For healthcare CIOs and CDIOs, career transitions have become commonplace. Whether it stems from M&A activity – and the resultant corporate restructuring – or a desire for advancement, leaders are increasingly pursuing new roles. Doing so, however, requires “a great amount of energy,” and therefore must be approached thoughtfully and strategically.
“Career transitions need to align with where you are in your personal life,” said Clara Guixa, Chief Digital Information Officer at Baystate Health. “It’s not just about the job itself. Is it the right timing?” And just as important, “How do I leave an impact?”
Clara Guixa
Recently, Guixa opened up about how she sought answers to these critical questions before taking on her current role this past June. She also talked about what drew her to the organization, and provided guidance on how to navigate a major transition.
One thing Guixa, a lifelong city resident, didn’t expect was to move to a rural part of Massachusetts. But the opportunity to apply the knowledge gained from her time at Boston Children’s Hospital and UChicago Medicine to improve care access was too good to pass up. At Baystate, “we’re looking at how to drive excellence so that we’re a destination – not only from a quality and clinical outcome perspective, but also from an experience perspective,” she noted.
A significant part of that, she knew, would involve developing a digital framework for the organization, which includes four hospitals and a large multi-specialty group spread out across a wide geographic area.
“We’re going through a lot of transition,” Guixa said. “Not just from a digital or IT perspective, but as a multidisciplinary team putting our heads together to build this membrane across Western Massachusetts.”
Not an easy feat, but one she felt prepared for after investing significant time upfront engaging in listening tours, attending town halls, and conducting interviews with clinical and administrative leaders.
The foundation for building a strong business case, however, started during the recruitment process, where Guixa made it a point to show up prepared. “You need to ask the right questions, and be very thoughtful about how you ask those questions,” she said. Guixa’s key concern? Ensuring she would have “latitude to bring recommendations forward, to elevate the position of IT, and to create a cohesive strategy,” she recalled. “To me, that’s really important.”
Also critical for new leaders? Setting the right tone and getting an accurate read of the organizational culture. For Guixa, the timing of her start couldn’t have been better, as Baystate had just conducted an engagement survey that encouraged – and received – honest feedback. “I was really lucky,” she noted. “From a service delivery standpoint, we’re only as good as the value we provide. We need to be very aligned with our teams and with the business to make sure needs are being met. And for that to happen, we need engaged employees.”
As it turned out, Baystate’s IT team garnered high scores, which Guixa hopes to build upon while addressing the challenges that were identified. “I’m learning a lot.”
And not just about what employees need to successfully do their jobs, but also about what makes them tick. “This is a close community. People tend to come here and build families. There’s a lot of history,” she said, adding that the surveys also shed light on “how people are connected, which is so important.”
Another key lesson Guixa has learned is that how leaders finish their tenures with an organization is just as important as how they start the next role. As she wrapped up her time with Boston Children’s, “it was very important for me to complete a few initiatives that we were working on, and get the team to a point where I felt they could successfully carry the work we had started,” she said.
In her case, that meant giving 30 days notice. “I appreciated the opportunity to do that,” she noted. “It also helped me to start strong.”
There’s an old saying that goes: ‘If you love something, set it free.’
Similarly, if an organization wants an innovation to thrive and make a true impact on healthcare, the same approach must be applied, according to Hank Capps, MD.
“Setting it free helps it to evolve faster,” he said. “The overriding purpose isn’t to create solutions for WellStar. We’re certainly intent on solving problems, but the purpose is to create value beyond that.”
Hank Capps, MD
It’s one of the core philosophies that has enabled Catalyst by Wellstar, the innovation arm of Georgia-based Wellstar Health System, to achieve success. Since its launch in 2021, Catalyst has initiated more than 20 pilots and continues to seek out “real-world, revolutionary ideas from across industries” to address common challenges.
Recently, Capps – who serves as both Chief Information and Digital Officer at Wellstar and President and Co-Founder of Catalyst – spoke with This Week Health about how and why the innovation company and venture firm originated; the results it has seen so far; and what sets it apart from other innovation hubs.
The impetus for Catalyst actually came several years back when Wellstar leaders sat down to revamp Wellstar’s strategic plan – and innovation was identified as a key pillar. “As we developed that approach, we developed two very basic theses,” he recalled. The first is that not all healthcare problems are solved by healthcare solutions. The second? Those closest to the patient should be shaping the problem.
That was precisely the case with Catalyst’s first spinout company. The idea for vflok, a workforce optimization solution, came from nurses who expressed dissatisfaction with the scheduling process – specifically the lack of flexibility and transparency.
“It started with a problem statement from our nurses around their schedules and ultimately evolved into an AI-powered tool that helps build connections between groups of nurses and gives them more autonomy over their schedules,” he said. And by having nurses participate in the design process, Catalyst helped ensure it was addressing their biggest pain points.
“We built technology to match the needs on the ground. We’ve already seen great feedback,” Capps said, noting that plans are in place to expand it further. “This isn’t a shiny toy. It’s not even about a scheduling platform. It’s about connecting nurses together and building that broader community.”
Beyond having an ear to the ground, another key to his team’s success is their atypical approach to the incubation process.
Most of the time, venture funds have a very specific focus,” he said, and tend not to keep an innovation inside of its own walls from the idea phase to the final product. “We took that same concept and said, ‘how do you apply that inside a corporate venture?’” The answer, he found, is to “select early-stage innovations and spin them out at the beginning – not once they’re fully developed,” and configure a way to allow information to flow into the health system.
By housing all of that under a single roof, as opposed to venture funds sitting in different locations, Catalyst has access to “a view of how it all interacts together and is integrated,” Capps said. “We believe that’s significant. It’s part of the secret sauce.”
Another important piece of Catalyst’s strategy is not limiting the scope to healthcare companies. From the beginning, the emphasis has been on six strategic focus areas – including Care of Tomorrow and Customer Experience – that “reflect the most urgent needs of communities, healthcare, and long-term value,” the website stated.
Through its initial research, Catalyst amassed a “giant repository of the biggest problems that we as a health system have identified,” leaning heavily on the many subject matter experts who lend their time and expertise along various stages of innovation.
