Do CIOs Have All The Pieces to Build a Smart-Health Enterprise? | Deloitte US has been saved
By Anwesha Dutta, managing director, Deloitte Consulting LLP, and Wendy Gerhardt, research leader, Deloitte Services LP
Imagine dumping a 500-piece jigsaw puzzle onto a table. Now imagine there is no picture of the finished puzzle to serve as a reference. That is what many hospital and health system leaders face when it comes to technology. They might have most of the pieces needed to build a smart hospital, but they might not know how the pieces fit together, which pieces are missing, or what the final picture is supposed to look like (see Smart health enterprise model could enhance patient experiences, outcomes). When technology pieces fit together correctly, they can improve operations, streamline clinical workflows, scale innovation, and help make care more accessible and equitable. When they don’t, it can create a frustrating environment for patients, clinicians, and staff. Leaders might feel stuck and might not know how to move forward.
Deepesh Chandra, chief information officer (CIO) at Montefiore Health System in New York City, recently participated in an internal webinar with our health care colleagues. He explained that some health system CIOs have access to Generative artificial intelligence (AI) and other sophisticated digital tools, but they might not know how those tools can be combined to address complex challenges. Here’s is an excerpt from our conversation:
Anwesha: Combining a physical space with digital and virtual elements seems to have worked well in other industries. The smart factory concept, for example, helped revolutionize manufacturing.1 Can that same concept be applied in health care?
Deepesh: Let’s use the analogy of puzzle pieces. The solution often isn’t one piece of technology, it is a combination. I believe that for every $1 spent on technology implementation, an equal amount should be dedicated to change management and adoption. New technology can be disruptive. If there isn’t a focus on change management, that technology might not get integrated into the workflow. It is easy to underestimate how important adoption and upskilling is when investing in technology. (See Restoring purpose in health care through technology and workforce innovation.)
Wendy: What can be done to help ensure digital tools are used effectively to reach the end goal?
Deepesh: To use another analogy, it seems technology officers have the hammer and are searching for a nail. We have a lot of tools, but the problem we are trying to solve might not be clear. A health system might have an interest in implementing Generative AI, but it might not have identified use-cases where AI can make a difference. This can have consequences. An organization can get stuck on a pilot project. Although a pilot might be an immediate success, it won’t have an impact if the organization does not have a plan to scale it. (See Navigating the emergence of Generative AI in health care.)
Wendy: As you interact with your peers, both inside and outside of health care, what do you see as the changing role of the CIO?
Deepesh: Some of my peers have adopted new titles such as Chief Digital Officer [CDO] or Chief Digital Information Officer [CDIO]. It reflects what they are trying to do. During the past 20 years, many CIOs built their legacies on digitizing the health system. For example, they deployed EMRs [electronic medical records] and ERPs [enterprise resource planning], and that defined their impact. But the role of the CIO is evolving and expanding. We are increasingly becoming part of the corporate strategy—both from an operational perspective and a growth perspective. Many technology officers are working more closely with leaders to help define strategies that can generate value…and they are being held more accountable for business outcomes. There is a step-up role for the CIOs happening in health care. More emphasis is being placed on combining technologies to reimagine supply chains, revenue cycle management, clinical workflows, and other business functions. Health system leaders want to know how all of the technology pieces will improve the overall business.
Anwesha: What should business leaders within a health care organization expect from their CIOs and technology officers?
Deepesh: They are coming to their CIOs, CTOs, or CDIOs and asking them how departments can take on more work without increasing staff or adding more cost. It is possible to accomplish that by augmenting business processes with a combination of Generative AI, automation, and workflow tools. The first step is to reimagine business processes. There are concerns about rising administrative costs and rising labor costs. And those issues won’t be solved by cutting or adding staff. They will likely have to rely on technology.
Wendy: What is your perspective on developing partnerships and alliances to remain competitive?
