This week’s The Winning Edge webinar focused on the backbone of the healthcare ecosystem, and how AI is being asked to make data management easier for healthcare leaders.
Healthcare organizations are dealing with massive amounts of data, clinical and financial, structured and unstructured. And while AI may be the tool to manage that data, there’s a lot of work that goes into setting up the rules and guardrails.
HealthLeaders’ The Winning Edge took on that hot-button issue this week with an in-depth discussion about data management from two renowned experts. Roopa Foulger, VP of Digital and Innovation Development at OSF HealthCare, and Sarah Pletcher, MD, MHCDS, Chief Digital Health Officer and SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, laid out how their health systems are managing data and governing data usage.
It’s not an easy task. Ironically, while AI may eventually take away all the heavy lifting for data management, right now there’s a lot of complexity.
“Where the data was acted on or how the data was inputted has a meaning depending on where it is in the clinical workflow,” Foulger notes. “We're just scratching the tip of the iceberg in terms of how we're going to leverage that data clinically and financially.”
CommonSpirit Health CIO Daniel Barchi says AI development over the next five years won't focus on better technology, but on healthcare leaders finding the right way to use the tools to make healthcare more efficient.
The CIO of the nation's second largest nonprofit health system says AI governance isn't a revolutionary concept. It's a strategy built on how the industry has embraced new ideas and technologies in the past.
"It's important to remember that clinicians, hospitals and health systems have been caring for patients for many, many years through many advances in technology and many changes in clinical care," says Daniel Barchi, EVP and CIO of CommonSpirit Health, the Chicago-based network of 142 hospitals and more than 700 care sites spread across 21 states. "And if we hew to the guiding principles that clinicians have and that we as caregivers should aspire to have, we can apply those same ground rules, guiding principles and vision to AI in the same way that we've used other advanced tools safely."
Daniel Barchi, EVP and CIO of CommonSpirit Health. Photo courtesy CommonSpirit Health.
That's not to say that AI isn't causing problems with its rapid adoption, but Barchi says healthcare executives need to temper their concerns with a little common sense. They've been down this road before.
"Our goal is to make sure that we use it in the most efficient way for how fully it's developed at this point," he says. "And [we] use it as broadly as possible, with the proviso that we always have a clinician between the AI and the patient."
Reviewing AI Use Cases
CommonSpirit Health has a three-tiered approach to AI governance. Barchi says the health system runs any AI projects first through data management and patient advisory councils, then through the enterprise data and AI governance committee (EDAG), before finally going before the IT executive steering committee. Some 200 tools have made it through review and are now being used with the health system.
But there have been some that didn't make the cut.
"We've rejected 15 use cases for different reasons," he says. "Whether we didn't feel that they were clinically efficacious, [or] we were concerned about the ways that a third-party company might be using data, [or] whether or they were concerns about algorithmic bias."
Most, if not all, of those rejections come out of the EDAG committee, which meets every two weeks and is comprised of roughly 30 members, including ethicists, medical informaticists and representatives from legal, innovation, finance, clinical (including nursing), IT and cybersecurity departments.
"These people come together and evaluate every AI initiative that we have and determine if there are risks, if we're using data appropriately, if there are risks of algorithmic bias, what the upside is and whether we should approve it for use clinically and operationally in our health system," Barchi says.
Analyzing Agentic AI
He says he's particularly interested in how agentic AI evolves.
"We're creating the capability for tools to surface information, analyze it, make decisions and interact with others in ways that are very similar to what many of our colleagues do with data today," he says. "And management of these AI tools in agentic AI is almost akin to managing a team of workers. Thinking of this not as a technical process, but as a management challenge and a way to use operational efficiency safely is the next frontier for us as health system leaders."
"I anticipate over the next five years many of the advances and adoption of AI are not contingent on AI getting better," he adds. "It's health leaders thinking more intuitively about how AI can make our processes more efficient."
Which ties back to the idea that AI will replace doctors and nurses. Barchi says that isn't about to happen, as healthcare is still based on human interactions. But he does believe that healthcare organizations using AI will replace those who aren't on the bandwagon, and those using AI will become better at delivering healthcare.
"Physicians, nurses and other clinicians are more likely to be more thoughtful caregivers, because they can focus on the patient in front of them and allow AI to do more of the work behind them," he says. "And I've seen clinicians be very open-minded [about] what AI can provide them, whether it's data or insight, because they know at the end of the day, their overarching objective is improving the health of the patient in front of them."
That concept will also apply to patients using AI.
"We are better patients when we're better informed about our own health conditions," Barchi says. "We'll never be as educated as the neurosurgeon who's caring for us, but we have better insights to what he or she shares with us by being more educated and using AI and other tools to gain insight about the ways we might help with our own caregiving."
Charting a Future for AI
Looking ahead, Barchi sees AI evolving in two directions. He expects new tools and programs to be integrated directly into existing technology platforms like the EHR, so that workflows aren't negatively affected. He also believes that healthcare organizations will develop the capabilities to create their own AI tools.
"We'll simply adopt them in a way that nobody would go off and buy aftermarket parts for a car if you can buy them with the car itself," he points out. "And so yes, there will always be point solutions, but I think those are going to be fewer and more far between and developed internally. And then much of what we get from AI is simply going to be embedded in the tools that we buy and it's going to be harder for standalone companies to try to sell point solutions that are not embedded in our core platforms."
