How AI is pushing healthcare leaders to rethink care beyond hospitals

Marc Perlman: Good afternoon from HLTH Europe. My name is Marc Perlman, and I am a global digital health leader at Deloitte, and it’s a pleasure today to be with one of the most influential leaders in healthcare today—Russ Branzell, the president and CEO of CHIME, which is a very influential organization, particularly for CIOs around the world.

Russ, welcome.

Russ Branzell: Thank you so much, Marc. It’s always great to catch up with you.

Perlman: First of all, [let’s] learn a little bit about CHIME, and then talk to you about the future of the CIO [role] as you see it. Maybe you can bring us up to date on CHIME and some of the great things that are happening first.

Branzell: I appreciate that, Marc. CHIME is a professional association for digital health leaders around the world. We’re in 62 countries now. We have chapters in 12. We continue to grow and grow and grow because the profession continues to grow and grow.

Perlman: Absolutely.

Branzell: Just to give you an example, we have 4x-ed our membership since December alone.

Perlman: Wow.

Branzell: And so, it just really is a hallmark of the need for the profession. You’re right. We started as a CIO, chief information officer [of an] organization, but now, it really represents all digital health leaders around the globe. And it’s really a testament to the industry doing some really great things—not with just technology, but really just advancing healthcare.

Perlman: Well, the CIO role is to advance healthcare, not just to keep the boxes running. You know, as you think about the future of the CIO role or the chief information officer, what do you see happening? How do you see us evolving? I mean, we’ve seen a lot of change over the years.

Branzell: Yeah, it’s interesting because when I first got into this, about the same time as you did, we were a little bit longer in the tooth than most here at this event.

Perlman: Yes, we are.

Branzell: We used to joke that the one person who knew everything in an organization was the CFO, because you could track all the money.

Now, really, it’s that chief digital officer, that chief information officer, because everything has a digital component to it. Everything has a current project happening. Everything has some kind of transformation going on. So, it’s really now the person who really understands the operations throughout the entire organization, and who the organization looks to help them make it better in meaningful ways—whether that’s with data, whether that’s with process, or yes, even with technology.

Especially today, we couldn’t do a podcast without saying “AI” within the first minute. It really is an industry that is not even just in transformation, [but] in a revolutionary change state, and the person helping lead that in the organization is that digital health leader—traditionally, the CIO.

Perlman: And as you think about how this evolution is happening from CIO to CDO, what are some of the skills that you see [that] people are having to really develop? Because CHIME, certainly, is an educational foundation.

Branzell: Yeah, so one of the biggest things we do is teach leadership, and we’ve been teaching now for 24 years, [with] our academies and boot camps. It is interesting how we’ve, at least I feel like we’ve, taken a step back to really teach the basics of overall healthcare leadership. We used to teach the ability to create change and change leadership, and help people through project management, and help bring people along, and major change programs.

Now, we’re taking a step back because the greatest skill they have is relationship-oriented change leadership, helping an entire organization change the way they think, change the way they operate. I mean, even now here at this event, if you go around, yeah sure, there’s a lot of buzzwords, but the real, core thought process is now we have to radically change the way health and care are being delivered in an affordable and meaningful way.

And that’s exactly what they’re getting their hands on right now. Just this week, two of the most influential CIOs in the United States were promoted to CAO—to be chief administrative officers—over everything nonclinical in their organization.

So, we would have in the past called them chief operating officers (COOs), right?

Perlman: Right.

Branzell: Well, now, it’s chief clinical officer and chief administrative officer—and those two organizations no longer have a COO. The COO for everything nonclinical is the previous CIO.

Perlman: So, in a way, instead of technology being the lead, it’s really a question of who’s going to help drive the transformation supported by technology.

Branzell: Absolutely. And these are the ones being asked to do that.

Perlman: And as we think about the AI revolution—we’re three minutes or more in now—what do you think the characteristics are of this new chief digital officer to really make it successful? Because there’s been a lot of things done, obviously—failed experiments, a lot of people testing around—and I think one of the things people are struggling with is how do you get it to scale. What do you see as some of those key challenges and characteristics of those who are making it well?

