at a macro and human scale, please message me.
Hi Kim, thank you for being here! What do you think are the opportunities and challenges in using technology to improve health and healthcare? What differentiate One Medical from others in this aspect?
Hi Kimber! Box has an Anita Borg Scholarship. Gemma Busoni is an extraordinary student - cover of Seventeen Magazine with Michelle Obama, a Peter Theil Fellowship. and a long list of Hackathon wins (we met when her team beat mine 😎💪) - that would love that coveted scholarship. Tips? Gemma's www.twitter.com/gemmabusoni
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