City of Hope's CIO Talks About Using Technology in Cancer Care

Jennifer Greenman discusses how to leverage technology already in place for cancer care needs, as well as City of Hope's acquisition of CTCA.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

Jennifer Greenman joined Cancer Treatment Centers of America (CTCA), a national oncology network of hospitals and outpatient care centers, in 2019 as chief information officer, where she has led the implementation of technology to meet the broad needs of the organization's workforce and the patients and families who come to the organization for their cancer care.

In February 2022, CTCA was acquired by City of Hope, a National Cancer Institute (NCI)-designated comprehensive cancer research and treatment organization based in California, with the goal to democratize cancer care and research. The combined system is one of the largest cancer research and treatment organizations in the country, reaching cancer patients and their families in California, Arizona, Illinois, and Georgia.

In a recent podcast interview, Greenman talks about her role as CIO for City of Hope, how she leverages technology that is already in place for new and upcoming needs, and the integration of Cancer Treatment Centers of America into City of Hope.

This transcript has been edited for clarity and brevity.

HealthLeaders: What initially drew you to work in healthcare and information technology? Can you walk me through your career journey?

Jennifer Greenman: Going way back, when I was very young, I had zero ambition toward working in medicine or even information technology. When I was in high school, I started volunteering at one of our local hospitals to get volunteer hours, and while I was there I worked in the pharmacy. They, surprisingly, after a while offered me a job as a pharmacy tech in high school. It was an interesting job to work there at a hospital, felt real [and] impactful in a way that most normal high school positions wouldn't give someone an opportunity to do. That was my entry into healthcare all the way back at the age of 17.

I continued to work in both that hospital as well as another hospital pharmacy all the way through high school and even part of the way through college. That time though, I still had no real strong ambition to work in medicine. After starting my undergraduate education in music, I quickly decided that was not the professional path for me. I joined the business school at Florida State University, which I enjoyed, and graduated in 2001, right after September 11.

The job market at that time was not good, particularly for new college graduates, but the Cerner Corporation in Kansas City was hiring a lot of new business school graduates from Florida State. I was fortunate at the time to have gotten a position with Cerner and learned a lot about healthcare software implementation [and] electronic medical record implementations at a pivotal time, as organizations were moving very rapidly from paper medical records to electronic medical records. It happened to be the right place at the right time and felt more of a passion as I did in high school to work in healthcare and to apply my business and my IT skills in this space.

I worked at Cerner for a couple of years, and one of my clients was the Bayfront Health System down in St. Petersburg, Florida. I loved the team there. I loved the people who worked in the hospital. I felt like I learned more in a short time at Bayfront than I had learned in any of my prior years of education or professional experience. I joined the health system in about 2004 and continued to work there all the way until 2013, progressing from systems analyst all the way through CIO at the time I left.

Around 2013, I was ready for more professional growth. Bayfront had been acquired by a large for-profit hospital operator at that time and I just had my second child, and I thought this is a great time to look for another professional opportunity. I was able to get a job at Moffitt Cancer Center in Tampa, Florida, and was fortunate enough to get a job as a senior director. Much to my surprise, I was promoted to CIO at Moffitt about a year later. I continued to work at Moffitt until 2019 [when] I was ready for more professional growth and was introduced to CTCA, now called City of Hope. [I] viewed that as an opportunity to impact oncology care at a national level. It was similar in mission and scope [to]what I had had at Moffitt. So it was a great fit for me professionally.

In all of healthcare, there's this intrinsic motivator to help patients, to help advance our clinicians' quality of care delivery, our patients' quality of life, and I saw that as a great opportunity to really influence and make a difference on a national level.

Having worked at Moffitt, I was familiar with the unique challenges and opportunities that are inherent to this industry. Just as the disease burden of cancer on patients and their loved ones is tremendous, I think anyone who has dealt with cancer on a personal level understands that the emotional and cognitive burden experienced by physicians, nurses, and scientists to treat them is also significant.

This role as a technology leader for cancer centers makes me feel a profound responsibility to help empower our workforce with digital solutions that can help ease this burden, wherever possible, so that our clinicians, our scientists, are able to cure patients, to improve their quality of life, [and] to provide them with some meaningful relief for the experience that they're going through.

HL: In your role as CIO, how do you choose the best technology to support the organization's workforce to address the needs of the patients?

Greenman: In terms of formal methodology, we follow similar practices that you find in most other businesses. We typically collaborate with our business partners, patients, family, or caregivers to define problems and opportunities. Then we drill down into functional capabilities that can fulfill their needs. The reality, often for those of us in healthcare, is that more often than not, we already have a solution or platform that can be leveraged to meet these needs. Our work is usually about creating new applications or workflows with existing platforms and less often new technology acquisition. This approach is always going to be preferred, as our existing platforms often have sustained interoperability or are capable of system integration with the other solutions that we already run within our organization, so the initial effort and the time to value tends to be less than if we were to roll out a net new product or service within our organization.