One of those challenges was the lack of resources around breast cancer screening. To that end, Catalyst partnered with WellStar’s Center for Breast Health to launch Gabbi, an early detection screening platform. Developed by Kaitlin Christine, a breast cancer survivor who lost her mother to the disease, Gabbi has already helped identify a number of patients who otherwise wouldn’t have been flagged as high-risk, said Capps.
“We’ve had hundreds of patients leverage the service,” he noted, adding that the partnership itself has been innovative. “The traditional way that a startup like Gabbi would enter a market would be to compete with the health system instead of working with it. That’s the kind of magic that happens when you bring together visionary founders like Kaitlin with our clinical leadership, and have the machinery to introduce that into the ecosystem here in Georgia.”
The success of both Gabbi and vflok lend further credence to the idea of setting innovations free and enabling them to experience “the full force of the market,” rather than the full force of one health system, Capps said. As a result, “they’re able to move faster,” and more importantly, touch more lives.
What really gives Catalyst a competitive advantage, he believes, is its structure. “Within our technology organization, we have the traditional core technology, clinical platforms, and business platforms. We also have data, AI, enterprise architecture, biomedical devices, and digital health,” he said. In that sense, “we are constructed very much like a technology company that is serving the needs of both the community and our team members.”
That community, of course, includes patients, which means the “technology engine has to work every single time,” Capps stated. As a result, “a lot of the work we’ve done has been in shoring up. We’ve worked really hard over the last few years to ensure we have a technology infrastructure that’s strong enough to support all of these activities,” and do so in a way that’s “invisible.”
As emerging technologies become table stakes, that dedication to having a solid foundation will become increasingly important.
“That’s what we keep coming back to: it’s not about solutions, it’s about problems,” Capps said. “If you’re identifying problems and then you're working with people to solve those problems, there’s something really special that comes from it. This is exciting work.”
Anna Schoenbaum’s career didn’t start on the IT side. But it didn’t take long for her to feel the pull – particularly when it became clear that technology’s role in healthcare was only going to grow. “I was enticed by the idea of improving processes from paper to automation,” she said. And even more so, the opportunity to “make a difference. Not just in one department, but across the enterprise.”
The transition, however, wasn’t an easy one. It needs to be approached thoughtfully, according to Schoenbaum, now VP of Applications and Digital Health at Penn Medicine, an $11.9 billion enterprise consisting of The University of Pennsylvania Health System and the Raymond and Ruth Perelman School of Medicine. During an interview with This Week Health, she shared advice for those looking to make the leap, drawing from her own career experience, and discussed how she has benefited from her involvement with HIMSS.
Anna Schoenbaum
It’s no secret that healthcare has a workforce problem. By 2030, the global healthcare worker shortage is expected to reach 10 million, which could lead to $1.1 trillion in costs (McKinsey). And that’s just on the clinical side.
According to a Security Magazine survey, 47 percent ranked IT staff shortages as a top-three challenge. Around two-thirds said routine IT tasks take longer to complete due to limited staff, and 74 percent cited IT staffing shortages as a deployment barrier.
For leaders, this isn’t exactly news. Neither is the fact that as adoption of digital technologies continues to climb, the demand for skilled IT professionals will only grow. And that means organizations need a solid strategy not just for recruiting and retaining talent, but also for helping existing employees transition to IT-based roles.
That’s where Schoenbaum comes in. As both a faculty member at the University of Maryland School of Nursing and a visiting professor at Chamberlain University, she has a great deal of experience mentoring both students and staff, and offered these bits of wisdom for those looking to break into IT.
This advice, however, isn’t just for those who are seeking a new role, or those who are early in their careers. Particularly the piece about networking. “You learn so much when you’re surrounded by colleagues and industry experts,” she noted. Being at events like HIMSS helps to shed light on common problems and provide forums for discussion and learning. “It’s connecting people to share experiences and say, ‘can we implement the same solution at our organization? If not, why?’ Or ‘what do we need to put into place to make it successful?’”
And for leaders, the objective is to take that knowledge – and that spirit of collaboration – back to the organization to help push forward key initiatives. “Technology is evolving very quickly,” she said. “We have to keep in mind that at the end of the day, technology doesn’t transform healthcare. People do. My job is to equip, empower, and elevate those people who can help drive change.”
When that happens, Schoenbaum concluded, “We’re all successful.”
Artificial intelligence itself isn’t new to healthcare – not by a long shot. But in the last few years – starting with the introduction of ChatGPT – a more advanced version of AI has swept across healthcare, prompting organizations of varying sizes and scopes to pilot tools in hopes of improving care experience and outcomes and alleviating the burden on providers.
But, as with any novel idea, AI has been met with resistance for myriad reasons, from cybersecurity and privacy concerns to costs to fear of change. Sameer Sethi likened it to the introduction of the Internet in the early 1990s. “At first, the world hadn’t figured out how to use it. I see AI as the next revolution, but I think we’ll get there faster this time because we have that foundation.”
And because of the risks involved with AI, healthcare leaders are approaching it deliberately. Still, a number of organizations have already seen positive results, including Hackensack Meridian Health, where Sethi serves as Chief AI Officer. Recently, he and Scott Waters, Chief Information and Technology Officer at Overlake Medical Center and Clinics discussed their strategies and shared how their teams are managing the biggest hurdles.
“How can we help clinicians function at the top of their license?” One way, according to Sethi, is by leveraging GenAI to summarize “thousands of data points” to provide the insights and intelligence needed to more effectively care for patients. “There’s so much data being generated. Your watch is generating data. Your computer is generating data,” he noted. “And humans don’t have the capacity to process it all,” let alone do it accurately and quickly.
Sameer Sethi
That’s where the AI platform from Google Cloud comes in, creating a summarized clinical note that can help with disease detection or prediction, while enabling providers to spend more time with patients.
“We’ve done a lot of automation so that a clinician can be a clinician, a nurse can be a nurse, and a therapist can be a therapist,” Sethi noted. Meanwhile, AI listens to the conversation between clinician and patient and generates a note that the clinician can then read and edit as needed. “That’s exciting.”
And that’s not all. Recently Hackensack Meridian Health, an 18-hospital system based in New Jersey, also launched HMH 24/7, a platform that connects patients with virtual providers. Developed in partnership with K Health, the solution performs triage, using an AI chatbot for intake and data entry, and then matching the patient with a provider. “The intent is to expedite the process, while also increasing access to services,” he noted.