And he sees AI helping healthcare move out of the hospital, clinic and doctor's office and into the home.
"AI will begin to assimilate data and make inferences about our healthcare long before we as patients think about a clinical condition," he says. "It might monitor the number of times we open the refrigerator, the number of steps that we take, the way that we sleep, our online patterns, and look for patterns in a way that might inform an emerging condition long before you even begin to feel it physically."
In this week’s The Winning Edge webinar, Roopa Foulger of OSF HealthCare and Sarah Pletcher of Houston Methodist discussed the complexities around gathering, assessing and using data – and how those strategies can improve patient care.
Healthcare executives are dealing with more data than ever before, and new technologies like AI and concepts like patient engagement are muddying the data management waters. How can leadership stay on top?
For Roopa Foulger, VP of Digital and Innovation Development at OSF HealthCare, the key is establishing a data governance chain of command and protocols. The Illinois-based health system has a data stewardship group in place to watch not only how data is used within the network, but also how it’s managed with vendors and payers.
“It’s just been crazy, how much we have to work with,” she says.
“Everyone is trying to get their kayaks onto the whitewater river that is data flow,” adds Sarah Pletcher, MD, MHCDS, Chief Digital Health Officer and SVP and Executive Medical Director of Strategic Innovation at Houston Methodist.
Foulger and Pletcher were participants in HealthLeaders’ The Winning Edge panel this week, during which they discussed the complex landscape of data management. In particular, they talked about how AI is changing the data management paradigm and creating a challenge: While the technology promises to better gather, assess and use data, it’s making life more complicated for those in charge.
“There's an irony in that the very thing that is creating a lot more work is also there to help us do that work,” Pletcher noted.
Staying On Top of a Dynamic Landscape
Both agree that AI can manage data much better than humans, but humans have to be on top of governance. And that means understanding how to manage transactional and analytics data, as well as unstructured and structured data, and working with vendors and payers over who has access to what and who owns the data.
“We can't just care about how we, the health system, store and manage the data,” Pletcher says. “We really have to be involved in how our vendor partners store and manage data, how our employees store and manage data as they're communicating in everyday life, doing their jobs, how contractors have access to data, supply chain, insurers and our patients. Nowadays, a patient can click on, agree, agree and integrate, and have data exchange right through the EMR. It has become a very complicated world and no longer can you just focus on your own organization.”
Foulger says healthcare leaders also have to understand that data management means more than just keeping track of data. Thanks to AI, there are “dynamic new landscapes” in healthcare to govern, including metadata, continuous monitoring for drift and decay, and tools that can parse data not only for clinical but also financial value.
“Where the data was acted on or how the data was inputted has a meaning depending on where it is in the clinical workflow,” she says. “We're just scratching the tip of the iceberg in terms of how we're going to leverage that data clinically and financially.”
Pletcher says that while health systems and hospitals are often forming committees to specifically assess and monitor AI programs, data management goes back a lot further. Instead of reinventing the wheel, she says, it’s important to integrate AI protocols into long-standing data rules and standards.
Keep the “philosophy of the original protocol … in place,” she says, and “evolve and refresh the language to better capture the modern landscape.”
Where challenges may arise is in generational AI, for many healthcare organizations a new and evolving landscape. Foulger says continuous data governance is a new concept, and it requires input from all departments as well as new arrangements with vendors.
Using Data to Help Patients
One of the more intriguing possibilities with AI and data management is turning that data around to help patients. With the move toward patient-centered and value-based care, health systems and hospitals are learning how to empower patients to better understand their care journey, ranging from how to improve care management, managing health and wellness and understanding financial responsibilities.
“There's still a long way to go to help patients really understand the insights from their data,” says Pletcher.
That includes using AI to improve healthcare literacy.
“We are looking at how we can translate some of the complex clinical data into plain language or visualization,” Foulger says. Aside from using AI to translate medical jargon, this includes adding experts in human-centered and experience design to make data tools more convenient for patients.
Pletcher says the rapid development of the Internet of Things means that there are countless opportunities to capture data in the healthcare ecosystem. And that also means helping patients to understand when and how they’re not only accessing their data, but creating opportunities for unintended uses or misuse.
“We have to hold ourselves accountable … and be aware of how much data exchange is happening, and how little control we sometimes have over how those permissions are being given away,” she adds.
That will be important as healthcare evolves and more services move from the hospital, clinic or doctor’s office to the home. Both Pletcher and Fouler say they can see a future where data from outside the enterprise is just as important for care management as data from inside the hospital. Concepts like remote patient monitoring, virtual care and acute care at home will require new protocols and standards to ensure that information being pulled in is entered into the medical record and put in front of the right clinicians at the right time.
Foulger says it will be important to track data for many kinds of value, and remember that clinical data can have financial value as well. The ROI can be as varied as the effect on variations in care, improved billing and reimbursement opportunities, improved treatment and outcomes, patient engagement and satisfaction, and operational efficiency.
Both agree that “archaic” policies around reimbursement and governance also have to be updated. Healthcare organizations are often held back from using data because of the rules around data gathering and use outside the hospital, and innovative programs are held back because of reimbursement barriers.
