John began his medical career at UC San Diego and Scripps Clinic, where he practiced in many clinical settings including primary care, critical care, preventive medicine, hyperbaric medicine, trauma and helicopter medicine, and held several directorships while at Scripps Clinic, including Quality, Utilization, and Critical Care. He joined Kaiser Permanente in 1989, and was appointed as Assistant Medical Director and Chief Medical Information Officer in 1992.

John’s interest in systems design began as a marine biologist when he created several software applications to model population behavior. He wrote his first electronic health record in 1984 and used fully automated medical records in his practice until the time he began a fulltime commitment to healthcare informatics. He has built, designed, or implemented seven different EHR systems, most recently KP HealthConnect. His team helped build and deploy the first highly scalable version of this system, which today stands as the largest private sector implementation of an EHR in the US. John was director of the largest regional deployment, encompassing 5,000 physicians, 140 clinics, 13 hospitals, and 2.3million members, but he is quick to identify his many colleagues within KP who have provided the support, the resources and the skills necessary for such a monumental achievement.

He has actively shaped a culture of extremely rapid issue escalation and resolution that became the single most critical success factor for this large scale and pioneering project. He was also one of the founding members of the IMIA Workgroup on Organizational Aspects of Informatics, which focuses on the cultural change management required to successfully transform cultures with new technology. His team included many world class project managers who completed the project more than a year ahead of schedule and nearly $100million under budget. KP has been recognized as the uncontested leader for both outpatient and inpatient systems, leading the country for hospitals awarded with the top HIMSS level 7 designation. In 2011, 6 of the hospitals in SCAL region, and 12 KP hospitals nationally were recognized among the top 118 “Most Connected Hospitals” by US News and World Report. KPHC also includes the largest and most active use of Personal Health Records (PHRs) in the nation. With over 60% of our eligible members using the PHR portal, we exchange over 25,000 secure emails daily with our patients. Whether it’s US News & World Report, JD Powers, or National Council on Quality Assurance, Kaiser Permanente tops nearly every third party assessment for quality of care.

John has co-chaired the National KP IT Infrastructure Governance for the past four years, and he also chaired the Inter-Regional Business Governance Group since its inception. In addition, he chairs the national governance oversight of Business Continuity, Disaster Recovery, and Data Center Strategy. He continues his active participation on National HIT Strategy, Security Council, Care Delivery, and Risk Management.

John has been intimately engaged in the development and deployment of international interoperability standards. He founded an independent Standards Development Organization (SDO) to introduce XML into Healthcare, and later brought that SDO and that work into HL7. He chaired the XML committee at HL7 for the first three years, and that group has generated the Clinical Document Architecture (CDA) and the Continuity of Care Document (CCD). Hundreds of extremely talented individuals have continued that work since he initiated it within HL7, and it is now recognized as the international standard for exchanging medical records between different EHR and PHR systems.

He has directed the KP team in the National Health Information Network project between KP, the Veterans Administration, and the Department of Defense, which began production exchange of documents in San Diego in late 2009, not coincidentally in the same geography where he and his co-founder Dr. Spinosa initiated the CDA. He is an active member of the National Health Information Network Coordinating Committee (NW-HIN CC), which governs the use of national health information exchange, and has also joined the team that is drafting legislation for rule-making underway for a permanent NW-HIN Governance structure. He has recently joined the advisory board for the $15M Beacon project for Regional Health Information Exchange through UC San Diego.

John also was the first clinician to join the SNOMED International Board and helped guide that medical international medical terminology standard for six years.

He has a strong commitment to ensuring that security policies and practices effectively protect patient privacy and has been an active participant in various state and national initiatives in this arena. Most recently, he has been appointed to both the Policy Task Force for Cal eConnect, and the Privacy Steering Committee for the California State efforts to build a statewide health information exchange.

He is a founding member of the KP Innovation Fund and Board of Directors, and reviews every innovation proposal for the national program. He has sponsored numerous innovation projects including direct text messaging to patients, Smartphone applications for healthcare consumers, Natural Language Processing for data mining, medication management tools using smartphones, and advanced decision support, among others.