The next use case for AI, interestingly, will focus on the other end of the spectrum, noted Sethi, whose team is training bots to assist with post-discharge follow-up. Although it would be ideal to have humans make the call to ensure patients are filling and taking medications, for example, the reality is that “there aren’t enough humans,” he said.
Through this capability, HMH can ensure every patient is asked critical follow-up questions, whether it’s by a bot or human, and a plan of action is created. “We might ask, ‘how are you doing? Do you need help? Have you been taking your medication? If not, why?’ If it’s because they forgot, the bot can be programmed to schedule reminder calls or even set up another appointment. Ultimately, “we want to keep patients at home,” he noted, and prevent unnecessary readmissions.
And while it may seem that Hackensack is going full bore into the AI world, that’s far from the truth, according to Sethi, whose team has been “very careful” in their approach. “I think deciding what it should do versus what it shouldn’t do is a very philosophical conversation,” he said. “But it’s also an operational conversation that needs to happen. What type of care do we stand behind? What type of care are our patients ready for? Just because we have AI capability, it doesn’t mean we should always offer it.”
Acceptance and adoption, he believes, can serve as obstacles to AI – but not in a bad way. In fact, he believes they are “great barriers” because “they challenge us to see things from the patient’s eyes.”
Therefore, it’s critical to offer ongoing education on how to most effectively use AI, and to communicate the incentives in a clear way. “We spend a lot of time educating people, running pilots, and collecting feedback, and it’s helped us quite a bit,” Sethi said.
Overlake Medical has taken a similar approach to generative AI by focusing heavily in the ambient listening space. “That’s where we see the most staying power,” said Waters.
Scott Waters
To that end, his team recently deployed a voice agent that can help troubleshoot MyChart issues. The objective is to resolve calls – which have been directed through a phone tree – without having to escalate to a live person. Although it started as a “simple use case to test the waters,” the early results have been “super promising,” noted Waters. “We’re seeing about a 50 percent call resolution rate, which is probably double what we hoped for.”
Importantly, “we now have proof that it’s getting value for our patients along with cost-savings on the backend, which is the perfect marriage. And so, even though Overlake is still “in the crawl phase of crawl, walk, run,” leadership is encouraged by the potential upside, and is looking to expand. “We’re implementing a platform that allows us to build out virtual agents to interact with patients or providers through a number of different channels, whether it’s SMS messaging, text-based interactions, or chatting,” he said.
Of course, anytime a change of this magnitude is introduced, it’s going to have a ripple effect into other areas, including workforce management. There’s no getting around the fact that voice agents “change the way we work,” according to Waters, particularly when it comes to things like training and coaching.
“It sets the stage for a future where I see us having two types of human resources,” he said – one dedicated to human assets, and the other to autonomous agents. Managing the latter is going to require a different approach. “You’re not looking at annual reviews with non-human employees,” he said. “If it’s not doing what you want, you would just terminate that employee and spin up a new one, or maybe tune it a little bit. It’s a lot of quality checks. It’s interesting.”
At the same time, however, “we’re just scratching the surface,” and given the vast potential of AI, he believes it’s critical for leaders to tread carefully. “I don’t think biologically that we’re set up to take on this much change, this quickly. These are conversations we need to be having.”
Part of the conversation for a growing number of organizations, including Hackensack Meridian, includes having a designated AI leader at the C-suite level. “I think it’s a must-have,” said Sethi, whose title changed from Chief Data and Analytics Officer to Chief AI Officer in November 2024. “Otherwise, you’ll be left behind, or you’ll overspend because people will sell you vaporware.”
At the end of the day, “AI is a technology first. You need a technologist who understands the capability to provide advice on whether it’s a good or bad technology, and whether it will deliver the best insights,” he said. “You need an AI officer to develop those workflows and educate the organization.”
Waters concurred, noting that the role “makes sense,” particularly given GenAI’s growing presence in healthcare. The question is how governance will be affected. His guess? “I anticipate that AI functions are going to roll back into a standard leadership model instead of having a separate AI structure.”
With an organization like Overlake, which includes a 349-bed hospital and a growing network of clinics, a dedicated Chief AI Officer most likely isn’t in the cards, which means most of it falls on the IT team. Fortunately Waters, whose role expanded recently from CTO to CTIO to reflect the organization’s strategic objectives around innovation and digital transformation, it’s all part of the growth process.
“That role evolved with the move to the cloud, and when you bring in AI, it starts to evolve even more,” he said, particularly as the technology becomes increasingly embedded in healthcare – and in the everyday lives of patients and clinicians.
Sethi shared the same sentiment.
“We can make a difference,” he said. “And honestly, that’s my north star–how do I make sure my doctor is smarter? That's what I work for every day.”
Picture the scenario: an organization is in the midst of rapid expansion while also taking steps toward digital transformation. To ensure growth happens in a sustainable way, more talent must be hired – unfortunately, the talent pipeline seems to have dried up.
Not exactly a unique situation in today’s healthcare landscape. What is unique, however, is the approach that Eisenhower Health has taken to address this issue. Their answer, according to CIO Ken Buechele, was to construct a new pipeline by establishing an IT apprenticeship program.
“The landscape of the technology skillset and the market in our community has changed,” he said during a recent interview with This Week Health. In addition to a 437-bed hospital, Eisenhower offers dozens of outpatient locations scattered throughout the Coachella Valley region of Southeastern California. Although the area, which is “somewhat isolated” due to nearby mountain ranges,” has never had a problem attracting visitors, filling onsite IT positions started to become increasingly challenging in the post-Covid world. “We need to think about how to grow and retain talent in a way that allows us to meet the organization’s needs.”
Ken Buechele
Compounding the issue is the fact that Eisenhower is “doing everything that most of the bigger players are doing; we’re just doing it on a much smaller scale” – and with fewer FTEs.
That’s where the apprenticeship came into play. Shortly after taking on the CIO role in January 2022, Buechele rolled out an initiative that he hoped would help fill key positions while also strengthening the workforce as a whole.
“It’s basically an internship on steroids,” he said. “They start with us in the summer and work full-time. But instead of going back to school after three months, we expect them to stay on part-time.” Indeed, most interns continue to work 1 or 2 days per week, and some have remained on for as long as three years.