Pletcher, meanwhile, says she sometimes wonders if healthcare is making data management more complex than it needs to be. Technology should not get in the way of someone accessing the healthcare they need.
“The patient just wants to live their life as well as they can, feel as good as they can, have as much convenience and simplicity as they can,” she says. “And that's kind of the trade-off they're making. Sometimes I'm surprised that we don't get out of our own way to deliver those experiences to patients.”
“I guess I'm surprised that there's still such an abyss between what patients want and the trade-offs they're willing to make for it and what we're delivering to them, in terms of a truly integrated convenient experience because of our worries about their privacy,” she adds. “I think that we may be making things much more complicated than they need to be.”
From enhanced EHRs to AI initiatives to new programs like RPM and virtual care, healthcare leaders are dealing with more data, structured and unstructured, than they’ve ever had before. This week’s panel takes a look at how to manage that data, separating value from noise and putting information in the right hands at the right time.
Before AI or any other new technology, there is data. And if healthcare executives don’t know how to manage their data, those new ideas won’t work.
This week’s The Winning Edge takes a look at how health systems and hospitals collect, store, assess and eventually use data, the backbone to all clinical and financial activities in the healthcare enterprise. Alongside information stored in the EHR and other technology platforms, healthcare leaders need to know how to gather and manage unstructured data coming into the system, separating value from noise and giving clinicians and others in the healthcare enterprise what they need.
And as AI and other new ideas like remote patient monitoring (RPM), digital health and patient engagement take hold, data management is becoming more important. Health systems and hospitals are dealing with more data than they’ve ever had in the past, and they’re being asked to do more with it.
HealthLeaders’ The Winning Edge will take place on Tuesday, September 30, at 1 p.m. ET. This week’s panel features distinguished experts from two large health systems: Sarah Pletcher, MD, MHCDS, Chief Digital Health Officer & System VP and Executive Medical Director of Innovation at Houston Methodist; and Roopa Foulger, Vice President of Digital & Innovation Development at OSF HealthCare.
Please join us for an informative hour on a topic that every healthcare innovation and technology executive should value.
At the HealthLeaders AI in Clinical Care Mastermind forum this week, execs from 14 health systems discussed how the technology will – eventually – improve patient care.
In the simplest terms, AI is a complex technology that aims to make healthcare simpler.
For healthcare executives, however, the devil's in the details. While AI promises to ease workflows for stressed clinicians and improve patient care, getting to that point takes a lot of time and patience. And a good understanding of what generative technology should and shouldn't be doing.
C-Suite executives from 14 health systems tackled these issues at HealthLeaders' AI in Clinical Care Mastermind forum Wednesday at the Stein Eriksen Lodge in Deer Valley, Utah, the opening event to the HealthLeaders CMO Exchange. The Mastermind program, now in its third year, brings together executives for three virtual round-tables and one in-person forum to discuss and share ideas with their peers on a key healthcare topic.
In this case, it's how AI is being introduced to care management. Early wins in this area have centered on ambient tools and bots, some designed to capture the interaction between doctor and patient (often in an ambulatory setting) and transcribe that data into the EHR, others taking on administrative tasks or even handling queries from patients.
James Blum, MD, CDH-E, Chief Health Information Officer for University of Iowa Health Care, detailed his health system's successful roll-out of an ambient AI tool for doctors, along with the ongoing deployment of chart mining technology designed to pull relevant data from the patient's medical record to help clinicians determine care pathways.
Blum noted the tools not only help doctors, but could also improve prior authorizations and even reduce denials. The key, he said, is developing AI products that address both clinical and financial – particularly revenue cycle management – pain points. That's because a tool that addresses doctor stress and burnout needs to have a more robust ROI to appeal to CFOs and even CEOs and be sustainable.
ROI is indeed a tricky component of AI. In many cases the technology is expensive and uses considerable processing power and data, straining even the largest health systems and out of reach for smaller and rural providers. AI has to have value across departments to truly succeed.
The Struggle for Clinician Buy-In
At the same time, Ai has to integrate seamlessly into clinical pathways. Many an ambient AI project has failed because the tools require doctors or nurses to take a couple extra steps or adjust their workflows. For clinicians who have weathered EHR implementations, the idea of doing one more thing to add more technology to the process is a deal-breaker; they'll ignore the tool entirely or develop work-arounds.
Corey Cronrath, DO, MPH, MBA, FAAPL, FACOEM, CMO of the Mental Health Cooperative, noted his organization tried an ambient listening tool a few years ago and was forced to discontinue it because their doctors found it to complex and intrusive. He said it took almost three years to bring their doctors back on board.
Candace Robinson, MD, CMO of LCMC Health's Touro Hospital, pointed out that the perception of AI in healthcare is that it has to be perfect, and anything that's less than perfect won't be embraced. But executives noted that AI doesn't have to be perfect to have value, only that it can improve on what clinicians are doing now.
Beyond improving clinical workloads, executives attending the Mastermind program said the value of AI lies in giving them information they need to improve care. Tipu Puri, MD, PhD, CMO of the University of Chicago Medical Center; Roopa Foulger, Vice President of Digital Innovation and Development at OSF HealthCare; and Tom-meka Archinard, MD, MBA, FACEP, SVP and CMO at University of Maryland Capital Region Health, all talked about new tools that analyze data to give clinicians insights on specific medical concerns, such as sepsis or the onset of chronic disease. But those tools need to be carefully managed to ensure that the data they're using is accurate.
