Paul Tang Puts Patients First in Healthcare Innovation

Long before electronic health records became commonplace, and decades before artificial intelligence (AI) entered everyday conversations, Dr. Paul Tang found himself confronting a problem he simply couldn’t ignore. 

As a young physician during his Stanford residency caring for patients at the Palo Alto VA Medical Center, he routinely saw patients whose thick paper medical records never made it to the exam room during a clinic visit.

“I could not stand the fact that one-third of the time we didn’t have their chart,” he recalled. “We were taking care of World War II veterans without having their information, and I just thought that was unethical.” 

One day, during a visit with one of his patients and his accompanying wife (both of whom would later attend Dr. Tang’s wedding) whose chart was rarely present when he came into clinic, Dr. Tang wrote his clinical note, crumpled it into a ball, and threw it in the trash can triggering a laugh from the patient, his wife, and Tang.

“That’s the way it was,” he said. “You basically saw people, wrote a note, and never got back the information. We all tried to laugh it off, but the status quo was unsafe. It was just plain wrong.”

Solving that problem would become the defining theme of his career.

Today, Tang is recognized as one of the nation’s pioneers in biomedical informatics and digital health. His work helped lay the foundation for electronic health records, shaped federal policies that accelerated their adoption, led to the creation of Epic’s MyChart patient portal, and continues today as he explores the promise and potential risks of AI in medicine. 

Yet throughout more than four decades of innovation, Dr. Tang has remained remarkably consistent in his philosophy: uncover the real problem-to-solve, then don’t give up until it’s solved. 

Engineering A Different Future

Dr. Tang never expected to become a physician. 

Growing up in Indianapolis before moving to Bethel Park, Pennsylvania for high school, he came from a family of engineers. His father, grandfather, uncle, and younger brother all pursued engineering careers, each in a different discipline.

Engineering appealed to him too because of its reach. He chose to major in electrical engineering. 

“By changing the course of electrons, you could impact so many people,” he said. “How else can you do something and affect that many people?” 

After earning his bachelor’s and master’s degrees in electrical engineering at Stanford University, Dr. Tang found himself applying computer science to medical problems. One evening, while riding his bike home from the computer center after submitting a computer program with medical applications on one of Stanford’s massive mainframe computers at the time, he experienced a realization that changed everything. 

“I knew I liked helping people through engineering,” he remembered thinking. “But I also liked helping individual people.” That was it. He decided to go to medical school.

He attended medical school at the University of California, San Francisco, completed his internal medicine residency at Stanford, and discovered that medicine offered the opportunity to improve both individual lives and the systems that support them. 

That intersection between engineering and medicine would define the rest of his career.

Fixing What Was Broken

As Dr. Tang began practicing medicine, he found himself continually returning to the same question: How can we support physicians making better decisions? 

The answer, he believed, started with information. 

The paper charts that frustrated Tang during residency were more than an inconvenience; they represented a patient-safety problem.

Rather than accept the status quo, Dr. Tang built a basic electronic medical record program inside the VA’s computer system so he and several colleagues could reliably access their patients’ information. It became his first experience with what would eventually be known as the electronic health record (EHR).

“You have to fix what’s wrong,” Tang said. 

That conviction led him to Hewlett-Packard Laboratories, where he spent much of the 1980s helping imagine a future in which patient information would no longer be trapped in filing cabinets. 

In 1989, he was asked by the Institute of Medicine (IOM) to develop a project proposal for a study about computerizing the medical record. A consensus committee was subsequently appointed and published its recommendations in the IOM’s landmark 1991 report The Computer-Based Patient Record: An Essential Technology for Health Care (https://www.nationalacademies.org/read/18459/chapter/1#ii), a publication that became the organization’s bestselling report and helped establish EHRs as an essential component of modern medicine. He later chaired the Computer-Based Patient Record Institute, bringing together healthcare leaders in a 1996 Summit to address privacy, interoperability, and patient identification, all issues that helped shape the passage and implementation of the Health Insurance Portability and Accountability Act (HIPAA) later that year.

Setting out to practice what he was preaching, Dr. Tang was one of the first to implement a commercial EHR (by Epic Systems) in 1996 at Northwestern. He next implemented the same Epic EHR at the Palo Alto Medical Foundation (PAMF), where he created the position of chief medical information officer (CMIO) in 1999.

Still, spread was slow. Technology alone wasn’t enough. 

Dr. Tang came to understand that meaningful innovation often requires more than good ideas. It requires persistence, and sometimes policy change if you want it to scale nationally.