As part of the program, apprentices rotate through departments, which exposes them to different tasks. “That gives them not only just the baseline of the complexity of the IT aspects, but also an orientation to Eisenhower as an organization,” he noted. “It’s important, regardless of where you are, to get a sense of the calls that we get, the technologies that are used, and what happens in that role.” And in doing so, learn that calls coming in from the ED or OR must be prioritized. “These are the customer service skills that make a good service desk technician.”
And, like many CIOs, he believes those skills are best learned onsite – the problem is that potential hires don’t feel the same way.
“Before Covid, we would see people with 3, 4 and 5 years of healthcare IT experience applying even for entry-level roles,” said Buechele. Now, “we’re really struggling to align helpdesk and network technician-type roles with locals.”
As a result, Buechele’s team had to restructure job descriptions and reset expectations by targeting a completely new audience. Instead of trying to squeeze more out of a shallow pool of applicants, Eisenhower partnered with local colleges and high schools to identify possibilities for partnerships.
What they learned was quite interesting: the technical education curriculum in high school has grown by leaps and bounds in recent years. “They’re basically getting their security-plus by the time they’re out of high school,” Buechele said. “And so, there’s an amazing opportunity to capture students right out of high school and introduce them to our program.”
The other compelling learning? Colleges are behind the eight-ball when it comes to career preparation. “We get a lot of applications from recent grads that don’t have any hands-on experience,” he noted. The apprentice program has “helped build the skills and the talent that we’re looking for.”
Importantly, it goes “beyond the nuts and bolts of how to image a computer and replace equipment, and how to be a desktop technician,” he added. By having trainees go through various rotations, “They get a better sense of who we are as an organization.”
And it’s not limited to desktop help – although that is critical. “We’re creating security analysts, network engineers, telecom engineers and ultimately, Epic analytics,” he said, adding that Eisenhower also plans to offer help with classes and certifications. “That’s the skin we’re putting into this. The goal isn’t just to fill seats.”
As with any initiative, it’s critical to ensure proper governance structures are in place. At Eisenhower, apprentices report directly to Buechele and his team facilitates onboarding; however, there are supervisors in place to provide more focused guidance. “I make it a point to be part of the process and make sure everyone understands how important it is,” he said, which helps ensure the program doesn’t “fall by the wayside” when things get busy.
“You have to continue to nurture it,” noted Buechele, who emphasized the value of both executive support and departmental champions. “The key is to find somebody who will take it on as a passion project and believe in it.”
It’s also important to note that onboarding practices for apprentices may differ substantially from those of traditional IT hires. “They may have to shadow and observe longer than those with previous experience,” he said. And while that might take more time, it’s important to ensure individuals are developing skills, and not just taking on tasks that others don’t want. “Every organization has projects like Windows 11 upgrades or lifecycle replacements that are the right mix of task and repetitive work, but we also have things that are meaningful from a knowledge and growth perspective,” Buechele noted.
“That’s one of the things that I've stressed with my team: I don’t want them just doing spreadsheets and cleanup work,” or in a desktop context, wiping hard drives. “I want them to learn, and they can’t do that if they’re just imaging computers all day or pressing buttons all day. We try to make it meaningful.”
What they’re not trying to do is expand too quickly. The program has had about 3 participants each year, about a third of whom have been hired full-time. And while it’s not making waves on a national scale, Buechele believes it has the potential to become a game-changer, particularly for organizations that aren’t partnered with large universities.
“We need to find a way to capture what colleges and high schools are doing right and provide experience in a way that’s meaningful,” he noted. Through their innovative program, Eisenhower has found a way to “source talent in the community.” And it’s a method that can work across the board, as long as organizations are willing to put in the work to develop partnerships, establish a solid foundation, and invest in people.
There’s no shortage of challenges facing healthcare CIOs, particularly in the current landscape. But perhaps the most significant, according to Brian Lancaster, is a lack of comprehension – not of the technology itself, but rather, everything required to make it work.
“People need and want technology, but they don’t know the cost. They don’t know the cybersecurity risks. They don’t know what a major incident looks like,” he said. “It’s our burden as leaders and technologists to make sure they understand all those factors, and at the end of the day, empower them.”
Brian Lancaster
That’s where the CIO comes in, according to Lancaster, who took on the role at Children’s Mercy Kansas City in 2022. In addition to guiding the IT strategy, leaders must be able to build and maintain relationships, instill confidence in teams, and create momentum for major initiatives – which is precisely what Lancaster is doing as he prepares to lead a migration from Cerner to Epic’s EHR.
In fact, that opportunity is what attracted him to Children’s Mercy, and it was his unique background – which includes 17 years with Cerner, largely in product management, as well as more than 7 years as CIO at Nebraska Medicine – that helped land him the position.
“I thought it would be beneficial from a career standpoint to have pretty deep vendor expertise with Cerner and then start to learn the provider side in an Epic shop,” he noted. Indeed, that experience set him apart during the recruitment process at Children’s Mercy, as the organization ultimately chose Epic, and relied on Lancaster to lead the migration.
As Children’s progresses toward its go-live, scheduled for March 2026, he shared some of the lessons learned and offered best practices for leading teams through periods of dramatic change.
When organizations transition to Epic – which has become a common trend in recent years – the onus often falls on CIOs not just to help sell it to the board, but also to the staff. One way to do that? By educating teams on the benefits of Epic – and of adopting its doctrine.
Because while that strategy of “here are our standards, here is your grade against those standards” may seem rigid, he believes it’s necessary. “It creates a better implementation and a stronger foundation for innovation,” Lancaster noted. “You can do new things because the basics are in place and that comes from a combination of technology, but also people and processes.”
Part of that philosophy is ensuring that individuals from a variety of areas, including informatics, business, and clinical, among others, are actively engaged in the process. “That’s the way it should work in healthcare – we should understand what their needs are and provide solutions to them. We should not be doing technology to them,” he said. “It’s a fundamental difference in how Epic operates. They get operations and clinicians engaged, and that helps with buy-in.”
Where it can get “sticky” with Epic, however, is when a suggested practice doesn’t work. In these cases, teams need to be able to ask questions. “We beat this drum that we’re going to follow Epic’s Foundation and leverage what our friends at places like Boston Children’s are doing,” Lancaster said. As a result, “our team wasn’t feeling empowered to say, ‘that’s strange. Maybe we shouldn’t do it that way.’ We have to strike a balance.”