While the “human in the loop” strategy is designed to ensure continuous governance of AI before it affects patient care, all the executives pointed out that it's also important to ensure that a human being is still delivering care. Aside from the concerns that AI will replace doctors and nurses, there have been some concerns that clinicians could rely too much on AI to make their decisions for them.
Michael Fiorina, MD, CMO for the Independence Health System, questioned whether AI could have an impact on critical thinking, leading to a discussion on how AI should be included in medical education. There's no doubt that tomorrow's clinicians need to have a good understanding of AI as they enter the healthcare field, but the executives agreed that it's more important that they learn medicine before they learn AI so that they're using AI to augment care delivery rather than replace it.
How Will Patients Use AI?
That same question about relying on AI could be turned around to focus on patients. Some have worried that an AI-emboldened patient could overwhelm doctors, while others feel the technology will help patients become more knowledgeable about their health and be able to contribute more to the doctor-patient relationship.
That, in part, is why Blum said he expects health systems like his will be investing in AI for patient engagement, and why the patient portal could be the next big proving ground for new AI tools and platforms. That's why many health systems are trying out bots and other tools that use AI to communicate with patients.
It's a tricky field. Mark Kandrysawtz, MBA, SVP and Chief Innovation Officer at WellSpan Health, noted his health system's implementation of a bot called Anna, which helps steer patients to the right care provider, has actually evolved from being an efficiency tools to drive growth. But there have been hiccups, from the bot using humor at an inappropriate time to convincing someone that it was an actual human.
At the same time, with some studies showing that patients prefer to talk to AI bots because they think the bots are more empathetic, some are wondering whether AI should prompt the industry to take a closer look at the doctor-patient relationship and teach its doctors and nurses how to be better care providers.
At the end of the day, and at the end of this Mastermind program, the consensus is that AI will improve healthcare, and that the industry has to weather the rough spots, learn how to best use the technology, and make sure there will always be a human being making that final care decision.
As Thomas Balcezak, MD, MPH, EVP and Chief Clinical Officer for Yale New Haven Health, put it, AI will eventually become so accepted and commonplace that we'll forget how much trouble we had putting it in place.
New technology like AI and digital health come with a price tag. That's why the CIO should collaborate with C-Suite colleagues like the CFO to build support.
The bugaboo behind any healthcare technology implementation is money. New projects need to be financed. And in today's perilous economy, health systems and hospitals often don't have the resources to justify the expense.
That's why collaboration between the CIO and CFO is crucial.
According to a survey of roughly 50 CIOs and executives with similar roles (all members of CHIME) earlier this year by healthcare IT company Cerecore, 29% are more concerned about technical debt than in previous years. And they're shifting their focus as well: More than half are allocating at least 75% of their IT budget to operational expenses, whereas in 2024 that percentage was around 40%.
The upshot is that new technology and innovation are being pushed to the back burner by the need just to keep current IT platforms up and running and the front doors open. This makes it even more imperative that a strategy for using AI, virtual care or digital health has a definable ROI and the backing of key decision-makers.
To that end, the CIO can't think of technology in a vacuum. IT needs have to be balanced with clinical and financial concerns – and CIOs need to be able to gain support from others in the C-Suite to push transformative ideas forward.
"I think the role of the CIO or Chief Digital Officer … has been [as] a strategic advisor, part of the C-Suite, tied to strategy," Andy Crowder, CHCIO, CDH-E, SVP and Chief Digital Officer for Advocate Health, said during a CHIME panel at ViVE 2025 this past year in Nashville.
That's where HealthLeaders Chief Digital Executive Exchange (CDEX), taking place Dec. 4-5 in Washington D.C., comes in. The invitation-only event will feature panel discussions on the teamwork needed to drive systemic transformation. CIOs will hear from select CEOs, CFOs, CMOs and other executives on subjects like driving financial performance through health IT, using technology to drive clinical quality and access, and successful transformation strategies.
Not only should CIOs be able to reach out and work with others; they need to be clear and concise about their IT plans.
The CereCore survey breaks down CIO priorities into four categories: Technical debt, IT staffing, infrastructure improvement and AI implementation.
At the top of that list is technical debt, long understood as the biggest barrier to progress. CIOs are often struggling with a mixture of legacy IT systems and new technology, and are spending an inordinate amount of time and money on maintenance and upkeep. Beyond that, their concerns are tied to security/compliance issues and end-user access and support.
In an article posted on the HFMA site to support the survey, CereCore Chief Strategy Officer Peyman Zand, CFCHE, said this is where a strong CIO-CFO relationship can have a big impact.
"The finance leader should take an active role in maximizing the strategic value of technology," he wrote. "Their responsibilities should go beyond budget oversight to include evaluating the long-term costs of short-term IT decisions. By factoring technical debt into financial plans, the CFO can help identify future liabilities hidden in temporary fixes."