Branzell: So, I think you have to take a step back and say: What is AI in an organization? And our dear friend John Manis will tell you there are two ways to look at AI: It’s a thing being done in an organization, or it’s integrated into everything they do.

There was no chief internet officer or chief analog officer. So, why are we looking at AI as a product rather than the tools and skills necessary to completely change the way we think? And yes, it will be influential. It’ll [drive] change in ways we’ve never seen before. But the people that are using this well are looking at opportunities to improve the very core essence of healthcare—clinical delivery, business delivery, and, well, at least in the United States, [the] rev cycle.

Perlman: Sure.

Branzell: While also looking at the long game, which is a considerable automation of things that were human nature. So, what’s interesting is we watched a program a while back, and it was still based on the original premise of Dr. Klaus Schwab from the World Economic Forum. He wrote a book 15 years ago called The Fourth Economic Revolution, based on AI.

Perlman: Oh, wow!

Branzell: And his very premise was this: In every economic revolution, the numbers are almost the same: 20% to 30% of jobs are eliminated; somewhere between 50% and 60% of the jobs are radically changed at their core; and about 10% to 20% of the jobs generally stay the same.

Perlman: So, we’re on the precipice of real change.

Branzell: I think it’s far more than even just real change. It is a radical way [in which] we think differently. I mean, think about it: What was it 100 years ago? Forty percent of the US population was agrarian. They were responsible for growing and producing food in America.

Perlman: Right.

Branzell: Today, it’s 1%—but the productivity is up 300x. The same is going to be true for almost everything we consider sacred because we’re old guys. The things we think in healthcare are sacred, the next generation coming up has no regard for that sacred thought.

Perlman: No, that makes a ton of sense. And really, as you start thinking about enabling the workforce of the future—whether it be technology or otherwise—what would be the advice you give folks coming up that are a few years into their career and looking to really make a substantial change? What would you think about?

Branzell: So, one of the statistics we got recently is the next generations—we call them the now generations coming up—the Xs, Ys, Zs, and As. As you look at those from a career perspective, the statistic is they will significantly change their career aspects in some way—could be in a totally different job or totally different path—13 times in their lifetime.

I don’t know how many you did. I did military, and I did healthcare. That’s two. Now, jobs change. I’m talking about their careers changing. So the reality is they shouldn’t hold a job or an employer sacred as much as they should what makes them interested, what makes them jump out of bed.

Because the job they’re doing today may not exist in five years. The reality is there’s going to be thousands of new jobs in 5 to 10 years. So, you’re constantly having to rethink, reeducate, and retool. You will never stop learning in today’s world.

Perlman: So, in a way, you’re almost challenging the aspect that all these jobs are going to be eliminated. Woe is me. It’s really a question of how you are going to reinvent yourself.

Branzell: Exactly. Well, I think about the very concept of the last economic revolution, when there were blacksmiths all over the place. Well, there are not a lot of blacksmiths left. But you know what? There are a whole lot of people that work on cars today.

Well, maybe the people that are working on cars are going to be working on the Jetsons’ mobile flying around here pretty soon. And you say, “Okay, that sounds silly,” except there are drones flying people around now in different places.

There are self-driving cars. So, even the premise of a significant portion of the world’s population operates vehicles. What are we going to do if 40% of the male population in the world no longer needs to drive vehicles? We had better find something for them to do. And it could be all kinds of different things.

Perlman: Well, I have to agree, I’ve been in Waymo a number of times and I actually think it’s safer than necessarily the other drivers that I might hire from time to time.

Branzell: The number that I just heard this week was that a person-car will have an accident 1 in 3,000 operations of the vehicle and a Waymo is 1 in 3 million.

Perlman: Wow.

Branzell: That’s a little different for the world and safety, except that if a Waymo gets in an accident, it’s on the front page. You get in an accident tomorrow, it won’t be on the front page.

Perlman: No, not at all. You know, going back to more of the healthcare trends, cyber is obviously something that people are facing a challenge with, today. There’s a continued push for more and more interoperability. How are people balancing the challenges of sharing and cyber and all of the things that are really making the world much more complex?

Branzell: Yeah, it’s interesting. We do the Digital Health Most Wired Survey, which is now [done across] nearly 100,000 entities worldwide. So, we get frontline data every single day, really, during the year even, on what the trends are.