That, interestingly, was one of the most critical lessons he learned. “It wasn’t necessarily how to run a work group or how to make the operational decisions we need to make; it was empowering the team to push back.”
And not in an aggressive way, but in a way that generates a productive conversation, while also helping analysts and informaticists develop new skillsets that will pay dividends in the future. “It’s helping us adopt some modern approaches in how we think about technology and how we continue to empower the frontlines,” he added.
With an implementation of this magnitude, it can be easy to focus mainly on the clinical and business aspects, but it also creates an opportunity to transform the infrastructure, which is part of Lancaster’s vision.
In parallel to the EMR modernization effort, Children’s is also developing a more robust data archive and conversation strategy that he believes will yield benefits in the future. “The consistent thing across any healthcare IT department, whether it’s an academic medical center or a children’s hospital, is that people want and need new technology to continue to be relevant. So how do you automate and consolidate to meet those demands?” By modernizing the infrastructure, organizations can “set the stage for a solid foundation to meet all of those demands,” he noted.
As part of that strategy of thinking ahead, his team is deliberately considering platforms that have built-in AI capabilities. “Our current plan is to have a selected ambient documentation vendor at go-live and do a pilot and enterprise rollout as a fast-follow so that we can stage it appropriately,” he said. “One of the compelling parts of Epic is all of the options they have for AI – both what they’re building as well as integrations with partners.”
Introducing ambient tools, however, represents a significant change in the workflow, as do other major initiatives like EHR migrations. CIOs, therefore, need to invest time and energy into creating “meaningful relationships.” And that, according to Lancaster, entails “spending time listening to peers and understanding them so that you can build the foundation to inform them of decisions that need to be made.”
That also means being bold enough to speak up when something doesn’t seem right – or when, for example, a leader is being influenced by a vendor to make a recommendation. “You need to have the confidence and the knowledge to go to them and explain, ‘I know why you want to do system X, but that will create this type of outcome. I think we could also get those outcomes by using this system we already have,’” he explained. “Walk through it from a business case standpoint, but in a very simple manner where it’s time, effort, outcome based.”
Having these types of uncomfortable conversations, Lancaster said, can play an enormous role in helping leaders shift from being an order take to a strategic partner.
Another aspect in that shift comes in how leaders measure key performance indicators. For example, an order taker will focus primarily on turnaround times, satisfaction scores, and availability, while strategic partners ask questions such as, ‘how do I transition to be value-based? How do we enable growth? How do we increase physician satisfaction? By doing so, “we’re creating value for the organization through technology,” he said. “That, to me, is an awesome aspect of change management.”
On the other hand, one of the more difficult aspects is ensuring the message not only reaches the intended audience, but sinks in. Sometimes it’s as simple as getting what he calls the ‘wait… what?’ response, which happens once individuals have had a chance to absorb the information.
“If you don’t hear that ‘wait… what?’ chances are you’re not going to get adoption. You have to keep communicating and make sure it’s clear,” he said. “Now they get it and understand why we’re no longer allowing you to use personal email, or why we can’t buy a system. And then, you get alignment.”
It’s one of the harsh realities of the CIO role, according to Lancaster. “Sometimes we’re there to enable opportunities and strategy. We're using technology to do something amazing,” he said, citing ambient documentation as an example. “But sometimes it’s explaining that we can’t do that because of the cybersecurity concern, or that you now have to use multi-factor authentication.”
The key is in finding the right way to communicate with different teams and individuals, he noted, citing advice he received years ago from a mentor to “consult like the CEO,” which entails laying out the options and cataloging the pros and cons. “It’s saying, ‘I strongly recommend option A. You can do option B and C, but anticipate that we’re going to have to hire a team, or we won’t get the results.’ And make sure they understand it.”
Another way to think about it? “You can’t cross a 10-foot chasm with two 5-feet jumps,” Lancaster said. “You have to have the ability to jump the whole chasm, or you’re going to break a leg.”
Governance.
No one wants to talk about it, and yet, it’s one of the top priorities on everyone’s list. The question is, why?
Part of the reason, according to Luke Olenoski, SVP and CIO at Main Line Health, is the negative connotation associated with the word itself.
“Governance has a rigid feel,” he said, likening it to “a meeting where things get a ‘yes’ or a ‘no.’ We’re really talking about an operating model of how we interact with our stakeholders,” he noted. One that “signifies an end-to-end process,” rather than an isolated project, and “represents a more dynamic relationship” among various departments.
Chris Walden, VP of IT at Tenet Healthcare, agreed, noting that governance can become “overly bureaucratic,” which is particularly problematic due to the common associate with IT. At the 49-hospital, multi-state organization, “There’s no such thing as IT governance. It’s operational governance,” he said. Doing so clarifies that decisions are made to align with organizational goals rather than meeting departmental needs.
Chris Walden
And while terminology is important, what’s even more critical is having a solid framework in place to evaluate, prioritize, plan, and execute projects. Recently, Walden and Olenoski spoke about the benefits of governance programs, and shared valuable insights on how to successfully implement them.
As health systems face a growing list of demands, it’s becoming increasingly challenging for leaders to prioritize tasks. That, noted Walden, is where governance comes into play. “We needed a way to be able to funnel those things in and determine which have the strongest business case and which fall under the category of ‘keeping the lights on’ so that people knew which path to take.”
And in fact, he believes a strong governance strategy can help teams by setting parameters. “Without it, how do your customers know, what do I do? What shouldn’t I do? Who’s helping me?” he said. Reframing the conversation can shift some of the burden away from IT while educating and empowering others.
It also provides teams with “a broader view of what’s going on” throughout the organization, and ensures diverse representation in the decision-making process. “By having a governance group that’s coming at it from different lenses, we’re able to get that collective agreement,” Walden noted.
So what, exactly, does the ideal governance model look like? While there isn’t a one-size-fits-all approach, there are best practices that can be adopted regardless of the size of an organization.
“It truly does take a village,” Walden noted, adding that at Tenet, “Everybody needs to weigh in because we’re all equally accountable. That’s one of the things that makes our governance successful and more mature than some.”