"In collaboration with the CIO, the CFO also should lead IT-asset lifecycle planning and advocate for dedicated budgets to refresh aging systems," he added. "This charge includes evaluating opportunities to consolidate vendors, which can lower costs and simplify operations."
The Crucial Role That AI Will Play
AI is seen as both a cause for CIO headaches and a cure. The technology is expensive, but it holds the promise of reducing or even eliminating many of the administrative inefficiencies that drive IT budgets through the roof. According to the survey, almost a quarter of CIOs of larger hospitals and health systems identified AI as a key priority to driving savings and efficiency.
"The governance of a health system's approach to AI requires direct leadership from the finance department," writes Zand. "It is incumbent on the CFO to champion a comprehensive AI framework that addresses cost, ethics, risk, long-term sustainability and appropriate-use policies. Financial oversight of AI pilot evaluations also is needed to ensure that key performance indicators and ROI thresholds are established upfront."
The point being made here is that CIOs need to orchestrate support for future IT and innovations plans, and that begins with a thorough inventory of IT platforms and spending. With that in hand, they can work with their C-Suite colleagues, beginning with the CFO, on a strategy that maximizes spending and outcomes. Healthcare transformation isn't an idea restricted to one department in the health system; it requires a coordinated approach to work right.
Oracle is unveiling AI tools that help patients better manage their healthcare journey through the patient portal. It's a strategy many providers are embracing as they look to improve their digital front door.
Healthcare leaders often talk--and not always kindly--about the patient portal being the digital front door to the health system. Now AI is giving both them and their patients reason to be hopeful.
Oracle’s unveiling of AI tools designed for the patient portal during last week’s Oracle Health and Life Sciences Summit in Orlando is the latest step in a reworking of what many feel is a clunky and ineffective platform. Company officials say this is a good example of AI being put to use for the consumer or patient.
“Just giving the answer isn’t good enough any more,” Seema Verma, Oracle Health’s EVP and GM, said during last week’s summit. Both on stage and during an interview later on, she talked of the interactive power of AI, in that it not only responds to queries but can also provide context and other information to help patients. That might mean responding to a question about medication, detailing co-pay and coverage responsibilities, scheduling an appointment and providing directions to the right location, even arranging transportation or tips on better nutrition.
Hospitals Have Them, But Patients Aren't Unsing Them
Nationally, some 90% of healthcare systems offer patient portals, primarily to allow patients to access EHR data. Yet only 15% to 30% of patients actually use those digital platforms. Complaints range from inefficient portal design to a lack of information and access to services a patient really wants, like scheduling, prescription refills, insurance coverage and payment information, and even virtual visits.
Driven by a need to be more patient-friendly, as well as studies that indicate patient portals can improve a number of key measurables, including engagement, care management and quality of care, health systems and hospitals are working to improve their portals. And EHR providers like Epic and Oracle Health are giving them the tools they need to make those improvements.
Ryan McFarland, a physician and Medical Director of Hudson Physicians, a 60-provider practice in Hudson, Michigan, said patient portals have been “very limited and clunky, and not at all patient-centered.” This weighs down providers by forcing them to devote staff to maintaining those portals and answering phone calls that could be handled through that portal. He’s looking for AI tools that can reduce the burden on his staff and his doctors, perhaps eliminating the roughly 30 phone calls he takes in a day that aren’t specifically tied to care.
That’s what he’s looking for in a new EHR.
“This has to be something that works for us and isn’t just a billing platform,” he said. “It has to be good at [eliminating] what gets in the way of care. Time to treat is a huge expense for us, and anything that disrupts that, that disrupts your revenue cycle and your workflows, then you’re losing revenue and disrupting care.”
Making the Patrient Portal Go Somewhere Meaningful
Verma emphasized Oracle Health’s efforts to improve patient engagement during her opening keynote last week. She said the company "is working to completely reimagine patient engagement through our new portal, giving patients access to their complete medical record and putting the power of AI in their hands."
They’re not the only ones to see AI as a difference-maker. Healthcare executives in HealthLeaders’ Mastermind program on AI in Clinical Care have been discussing the power of AI to democratize healthcare, giving consumers more power and resources to manage their own care journey. This is prompting hospitals and health systems to rethink their patient engagement activities, beginning with a patient portal that does more than just give out information.
Randy Thompson, MD, Chief Health Analytics Officer at Billings Clinic, said AI is giving the Montana-based health system an opportunity to reimagine how its patients access care through the portal. Now, he said, that portal can be interactive.
“The EHR is finally working for us, rather than us working for the EHR,” he said.
Thompson said AI tools are making the portal more conversational, allowing patients to make a query and then continue with that line of questioning.
These tools aren’t limited to providers. During a session at the Oracle Health Summit, Optum CEO Patrick Conway said they hope to “reduce friction” by having AI agents handle calls to the health plan, providing real-time benefits reviews and other information instead of having staff members scroll through their computers for the data or promise to call or e-mail back as soon as it’s found.
Conway said too much time – and tension between payers and providers – is spent looking for information in disparate places, all of which costs money. By using tools to make that information more easily and quickly accessible, payers can reduce delays that interrupt care.
“The system does need to perform better,” he told Verma during the session.
One issue holding healthcare providers back may be a lack of understanding how AI can improve the patient portal.