I think we’re seeing two things. One, the world and the threat matrix, the threat landscape, is getting worse and worse every single day. I’ll give you a statistic for ours. We would normally get somewhere around 10,000 to 15,000 major phishing attacks against our small organization in a normal month. Just two months ago, we had 500,000 in one month.

You get your name out—the more they attack you, just like you all. You all are a major target. So, what’s occurring is that the threat vector is getting bigger and bigger and bigger. But yet, smaller organizations don’t have the resources to scale at the same time.

I think, from a healthcare delivery perspective, I think what we’re finally seeing is security is built into the architecture of the delivery of the data and the solutions in a way that we’ve never thought before.

What you and I grew up doing was we built applications, and we said, “Oh crud! Now we gotta secure them.” It’s now security first. And now, deliver the solution and the mechanism and the access to the data. So, it really does make it—I hate saying easier—not as difficult to create a threat environment. Plus, you have partners now. Small organization like ours, we have no hosted systems. Everything’s in the cloud. Everything’s a major player that really has the security expertise, and even the giant health systems are pushing to that direction so that they can take advantage of the whole environment.

Perlman: Yeah, very much so. Interestingly, I’ve talked to a number of CIOs and CDOs throughout the United States and around the world. And they’re saying to me that they believe a lot of their role in the future will not be operating the boxes, will not be actually controlling things. It lends itself, you know, [to questions like]: Where does outsourcing get into this? What are people looking toward versus staying within their core competency, whatever that might be?

Branzell: Well, I think you’re going to see across the board everything that we consider sacred, because we’re old, will be challenged. And that is even down to: Why does an organization run its own materials management when Amazon probably does it 10 times better or some other supply chain company?

So, I think everything we consider sacred is now on the table. And we’re going to have to look at what the best way to provide that [is]. Outsourcing has a nasty word for it. Selective sourcing for the best solution for our money to provide the best patient care we possibly can makes a lot more sense now if we run the business to deliver our core competency, which is healthcare to the best ability.

Perlman: Right. And I think that’s if it’s not a core to their business. They can take it to a provider who is really [an] expert in what they’re doing there, which [it] is supposed to be.

Branzell: One of our CIOs took a very hard look at it at the beginning of last year: Fifty percent of what they were doing in-house […] they have a different provider providing the service than their own people. They didn’t have to let a single person go though, because they had so many shortages that they were able to retrain all of them.

Perlman: Well, that’s interesting. You are right. There are a lot of shortages, and then, as we look to reskill people, particularly the younger folks who are coming up in it, there’s going to be a need to put them at a different level, to be much more of an executive over the data, somebody responsible for the outcome, not necessarily saying I kept the box up 99.99%.

Branzell: I would imagine that, in a vast majority of organizations, the things we used to have conversations on, [such as] architecture, infrastructure, having horrible meetings on how much we needed to improve and update our network—none of those meetings occur anymore.

One, it’s just table stakes, right? And it’s just [that] the money is given to make sure it’s done. The other part of it is, it’s not the conversations that need to occur: The conversations that need to occur is what’s the right data for the right place for the right application to drive the business change that we need to change. That’s where you come in, I know for a fact, is you help people make good decisions with better data. And I think that’s the thing we’ve got to focus on—far better processes […].

Perlman: So, if you were a mid-career–type person sitting there going to your board saying, “We’ve got to look [at this]. It’d be the catalyst of change.” What would you say?

Branzell: If I was saying that to the board? Well, I think the conversation is, before we ever got to the board, I think it would be built into the core strategy of the organization. There would be a collaboration with the CEO, working with core strategic planning committee of the board to decide what and how our organization needs to operate into the future. And it sounds like a silly analogy to make is [that] our organizations better be ready for the Jetsons. More importantly, we better lead the revolution to the Jetsons, because the Jetsons didn’t get their healthcare at the local hospital. They got their healthcare in their house.

They were integrated into everything they did. And if you just even walk around this floor, the concepts of a little bandage on my shoulder that’s going to monitor my sweat, which will tell me whether I need to have more vitamins tomorrow morning. That is not fiction anymore. And John, our buddy, the CIO of CHRISTUS, even in his presentation this morning, his keynote, said, “The Brave New World of 1920s or 1930s is not a fiction book. It’s actually a documentary now.” Because everything that is mentioned in that book is actually real, and the thought that this person would think this is someday. The reality is what if we write the new Brave New World?