Luke Olenoski
At Main Line, a four-hospital system located in the Philadelphia suburbs, Olenoski’s team is shifting its thinking in three critical ways.
The first is a shift in thinking as the organization moves away from isolated projects and focuses more on enduring programs, he said. Now, “each program has an ongoing roadmap so it’s not just, ‘I want this project approved.’ It’s more about asking what’s in the nursing pipeline? What's in our physician wellbeing program? What's in our HR and finance program? It’s less about ‘can we get this project approved,” Olenoski added.
The second is to plan for change rather than avoiding the topic – which is often easier said than done. To that end, his team has set up monthly steering meetings and quarterly capital planning meetings. “Knowing and accepting that change is going to happen means we have an operating model that works with change.”
The final piece of the new direction involves ditching the technology-focused approach with projects and adopting an integrated strategy that includes HR, finance, and IT. The impetus for the change? “We tend to build processes that protect our teams but may not work for end users,” he noted. “We would go through a process on the IT side and then present it to finance and wait.”
The decision to integrate with finance, he believes, was a no-brainer in helping Main Line become more efficient while streamlining processes. “We’ve worked closely with them to have the same prioritization framework and the same business planning templates,” he noted. That way, “it’s not just a technology process.”
For Olenoski, who first entered the healthcare space just five years ago, having outside experience has paid dividends – specifically when it comes to governance. His first piece of advice, based on more than a decade with Vanguard, is simple: know the business.
“It’s something we take for granted,” he said. And yet, taking the time to know the business strategy and understand the experience for front-line users can be extremely valuable.
He also cautioned peers to avoid becoming an order-taker – a mold that can be hard to break out of. “I always tell my team to have an opinion and a recommendation,” Olenoski noted, especially those in high-level roles.
At the same time, it’s also important to avoid making too many decisions. Although it may seem contradictory, he believes “the fewer decisions you make, the more influence you have,” and encourages others to focus energies more on informing and providing insights, and less on being the one to stamp the project.
Above all else is the ability to cut through the noise – something that is becoming increasingly difficult. “We need to make sure we’re working on the right technology projects to help our end users to be as effective and as productive as possible,” he stated. “It doesn’t always have to be a big flashy project.”
In fact, “a lot of our focus isn’t around capital projects, but rather, the day-to-day partnership with our end users, whether that’s doing break-fix work, responding to questions, or providing support,” he said. “That ongoing work is what makes such a big difference.”
Finally, Olenoski urged peers to avoid common traps such as “shiny object syndrome” and prioritizing ROI above all else. “If you’re too focused on ROI, you might be missing opportunities for innovation,” he said. Instead, leaders need to determine the organization’s appetite for spending and strike the right balance between the two. “Yes, we need to ultimately tie it to outcomes, but if we think about it as in terms of appetite, that might open up some opportunities as well.”
Sometimes the best thing an organization can do is to go back to its roots. That’s been the strategy for TrueCare. Although the Southern California-based network now has 20 locations, its beginnings were far more modest.
“We started out of an RV,” said Chief Innovation Officer Tracy Elmer. The goal was to provide vaccinations, wellness checks, and other forms of care to farmers who had little to no transportation.
Despite its growth, TrueCare hasn’t strayed from that. In fact, mobile health delivery has become a vital part of the overall strategy to “take care of people,” Elmer noted during a TownHall interview with Sarah Richardson.
Through its fleet of mobile wellness vehicles – which include medical and dental exam rooms – TrueCare is able to provide care at schools, shelters, senior centers, foster care homes, and community-based organizations. “Distance shouldn’t be a barrier to care,” she noted. “The mobile program takes us back to our roots and helps bring service to those who need it most and have fewer means to leave their communities.”
That, however, is just one component of TrueCare’s multifaceted strategy to improve care across the community.
Another is the introduction of QuickCare locations that offer same-day appointments for non-emergency health issues, providing convenient care without the typical “urgent care” experience. At these locations, patients have access not just to primary care, but other supportive services as well.
“It goes back to our mission,” Elmer stated. “We want to make sure care is comprehensive, and that we’re providing in diverse locations.” Not just that, but locations that are specifically chosen based on the population and its unique needs.
For instance, a hub in an area with aging patients could be configured with extra wheelchair ramps and wider hallways to better accommodate the target audience. “We’re doing our best to create points of access or care that truly serve our communities.”
Of course, sometimes that point of access is a mobile device. As such, TrueCare has prioritized virtual care initiatives like Epic MyChart to improve the user experience.
But it’s not enough merely to turn on functionality, said Elmer, who has long been a proponent for digital literacy efforts. “It’s not just about creating the connection; we need to ensure our patients are engaged in their care journey and empowered.”
To that end, TrueCare has launched a number of educational and outreach initiatives, one of which is the “Golden Years group” focused on seniors who speak Spanish as a first language. The program consisted of five sessions that started with the basics of digital technology, then progressed to more complex areas like MyChart. “We had found early on that adoption was slow despite our best efforts,” she said, adding that the program helped build confidence among users, leading to a spike in satisfaction.
“They felt that someone was investing in them and their wellbeing beyond health, and it was very powerful,” said Elmer, who attended the graduation of the pilot Golden Years class. Doing so enabled her to “see firsthand the power of how we’re using technology to connect with our patients, but more importantly, bring them into our culture, meeting them where they are and assuring them that they belong.”
And the support doesn’t stop there. TrueCare has also embedded digital ambassadors in waiting rooms to show patients how to navigate MyChart and leverage its features to stay connected with providers. By “taking the education to them rather than relying on written messages or YouTube videos,” her team is able to help bridge the gaps and offer a better overall experience. “It’s been very successful,” she added. “So much of the power of that is in the value of what we're serving. If we were to just turn it on and allow things just like messaging, but not online scheduling, that limits its reach.”
By opening it up, they’ve experienced a “slow but steady” increase in adoption, and moved closer to its mission of improving the health status of its diverse communities.
That spirit of inclusivity, however, isn’t limited to patients and families, said Elmer, noting that TrueCare has created committees focused on wellness and belonging. “Our President and CEO Michelle Gonzalez always reminds us that the work we do always starts and ends with people,” she said. “We’re reminded every day that our workforce represents our community and our patients,” and therefore, “taking care of them means we’re taking care of everyone.”