“What surprises me the most is the lack of imagination,” said Kristen Miles, VP of Healthcare Product Strategy at Oracle Health. She said both providers often think of administrative tasks and other portal services as “mundane” activities that get in the way of actually healthcare, while patients see those tasks as annoying.
Miles said providers should understand that AI can handle those tasks, and by integrating AI into the patient portal they can reduce or even eliminate the hangups and delays that keep patients away from the hospital. But they have to know what tools to use.
Helping Patients Understand Their Care Plan
One key element of an AI-infused patient portal is the ability to translate medical terms into language that a patient can understand – a valuable tool, considering reports that 38% of adults have basic or below-basic health literacy skills and only 12% are considered to be proficient.
In her keynote, Verma touted Oracle’s new Semantic Database and Knowledge Graph, tools designed to help patients understand their medical records by translating jargon. The idea is to not only help patients understand what their doctors and nurses are telling them, but also give them the support they need to better prepare for upcoming visits, including helping them ask the right questions of their care team.
This is actually the next step in the ambient AI process. Some companies are developing specific AI scribes that capture the conversation between patients and specialists, such as oncologists, psychiatrists and chronic disease specialists. Those tools have data engines designed to accurately capture complex medical jargon so that it’s entered correctly in the medical record.
Now those tools are being turned around and used to help patients.
“It’s all about navigating the delivery of care,” said Scott Eshowsky, Chief Medical Information Officer for the Beacon Health System, an 11-hospital health system spanning parts of Indiana and Michigan, meaning more than just helping people get to where they’re going. “I would love it if there were an AI-generated set of instructions for patients.”
As AI weaves its way into the healthcare ecosystem, Oracle is reshaping the EHR debate to focus on collaboration and interoperability. But will everyone be willing to share?
As EHR companies ramp up their efforts to convince health systems and hospitals to sign tech contracts or switch from one platform to another, there are some who argue that the process of giving care to patients shouldn't be a business. The best business practice, they say, is sharing data and technology to ensure that patients get the best care.
That's Oracle's pitch this week at the Oracle Health and Life Sciences Summit in Orlando, and Oracle Health Life Sciences EVP and General Manager Seema Vermawas its biggest cheerleader.
With a nod to Epic, the biggest player in the pool, Verma and others at the conference made an argument that the EHR platform alone isn't the key to success. The difference will be found in how that platform embraces AI.
"Not all AI products are created equally," she said, touting an Oracle AI strategy that integrates with the EHR rather than acting as a bolt-on. "No other company is taking this end-to-end approach."
And speaking of interoperability, Verma pointed out that healthcare will only succeed if ideas are shared openly.
"The future belongs to open, extensible platforms and innovation compounds," she said. "There are no walls in our garden."
The concept pushes against traditional business norms, but healthcare isn't a traditional business. Vendors work on the idea that their products and services add value to the care continuum, and that data is a commodity that can be gathered, stored, analyzed and used for profit. Sharing those services and data, as opposed to walling them off in a silo and charging for access, is anathema to common business practice.
But that may very well be where healthcare is going. Providers need access to all patient data to improve care and clinical outcomes. The emerging business plan in healthcare is to create platforms and products that facilitate data sharing, and to derive value out of making those processes seamless for both providers and consumers.
To be sure, the EHR isn't going away. But Oracle is banking on its experience in industries outside healthcare to bypass the inconsistencies and hangups of legacy platforms and deliver products that work. And to do that, Mike Sicilia, President of Oracle Industries, said the company has to practice "thoughtful co-dependent co-building."
In the only (and perhaps final) mention of Cerner, the EHR platform that Oracle acquired for $28 million in 2022 to form Oracle Health, Verma pointed out that AI tools running through legacy EHRs are using "old data" and not providing meaningful value. She said the new AI-First EHR, built from the ground up and unveiled earlier this year, has been integrated with Oracle's cloud infrastructure and data platform, as well as tools like the Oracle Semantic Database and Knowledge Graph that capture the conversation, pull in data from separate sources and make it meaningful.
"The new Oracle EHR is voice first, and the record writes itself," she said.
Verma said more enhancements will be coming out in the next couple of years, including an Autonomous Reimbursement System that's designed to apply AI to revenue cycle management (what she called "a labyrinth of the ‘80s") and, working with payers, tackle prior authorizations and denials.
The company also plans to roll out a Life Sciences AI Data Platform and suite of apps in 2027 that will address clinical trials through the EHR, enabling researchers, clinicians and even patients to work together to find the right candidates for clinical trials.
The gist of Oracle's presentation is that its healthcare platform will be open, and that anyone can be part of the ecosystem. The company even unveiled an Oracle Center of Excellence, with Sicilia pointedly noting that organizations "whose partner is our competitor" can participate.
At the end of the day, however, Oracle is still one player in a very big pond, and its vision of a connected healthcare ecosystem has to deliver before health systems and hospitals will even consider changing their EHR platforms. Oracle did get the jump on Epic when it released its AI-First EHR, and Verma noted that the company is embracing federal efforts for nationwide interoperability with plans to become a Qualified Health Information Network (QHIN).
Sicilia also made note of the speed with which organizations are adopting AI tools and using them. Now comes the hard part of seeing real value and developing programs that reduce costs and complexity, improve workflows for doctors and nurses and boost clinical outcomes.