When we do have a need to look at novel technology to meet business needs, workforce needs, [or] patient needs, then we'll scan the market for established vendors and identify those that have a track record of success, ideally with other cancer centers. Oncology is a highly complex multidisciplinary care model. The products that are out there on the market that are tailored to non-oncology conditions in many cases are not capable or out-of-the-box ready to enable the unique data and workflow requirements that we have in oncology care.

Cancer treatment has a number of unique characteristics that require highly specialized technology needs, particularly in these acute care cancer hospital organizations. High-quality cancer care requires a team approach, so coordination across the care team can be impacted both positively and negatively with technology. I personally am energized by the potential opportunity for disruption in the space and looking forward to how we can drive innovation and transformation with new partners, new products, and new services.

HL: There's been a lot of talk about AI and ChatGPT recently. What are your thoughts on those tools and do you plan on using them if you don't already?

Greenman: I'm cautiously optimistic on the potential for augmented intelligence in general and generative AI such as ChatGPT specifically to improve healthcare. Augmented intelligence is already being utilized broadly for clinical decision support to deliver precision oncology, for example [in] identifying therapeutic options based on a patient's genomic profile. Another example would be supporting radiologists and pathologists in reviewing and evaluating diagnostic imaging.

I think it will be quite some time before generative AI is accepted for use cases beyond administrative and marketing workflows. There would have to be a lot of evidence to back up the efficacy of those tools for clinical use cases broadly. But I am excited about the potential. It's something that we in healthcare do need to continue to explore. We are exploring generative AI tools to facilitate large-scale information curation and dissemination for our call center workflows. To be clear, all of it's very early, it's not live yet, and it's still in sort of exploratory mode. But I do think it's a potentially significant opportunity to improve both efficiency and efficacy of these workflows.

HL: What pain points and other initiatives are you hoping to address this year as CIO? 

Greenman: Cancer Treatment Centers of America was acquired by City of Hope a little over a year ago. We are now nationally recognized and known as City of Hope across all of the markets that we support. For the past year, we have been focused on prioritizing integration of our legacy CTCA markets with City of Hope in IT, and that has certainly been my top priority. I would not necessarily characterize it as a pain point; I would say it's a very important and necessary part of our transition and operating at scale across all of our markets across the country.

The vision of this acquisition was to democratize access to cancer care, bringing cutting-edge therapies that are pioneered at City of Hope, which is an NCI-designated comprehensive cancer center located in southern California. Our vision has been to democratize access to these therapies to cancer patients located in communities across the country that we serve, whether those be in the southern California market, where City of Hope has historically operated, or our Phoenix, Atlanta, and Chicago markets that CTCA historically has served.

Some of the work that we've been doing has been to deploy a common electronic medical record platform to all of the legacy CTCA hospitals and clinics. It's been one of my priorities this year, and it's something we're extremely excited about, [as it] is an opportunity to standardize care delivery models and bring a modern technology platform to our clinicians across the country.

Another high priority for us has been to deploy our patient access model across all sites of care, leveraging and powered by technologies such as [our] CRM platforms. This also will help better standardize the intake model for our new patients located in communities across the country.

Those have been opportunities to really build upon the strengths of our respective organizations to build a leading-edge, exceptional care experience for patients regardless of where they're located.

HL: What advice do you have for women and others who aspire to be leaders in healthcare and tech?

Greenman: Throughout my career, which is now over 20 years in this industry, I have often struggled with lack of confidence. Sometimes I felt intimidated, particularly in those situations when I was the only female, which is regrettably still quite often. Or in cases when I might have been younger than others, which is regrettably not as common as it used to be. But those are situations where I didn't always feel as competent in delivery. I shared this insecurity once with a very wise colleague and she told me to remind myself in these circumstances that I have earned my seat at the table; that everyone brings a unique expertise, a unique value to the conversation, and mine is information technology leadership in healthcare. This is advice that I often remind myself [about] in these situations when I feel uncertain or insecure, or not as competent as I should be. This has helped me bolster my own confidence to speak up, to be heard, even at times when it doesn't feel comfortable to do so.

I've also noticed that some leaders, particularly female leaders, don't always feel comfortable with self-promotion. We can downplay our personal accomplishments and are often inclined to share credit and promote others' accomplishments which, to be clear, I think is a positive trait. It's not something I would ever want to portray as negative. Unfortunately, in professional settings, it can put us at a disadvantage compared to our peers who are very adept at self-promotion. My advice for rising and established female leaders, or any leader for that matter, is we have to remember that we have a brand, a personal brand, a professional brand, and that it's incumbent on us to promote that brand along with the strengths and accomplishments of our teams that we lead. We cannot neglect the importance of our personal reputation and professional reputation and profile within the industry.