By investing heavily in workforce growth and development and prioritizing belonging, TrueCare leadership believes they’re empowering staff to reach their full potential. “They’re able to bring their best selves to work,” Elmer noted. “And that transcends beautifully into the patient care experience.”
Illustrating that connection has been a pivotal part of her strategy since she first started with the organization in 2018, and will continue to be a priority. “There’s not one person on the team who doesn’t realize or recognize the impact they have on the patient care process,” she said. “They feel like they’re part of the care team. They’re not in the clinic, but they’re connected and they know that if the system doesn’t reliably work or if the mobility isn’t designed in a way that assures continuity and connection, that has an effect on the experience. Every day, the work they do is a reflection of how powerful they recognize their role is.”
Jennifer Goldman distinctly remembers when she first got “bit by the informatics bug.” Memorial Healthcare System had created an express lane with its Epic EHR system that automatically added critical data points such as recommendations for mammograms or colorectal cancer screenings.
“That was my first real foray into informatics and the results were tremendous,” she said during an interview with This Week Health. Not only did it improve workflow – and, consequently, clinician satisfaction – but it also resulted in more than $25 million in shared savings. “I thought, if we can do that in primary care, then there are so many things we can do to impact physicians across the board.”
Jennifer Goldman, MD
Since that time, Goldman, who now serves as CMIO in addition to Chief of Primary Care, has led several initiatives that have done just that. Recently, she spoke about how her team is working to improve usability and efficiency, along with the importance of rounding and the keys to a successful CMIO-CIO partnership.
For Goldman, who continues to practice as a family physician, one of the core objectives is to ensure that clinical decision support tools live up to their name, rather than having the opposite effect. “We very carefully measure the number of clicks that providers have to endure when utilizing decision support tools,” she noted, zeroing in on alerts with the highest levels of dismissals without action. Her team then works with its multidisciplinary governance team – which includes physicians, pharmacists, nursing informatics and more – to identify alerts that are no longer relevant.
As it turns out, there are quite a few. According to Goldman, Memorial removed more than 1 million clicks from the EHR last year, simply by standardizing and combining wherever possible. But they didn’t stop there. “We looked at how the rates at which providers interacted with those alerts and how often they took the action it was indicating,” she said. “That increased tremendously once we removed the unnecessary clicks. We’re now above the 95th percentile in the country for Epic clients,” in terms of both interactions and user response rates.
According to her team’s data, users report saving more than 94 minutes per day, which has helped decrease “pajama time” while increasing satisfaction. “What we’ve seen organically is that they’ve been able to squeeze in more patients; that one extra visit is not as difficult to get in because the documentation burden is that much lighter,” Goldman stated. “We haven’t seen a tool that’s had this much satisfaction from both physicians and from patients,” both of whom have experienced “increased eye contact” during visits.
For CMIOs, it’s the ultimate validation that an initiative was worth the effort. “My key priority is increasing efficiency for providers,” she noted. To that end, “we’re constantly innovating and ensuring people can do their work without much friction.”
The key to that? Ensuring that every project focuses on “solving an actual problem on the ground,” that’s been vocalized by frontline workers. To that end, Goldman is part of a multidisciplinary team that participates in active rounding. “We talk about workflow in addition to how we can leverage technology to support it,” she said. “That’s been the most impactful thing.”
Also critical is a willingness to continue the conversation. “Rounding is one thing, but you have to follow up. And if you don’t get it done right away, they remember that.”
And so, “it’s been our intention to get things done immediately,” which means bringing along cohorts from nursing and physician informatics, along with technology. That way, “we can address things right then, and people can see improvements rather than waiting on us to find the right team member.”
It doesn’t stop there. Goldman makes it a point to invite those users to the table, which can help drive immediate adoption while also building “clinical champions so that when we’re rolling it out more broadly after the final phase, we have people beside us who will go to the bat for the new technology because they’ve seen how it works.”
Frontline workers, however, aren’t the only ones to benefit from rounding. It can also help physician and nursing leaders “stay grounded,” she added. “It highlights the importance of having a seamless way to document notes and interact with patients.” Goldman is then able to bring that perspective into her discussions with Chief Digital Information Officer Jeff Sturman, which are becoming increasingly important as organizations ramp up digital efforts.
“That communication is key to aligning priorities and ensuring we’re serving the needs of our users,” she said, adding that Sturman offers decades of experience in relationship building. “He knows our clinicians, he’s well-versed in the executive culture at the system, and he knows our priorities and our budget.”
For Goldman, the ability to leverage both of those perspectives and work “collaboratively at the table on go-lives is extremely important to secure physician buy-in,” she noted. And therefore, it’s “critical to the success of the organization.”
CMIOs are in a unique position. “We touch so many areas of healthcare delivery,” said Rebecca Mishuris, MD, CMIO at Mass General Brigham. “We get involved in everything from in-basket management to billing to actually delivering care.”
And because they’re straddling the clinician and user worlds, CMIOs have a unique perspective on how the tools and technologies that are being implemented at such a rapid pace are affecting the entire care delivery process.
That birdseye view has become extremely valuable when it comes to AI-driven tools like ambient listening, which has already demonstrated enormous potential for improving the experience for both providers and patients.
Recently, Mishuris and Natalie Pageler, MD, CMIO, Stanford Children’s Health, spoke with This Week Health about how ambient documentation is changing the game, and shared insights on how their teams are incorporating it into the practice while managing the unique challenges that have arisen.
Rebecca Mishuris, MD
Mishuris believes everyone should have a north star. For her team, it’s leveraging technology to deliver better care, and reducing clinician burnout.
And while there is certainly no silver bullet, ambient documentation comes pretty close by offering a “transformative way in which people are documenting and interacting with patients,” she said.
It’s not hyperbole. At Mass General Brigham, what started as a small pilot escalated quickly after the initial results were so positive. “What we found is that 80 percent of providers felt like they were paying more attention to their patients,” she recalled. “That’s gold – for the provider and the patient. The relationship with the provider changes when they’re able to look at you while you’re talking, rather than clacking away at a keyboard. Clearly, ambient documentation is here.”