Whether that will stem the tide of health systems embracing Epic or other EHR platforms remains to be seen. But the concept was backed by a quartet of health system executives in a separate panel. Richard Gray, MD, CEO of the Mayo Clinic's Arizona hospital, said healthcare organizations and their patients suffer when they think they have all of the answers.
"We don't know who is going to have the best idea, but we do know that Mayo Clinic isn't going to have all the best ideas," he noted.
At Nemours Children's Health, Scott Shaw helps the health system's young patients play games. He's doing a lot more than just letting them have fun.
Health IT isn't all fun and games. Until it is.
Scott Shaw has perhaps the most enviable tech job in healthcare. His job at Nemours Children's Health in Wilmington, Delaware is to make sure all of the hospital's pediatric patients can play video games – and to play with them if their family members and friends aren't available.
"A lot of people go, 'That seems like a dream job,'" the pediatric health system's Game and Technology Specialist says. "And yeah, it is. I get to play video games with kids in the hospital while they're here."
"We have a lot of long-term kiddos," he continues. "We have [children] that are here for repeated treatments and things like that. Getting to build relationships with those kids, doing something fun and normalizing … can distract them from what they're going through and … connect them back to a community that they've already been taking a part in. That really helps to make the day go by a little easier."
Serious Business
Fo Shaw and Nemours, playing is serious business – and it's a strategy that healthcare leaders across the country should be considering. Video games as part of inpatient entertainment services promote patient engagement and satisfaction, helping both patients and their families get through the trying time of being in a hospital. In addition, innovative healthcare providers are using games and gaming technology to boost clinical outcomes, through specially designed games that tackle hot-button care gaps like chronic care management and medication adherence.
While it isn't known how many health systems and hospitals actively support gaming or have programs in place, organizations like the Starlight Children's Foundation and Child's Play Charities work with children's hospitals to help their patients access games. As of 2021, Starlight Gaming has helped more than 11.6 million children in more than 900 children's hospitals in the U.S. and Puerto Rico, while Child's Play is partnering with nearly 200 pediatric hospitals to integrate gaming and technology into pediatric patient care.
And that's where Shaw comes in.
A former chair of the Game Design and Development Program at Wilmington University, he was brought into Nemours in 2022 through a two-year grant from Child's Play. His work was so successful that Nemours made him a full-time staff member last year.
The 4 Pillars of Gaming at Nemours
Shaw's work at Nemours is structured around four strategies:
Set up and maintain the gaming platform at the hospital and make sure all patients can access and play games. Shaw says he often gets surprised looks from patients and their parents when he walks into a room (he used to get surprised looks from the doctors and nurses as well, but he's become a familiar figure now). And not just because he's usually in a Hawaiian shirt.
"I have had parents, after I give my intro, explain what I do, they will immediately look at their kiddo and be like, there's your dream job right there," he says.
Aside from introducing patients and their parents to the gaming platform, he's in the background, making sure everything is working properly and the kids have access to age-appropriate games.
Play games with patients who need gaming partners. This is an undervalued responsibility. Parents and siblings usually can't stay in the room forever, and the toughest time for kids is when they're alone in the hospital room. That's when Shaw steps in.
"If you don't have a buddy, if mom or dad or your brother or sister aren't here and you need somebody to play with, just tell your nurse and I'll come and hang out for a little while and we can either talk about gaming or play some games," he tells the kids.
That goes a long way toward making someone feel a little bit more comfortable at a very trying time.
Help develop programs that use games to improve care management. This is where Shaw's job intersects with clinical care. Aside from entertainment, these games can help kids better understand their care, or get them through a tough time. Shaw says he's helped kids during a stressful wound dressing change by putting them on a VR set that has them interact with kittens, or on a roller coaster ride timed perfectly to end with the dressing change.
Shaw also develops games that can help kids stuck in their rooms explore the hospital campus, or go to places they would have gone on vacation with their families had they not had to go to the hospital.
They're merging gaming tech and patient care to "help kids feel normal again [and] distract them from what they're going through," he says. Most importantly, "when they need it, [he can] be the support system throughout the hospital for kids."
Help develop special projects that merge gaming with patient care.
These are the clinical games – games that help children diagnosed with diabetes to understand their chronic condition and how to care for themselves, or games that explain cancer or asthma or heart disease. These can be better tools than any doctor's printout or tutorial.
This is where gaming, games and gaming theory hold the most potential in healthcare. They can be used to help not only children, but patients of all ages understand what they're going through and teach them how to manage their care and live healthier lives. They're tools that can unlock not only better engagement and adherence, but also better clinical outcomes.
"I think we're going to get to that point where a lot more folks are looking at it seriously and going, 'This is where we need to be,'" says Shaw.
Understanding Why Games Are Played
One important aspect about gaming at Nemours, Shaw says, is that it's not based on the idea of getting a reward for completing a task successfully.
"Making you better is not a reward," he points out. "This is what we do. We want to enable that."
Games, he says, are for entertainment and learning, not winning prizes. To that end, it can be fun to lose a game and see what happens, and to be able to play it again with a different outcome.