Years of advocacy culminated in the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which encouraged healthcare organizations to adopt EHRs through financial incentives tied to “meaningful use,” or use in ways that measurably improve patient outcomes, patient safety, and efficiency. Before the legislation, only about 4% of physicians used EHRs. Within a decade, adoption exceeded 90%.

The push for meaningful use EHRs yielded specific, quantifiable improvements in patient safety and outcomes, though data shows it was a gradual system maturation rather than an overnight transformation. Subsequent outcomes showed improved clinical decision-making, increased use of preventive services (e.g., immunizations), reductions in prescribing errors, and reduced costs.

“The thing that surprised me most was finding out that a piece of policy and a relatively small investment of federal funds could make such a huge difference, virtually overnight,” Dr.Tang said.

Putting Patients At The Center

As health care became increasingly digital, Dr. Tang began asking another question. If physicians could access information electronically, why couldn’t patients? 

“If we’re going to have data in the computer,” he recalled thinking, “we darn well better make it available to patients.”

Working with Epic Systems in 1999, he helped develop MyChart, which would become the nation’s most widely adopted patient portal.

Today, hundreds of millions of patients use MyChart to schedule appointments, review test results, communicate with their physicians, and play a more active role in managing their health, a concept that was far from standard when he first championed it. 

The Next Frontier

The technology dominating today’s healthcare conversations would not exist without the work Dr. Tang advocated for decades ago. AI depends on digital information, and without EHRs, there would be little data for AI to learn from.

After spending much of his career building that foundation, Dr. Tang is both excited and cautious about what comes next. 

“This is the biggest advance in technology and potential for impact I’ve seen in my whole career,” he said of AI. 

Tang believes AI has enormous potential to improve clinical decision-making and to reduce physician burnout, but only if health care develops equally rigorous ways to evaluate these tools. 

Without those safeguards, he warns, AI can introduce errors that quietly become part of a patient’s medical record.

Innovation, he believes, should never outpace responsibility.

Looking Beyond Sick Care

Although Dr. Tang has long focused on digital health as an enabler of transformation, his innovations have always started by understanding what is important to people. 

He frequently starts new initiatives with ethnography, observing people in their native environment rather than relying solely on focus groups or interviews.

“If you understand the root problem-to-solve, the solutions are invariantly more elegant and impactful,” Dr. Tang said. 

That philosophy led him to one of the most meaningful insights about wellbeing while he was chief innovation and technology officer at the Palo Alto Medical Foundation and working to address the grand challenge of aging.

When the team’s ethnographer was visiting a 78-year-old woman in her home, she shared a simple observation: “The problem with getting older is your world dies before you do.” 

Dr. Tang and his team never forgot those words. 

For him, they revealed that one of healthcare’s greatest challenges wasn’t a disease — it was loneliness. 

That realization inspired the creation of the linkAges (short for link across the generations) TimeBank, an innovative model that strengthens community connections by matching people who need help with those willing to share their time. Rather than being recruited to “help,” however, most of the exchanges turned out to be for enrichment experiences (e.g., learning to play the drums, going to a garden exhibit) and were inter-generational. It was the social connections that were created amongst neighbors, families, and communities that raised the health and wellbeing for all.

The results were remarkable. Participants who completed just two TimeBank exchanges over the course of one year had 25% fewer clinic visits.

“It’s disruptive because it requires changing our sick-care model into one of health promotion, and lo and behold it reduces the need for sick care” Dr. Tang said proudly. 

Persistence, Purpose, and People

For all of Dr.Tang’s accomplishments using technology, the thread connecting his work isn’t the technology. 

It’s people. 

That philosophy also explains his long relationship with JHF.

Drawn to the Foundation’s willingness to tackle difficult problems through policy, partnership, and persistence, Dr. Tang has collaborated with JHF for many years. 

That same persistence is required to improve patient safety, Dr. Tang said, which is one of the Foundation’s long-standing priorities. 

Just as importantly, he believes lasting change depends on storytelling.

“Data may convince you about what the right decision is,” he said. “But stories make you act.”

It’s a fitting observation from someone whose own story spans the evolution of modern health care — from paper charts to patient portals and now to AI. 

Through every chapter, Dr. Tang has returned to the same North Star: making the world a better place by doing the right thing. 

And after four decades of transforming health care, he remains convinced that meaningful innovation begins not with technology, but with understanding people. 

As JHF continues to convene leaders around patient safety, healthy aging, and the responsible use of AI, voices like Dr. Tang's remain invaluable. His career exemplifies the kind of bold thinking and persistence that have long defined the Foundation's work with the belief that healthcare is transformed not simply by better technology, but by people willing to challenge the status quo in service of patients.