Deepesh: Health systems generally don't have much margin. (See Expanding health care CFOs’ methods). The biggest health system in our industry has a 3%-to-4% margin,2 which is nowhere near margins in life sciences or banking or retail. That lack of scale is challenging. Some technologies can cost millions or sometimes billions of dollars. Implementing AI or automation at that same scale could add significant costs. Health systems are increasingly relying on their partners and vendors to help implement and scale technology. Some of these partners have made the much-needed front-end investments by virtue of their own business model. Rather than trying to build the technology on their own, health systems should instead invest in driving change management on the ground working closely with key partners who have already solved the technology side.
Anwesha: What role can next-generation technologies play in making health care more accessible and equitable?
Deepesh: Technology is a great equalizer across industries. A banking app, for example, is the same regardless of the user’s income or net worth. Similarly, a cutting-edge virtual care platform or patient-engagement platform should work the same for everyone, whether they are covered by Medicaid or commercial insurance. From a health-equity perspective, the ability to drive a common denominator through technology can be a great way to help ensure health equity and access for everyone. There is work to be done on health equity, but you can relieve a lot of pain points if you have a robust technology solution that can drive patient access in a meaningful way.
Anwesha: These technologies hold a lot of potential in making care more accessible and equitable, but what about people who might not have internet access or health literacy? How can you create an equitable design? How can you reach everyone?
Deepesh: This area gives me a lot of hope. For example, a health system could use Generative AI to deliver a significantly better language-translation services. If a health system creates multi-language educational materials, the patient is more likely to engage with that content. Materials or care instructions written in English could be immediately translated based on the patient’s preferred language. Patients can then engage in meaningful conversations about their health regardless of their preferred language. I am optimistic that Generative AI is going to help substantially lower, if not eliminate, language barriers. (See Health equity through analytics: Literacy and numeracy.)
Wendy: Many consumers like the convenience of virtual care. In your experience, are people becoming more focused on convenience in health care?
Deepesh: Efforts to improve loyalty and patient engagement mean nothing if [a health system] can’t provide access where and when patients want it. Patients are often focused more on convenience than making sure they can see their doctor. However, that might not be the case when it comes to a pediatrician, or for someone who has a chronic condition where a long relationship with a specialist may outweigh convenience.
Anwesha: Where are you and your IT peers likely to be investing next year in terms of technology?
Deepesh: Health systems increasingly have core IT issues that need modernization. As an industry, our infrastructure is quickly becoming dated. Cybersecurity continues to be an issue. I would like use technology to improve the patient and the provider experience. In a few months, we will be one-quarter into the 21st century. Given our access to technology, and the amount of money spent on the health care ecosystem, the patient experience should be much better than it is today. Aspirationally, I would like to see technology improve access and the overall patient experience. Limited focus on change management can make it difficult to effectively deploy the technologies that can make that happen. Generative AI can transcribe conversations between a patient and a doctor. The technology allows them to talk face-to-face rather than requiring the physician to type notes into a computer while the patient describes a problem. The technology offers a high degree of accuracy. A question is, how can a CIO convince hundreds or thousands of staffers to use it? That can be a fundamental challenge for someone in my role. The technology is accessible, and it is generally affordable. It's a matter of how it is implemented, scaled, and used to drive change-management. To me, this is a moonshot, but hopefully not for much longer. (See Integrating digital health tools.)
Conclusion
New technology tools won’t necessarily make life easier for patients, clinicians, and health system employees. If health system leaders fail to consider equity-based design, change-management, and adoption strategies, the implementation of technology could have a negative impact on the patient experience and do little to reduce workloads and minimize clinician burnout (see Addressing health care's talent emergency). Health system business leaders, and their technology officers, should collaboratively determine how to use technology most effectively to create value. This should involve defining the problem, identifying the right technology solution for that problem, involving the voice of the end-users in the design, measuring value (more broadly than just financial), and building a plan to scale and achieve organizational goals. The puzzle pieces might all be there. The challenge is getting them to all fit together.
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Endnotes:
1The future of manufacturing: How AI, robotics and data are revolutionizing the industry, Forbes, August 9, 2024
2Hospital operating margins in the US, Definitive Healthcare, March 18, 2024
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