The Clubhouse
Shaw works often from The Clubhouse, a third floor haven in the health system that encompasses activities and arts and crafts organized by activity coordinators and child life specialists, a preschool area and dramatic play area, a teen area with an air hockey table, pool table and the aforementioned gaming systems, and even a CCTV studio (he says Bingo on Wednesdays is very popular).
It's a very different atmosphere in there, compared to the rest of the hospital. That, given the very nature of a pediatric hospital, makes it a special place.
"If we're out here at The Clubhouse and we're playing [games], you'll hear lots of laughter, lots of hooting and hollering and giggles," he says. "And to hear that within a hospital, I know I'm doing something right. If we're bringing smiles or bringing laughter, families are having fun, kids are having fun, siblings are having fun. … That is the best indicator that I think it's working."
Shaw, who networks often on a Slack channel for fellow pediatric gaming specialists and attends symposiums on gaming in healthcare, says the network isn't big enough by far. When asked what most surprises him about the use of games in healthcare, his response is, 'Why doesn't every hospital have a me?'
This should be an integral part of any health system, he says, helping adults as much and as often as children. Every hospital IT platform should encompass games and gaming, and every hospital should have gaming specialists.
"I would love to take this up and down the care spectrums to really see what kind of impacts we can make using gaming," he says. "It would be a lot of fun."
OSF CompleteCare 55+, a hybrid virtual and in-person healthcare clinic in Chicago, offers high-touch wrap-around services for the growing number of seniors in the area. This could be the model for sustainable population health programs.
As the nation’s senior population grows, healthcare providers are launching new care management platforms to improve access and outcomes. In Chicago’s south side, that comes in the form of a clinic exclusively for those 55 and older.
OSF CompleteCare 55+, located in Evergreen Park, is a hybrid clinic created by Peoria-based OSF HealthCare. Offering both in-person and virtual care around the clock, it’s designed to give seniors personalized care and help them navigate an increasingly complex healthcare landscape.
“Really, navigating healthcare should be done by healthcare,” says Kate Barth, VP of OnDemand Services and CNO of OSF On Call. “Healthcare is very complex.”
“It really should be up to us to navigate that patient into their journey,” she continues. “If we refer you, let us help you get there. It’s not, ‘Here’s a number. Call it [and] let us know if you have any issues.’ We want to do that for you so that you can continue in your busy life and … get the care that you need at the right moment.”
The number of Americans age 65 and older is expected to jump 47% by 2050, to roughly 82 million. With that surge will come an increase in healthcare needs, putting pressure on an already stressed healthcare ecosystem. Healthcare leaders are looking to keep seniors out of the hospital with services that address prevention, health and wellness and chronic care management, as well as programs that meet seniors where they are.
The Value of Navigators
For OSF HealthCare, that means using navigators.
“Navigation can mean a lot of things to a lot of people, [but] navigation to us means whatever the patient needs it to be,” says Barth. That can mean helping seniors understand their insurance coverage, moving them into Medicare programs, or even finding them nutritious food or a ride to the doctor’s office.
“It has to be an evolving role,” Barth adds. “It has to be a role that steps back to look at the big picture, assesses the individual needs of each and every individual patient and guides that navigation based on that individual. We think that is critically important for the future of healthcare and something that we continue to lean into every single day.”
The model, an offshoot of the concierge care strategy that is morphing into Direct Primary Care, requires healthcare leaders to be very precise in how they deliver tailored care to a specific population. To that end, Barth and Sandra Valino Stock, DO, MBA, the program’s managing medical director, are quick to focus on clinical outcomes rather than financial impact.
“We need to focus on the quality of care, making sure that we have strong outcomes for our patients,” says Barth, adding that top KPIs for the three-month-old program are hospital admissions and readmissions and patient experience.
“We are helping patients make decisions that are most appropriate for their health,” adds Valino Stock, noting the strategy revolves around creating a better relationship between patients and their care teams so that they’ll continue to work with OSF HealthCare rather than go to other healthcare providers or try out disruptors aiming to grab a piece of the healthcare market through online offerings.
So they’re deliberate in using navigators, creating a team-based approach, offering patients access around the clock, and combining in-person care with virtual visits.
An Emphasis on Technology
The emphasis on technology is important. Providers are increasingly relying on virtual care and digital health to improve access for a population that might have problems getting to the doctor’s office. That, and the average wait time for an in-person visit is 20 days.
“In primary care, we typically see those traditional visits being made in the practices,” Barth notes. “And while many are starting to dabble in the world of technology, doing virtual visits intermittently and using different tools such as MyChart to communicate with a patient, we knew that it needed to be a little bit of a higher touch and easier access.”
This includes wrap-around services, another value-based care strategy that veers away from the old routine of episodic care. In an effort to reduce friction and time spent on administrative tasks, navigators gather as much information as possible prior to the visit, so that the visit is focused on care.
Valino Stock notes the program is also geared toward helping seniors become more comfortable with technology, a key pain point in care management.
The key to success, of course, will be sustainability. Aside from improved clinical outcomes, OSF HealthCare executives will be looking at how the clinic reduces stress on the health system’s 16 hospitals.
It could also be the first of several clinics designed for different populations.
“We are learning new things every day,” Barth says.
“We don’t know yet what we don’t know,” adds Valino Stock. “So we keep listening to the patients. What do they want? What do they need?”