The question, however, wasn’t about how it would be received, but rather, how it would integrate into existing workflows and impact users. And so, a decision was made to launch a 20-physician pilot and evaluate how ambient documentation handled different clinical settings and adjusted to situations like noisy emergency rooms or physicians speaking another language.
“We wanted to understand the impact on productivity, on revenue, and on risk,” Mishuris noted. “Did it work as well in primary care as it did in neurology? What about hallucinations? We had questions upon questions.”
Meanwhile, the response was so favorable that the pilot expanded exponentially, with MGB offering access to all physicians who wanted to participate. “It was clear that this was going to be transformative in terms of how clinicians interact with technology and with their patients,” she said, noting that more than 2,500 providers are currently using it, with requests continuing to roll in. “There’s a bit of a viral sensation to it.”
And while that has certainly been a positive, the rapid-fire adoption has also required leadership to take a radically different approach than with previous initiatives. “In healthcare, we tend to implement tried and true technologies,” she said, which isn’t the case with ambient listening tools. “This is a truly different space in terms of the speed with which the technology is developing and changing. We need a more nimble, innovative approach where we can quickly scale things that are continuing to evolve.”
Part of that is the communication strategy with users. Rather than presenting a fully-baked system, leaders find themselves saying, ‘here’s something that works really well. We know it doesn’t have all of the things you want. We’re actively working with the vendors. But we want your feedback. Try it out, and if you don’t like it, come back in six months because it might look pretty different,’” she said.
It represents a major shift from how things were done in the past, and that needs to be reflected in the messaging. “Changes are happening so quickly,” she noted. As a result, “having an open communication channel with users is really important.” Although some might respond to emails offering quick snippets of information, others prefer learning from super users. What’s important, however, is that the information is being absorbed, especially when it comes to responsible use of AI.
To that end, MGB has launched an education campaign explaining the limitations and guardrails around ChatGPT, and has established a secure lane for accessing large language models. “It’s the same thing we did in clinical informatics,” Mishuris said. “You can’t just tell someone not to do something. You have to make it easy for them to do the right thing. We’ve taken that approach in this space as well.”
And while it has required some adjustments, it’s been well worth the effort, she said, adding that 60 percent of providers said they were considering extending their clinical careers because of the benefits seen by ambient listening. “It’s so transformative. It’s a piece of technology that’s taking technology out of the way. “That’s super exciting to me.”
Natalie Pageler, MD
Like many forward-thinking organizations, Stanford Children’s is actively pursuing ways to improve patient care and increase efficiency by leveraging AI. “It’s an incredibly exciting time. The tools are developing quickly, and so, we’re really thinking about how we can make sure we’re providing continuous, proactive healthcare while being more effective and efficient with our resources,” said Pageler.
Being a pediatric facility, however, adds a few layers of complication, particularly when it comes to communicating with patients and families. “Our providers are being asked to do a lot,” she noted. “As we try to create ways to open access, we want to make sure they can focus on the patients and minimize the extra administrative burden.”
One way is through ambient scribe technology, which can assume some of the tasks that make it difficult to engage in face-to-face conversations. “If a provider doesn’t have to type and look at a computer, they can watch the interactions between the child and the family or watch the behaviors of the child,” Pageler said, which is particularly important when watching for signs of developmental delays. “We’re seeing some very exciting outcomes there.”
Despite the initial concern of how it would translate into the complex pediatric setting, in which there are often multiple caregivers involved, it has worked “incredibly well.” Providers in particular have reported feeling “more connected with the patient and family,” while patients have said providers are “more engaged and present.”
And it’s not just patient-facing tools that are having an impact, as Stanford has applied LLMs across different settings to provide “a better picture of patient safety and quality improvement work,” she stated.
One example is surgical site infections, which can be difficult to define due to the amount of data in free text form. Large language models can help screen the data, enabling team members to more quickly identify serious infections. Stanford is also using those models to comb through incident reports and find areas that might require intervention, she added. “That’s some really exciting work.”
Even more exciting is the use of machine learning to solve one of the biggest problems pediatric organizations face: engaging appropriately with adolescent and teenaged patients. After learning that more than half of those using teen portals were, in fact, guardians, Stanford
reset the portals, and began using natural language processing to double-check for accuracy. “That enables us to release all the non-confidential notes to the entire family, which is 99.9 percent of the notes,” Pageler added. “It’s really about how we can protect the small amount of confidential data so that we can get information to both the patient and the family.”
Doing so helps build a level of trust that enables physicians to ensure they’re getting proper care, while encouraging teens to be proactive and take ownership of their health, she added.
The portal has also made a difference for families of children with complex conditions, she noted. “We’ve gotten some incredible anecdotal feedback from parents about how being able to see all the notes from their different specialists helps them coordinate care and better understand it. That’s where we’re seeing really high rates of engagement.”
The complexities that arise with adolescent and teen patients – and how information is released – is just one of the key considerations of AI in the pediatric space, according to Pageler. Others include the variability across the age and size spectrum, the dearth of clinical information on pediatric patients (due to both smaller data sets and regulations), and the lack of algorithms and medications developed and tested specifically for pediatric patients.
Without those in place, it makes it extremely difficult to “safely, equitably, and meaningfully apply AI in this population,” she said. So what needs to happen? First and foremost, “we need the right decision makers at the table from the beginning to define the right questions for children and families, and to develop datasets that actually represent children across the spectrum. “We need data scientists, and we need to pair them with knowledgeable, thoughtful clinical informaticists who can help develop the right interventions and use those core clinical informatics principles to ensure that they are appropriately adopted and monitored and getting the right outcomes.”
And of course, it doesn’t stop there. Mishuris believes that ambient documentation will become “tablestakes,” and could eventually play a critical role in clinical decision support. “It knows the patient’s chart; it knows what we've talked about.
Could it also know the entire corpus of medical literature and help me decide what's the best medication to treat the blood pressure? Could it help make decisions better?” And while she believes humans will always play a critical role in providing care, she also projects that AI technologies can potentially make that care “safer and more effective,” provided the right steps are in place.
Pageler agreed, noting that ambient listening has already made a mark by freeing up physicians to “focus on the relationship part of medicine, which is what brings so much meaning in our everyday interactions.” For pediatric clinicians, “the idea of being able to set aside the computer and focus on the child and the family has really been empowering, and I think it will ultimately lead to better outcomes and happier providers and patients.”
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