He has published numerous papers in medical informatics and has delivered national and international presentations on various topics on Innovation in Healthcare, Consumer-directed Healthcare, Mobile Healthcare, Clinical Ontologies and Medical Informatics. His most recent grant participation includes the establishment of a cross-institutional mechanism for research (SCANNER) that respects the local privacy policies at each institution. Recent speaker engagements include keynote addresses at 2nd mHealth Networking Conference, 2010 San Diego, the CIO Conference 2010 in Scottsdale, HealthTech 2011 in San Francisco, CIO Forum at HIMSS 2011 in Orlando, Canadian Health Information Exchange Summit 2011, Toronto, and others.

John and his team have hosted dozens of delegations from around the world who are interested in how they have automated every aspect of care, throughout every clinic and hospital in the Southern California region. He presented at a 3 day course on Care Delivery Strategies given entirely in Spanish to a delegation from Catalonia. He has consulted internationally on Health Information Technology, Integrated Systems Deployment, Interoperability Standards and Strategies for Transformational Change in the UK, Canada, Italy, and the Netherlands.

He has lectured at UC San Diego, UC Berkeley, UCLA, and Stanford, and currently contributes to graduate courses in Healthcare Leadership at UCSD, and Clinical Informatics Courses at UCSD and CSUSM. He most recently presented to the Telecom Council at Stanford Research Institute, exploring the relationships between mobile applications, social networking, gaming, avatars, and behavioral tools in computers (captology) and health and wellness.

One of his key ultimate goals is the translational bioinformatics opportunities for exploiting a large linked database of genomic, proteomic and metabolomic information and phenotypic findings among the millions of patients within the databases under management. This opportunity is perhaps the most revolutionary opportunity that will come from our investment in clinical information systems and will allow for vastly greater precision and personalization in prevention, diagnosis, and treatment of all diseases, and in the maintenance of health. It also creates an opportunity and an imperative for what John refers to as “meta-diagnosis”. Specifically, the vast databases created by the ubiquitous sequencing will help refine clinicians diagnostic approach to many problems. While a genomic sequencing will soon be so inexpensive that it will become part of most health records (with appropriate consent and security), the metabolomic and proteomic probes will likely be subject to patents, profiteering, and additional expense to the healthcare enterprise. John envisions how advanced decision support systems must provide the meta-diagnostics to focus the clinician on opportunities to use expensive probes only when the genomic datasets suggest their value.

John also leads a team that is building the infrastructure and applications for consumer directed healthcare using advanced decision support, mobile platforms, social networking, and computer-managed behavioral models of affecting change (captologies). He keynoted two national conferences on consumer/mobile healthcare in September of last year, and continues to keynote various conferences on healthcare information technology on a frequent basis. John has an intense interest in how to exploit information technology to create new ways to support how consumers interact with their health and wellness coaches, but also how they interact with the ever-escalating avalanche of communication created by the internet revolution, through the use of mass-customized avatars and personal digital health coaches.

John’s passion is to reduce the cycle time from the discovery of new information to universal deployment of that new knowledge through effective decision support systems. Improving the health of the entire population is the critical organizing force behind the efforts of his entire team. He is also committed to transforming the incentive system around healthcare delivery to one that directly rewards objective improvements in health outcomes while reducing costs. He is convinced that HIT is not only table stakes for achieving that goal, but also represents the critical underpinning to a mature incentive system that focuses on meaningful outcomes (rather than widgets of work or proxies for health in most current incentive models). He focuses on the next transformational shifts required to achieve those goals, and is especially interested in systems that directly incentivize consumers and their social networks to improve their own health through the use of mobile applications, gamification, health coach avatars, and pervasive sensors.
In January 2011, John was named as one of the first six to receive the Health Data Management recognition as a “Game Changer” in Health IT for his many contributions to this field.

In his spare time John enjoys scuba diving, underwater photography, surfing, tennis, growing tomatoes, and most of all time with his family.