The reality is your clothes are biomedical. Your glasses are biomedical. Everything in our life is monitoring and fixing us. We are the matrix. I mean, it sounds scary. I don’t like getting a Waymo, still. It just terrifies me. But it’s reality.

Perlman: Right.

Branzell: And as we talked about getting old and retiring in the near future. The reality is what’s going to help us be productive at 88 and 92 or whatever we think we’re going to make it to—we want quality, not just quantity. And the technology is going to help us get there.

Perlman: Well, interestingly, our Future of Health study that we’ve been running now for well over 10 years talks about the fact, of course, that hospitals will shrink for the most acute patient in the future. But preventive, proactive [care] and delaying the onset of disease will be critical. How do you see the CIO working as part of that system that will not necessarily be in four walls anymore?

Branzell: So that’s a good thing. And we’ve said that the traditional walls of the hospital have come crashing down.

Perlman: Yes.

Branzell: Not the actual physical wall of the hospital, the wall that went around the hospital. That was our cybersecurity protection, by the way. Was this the wall that went around the hospital? The reality now, pick Amsterdam: I don’t know how many hospitals there are here. Let’s just say there are 30 hospitals in a big city like this. The reality is that if there’s a CIO of one of those hospitals who thinks their job is the hospital, they are a dinosaur.

Their area of responsibility is the entire ecosystem of Amsterdam in a mobile environment, in their cars, in the work, while they’re riding all these bikes going around everywhere. We live in a mobile society in a mobile world, and it’s not even home care anymore. It’s you [who has to] provide me [with] care everywhere I go, all the time, and you [will] be integrated into my life. I’m not integrating into your hospital.

Perlman: Well, interestingly, if you think about it, we all have a health status. Sometimes we’re sick, sometimes we’re healthy, sometimes we’re feeling kind of blah. And what you’re really saying is that we’ve got to be able to address that person. It’s a person, not a patient, not a citizen—it‘s a person.

Branzell: Hate the word “patient.” […] So, it’s really interesting, and we were doing a keynote at something else, and this came up, and I said, “Do you know the origin of the word ‘patient’?” It’s to endure [suffering]—suffer pain and other things. That is the concept of a patient. You don’t ever want to be a patient. Bad things happen in hospitals. People get sick. Yep. There are things like sepsis. There are all these other things.

Hospitals provide great services. I’m not saying they don’t. What I’m just saying is you don’t want to be there if you don’t [have to]. It’s one of the few parts of the economy that people really don’t want to be a customer [of].

Perlman: Well, and I think you‘re right. You don’t want to be there, and as we have a much more aging population, we’re going to have to think differently about how we service them. Hospital at home came very much to the forefront during COVID-19. The question is: What’s the next generation? And you know, I believe that, you know, aging in place is not necessarily the right way to age. It’s really finding the right place to appropriately age over time. And that’s going to need to be supported by technology.

Branzell: Well, and there’s a little bit of it here, but think about some of the concepts. I mean, in South Florida right now. There are emergency rooms in RVs—in recreational vehicles, big mobile homes. The emergency room will come to a seniors’ home. They can cast them there. They can take an X-ray inside the mobile home.

People are thinking differently. And this is the bad part for your customers and my customers—primary customers. They’d better start thinking differently—or they are going to be Kmarts; they’re going to be Blockbuster. They have to be the ones deploying the solutions, or the disruptors will actually disrupt their business model.

Perlman: And that’s right. They’ve got to be the ones that think ahead of the game, start thinking about what’s going to be needed, and have a little bit of vision.

So, as we look to wind up, Russ, what would be your vision for the future of healthcare if you had to look out 10 or 15 years? How do you think this is all going to evolve with the new chief administrative officer/CDO/CIO? How’s it going to evolve?

Branzell: So, I do think if you start with the world of acute, I think your representation is very fair. I think they’re going to be busier than they’ve ever been in those acute facilities. But there are going to be extremely high levels of care. Doing stuff we can’t even understand—artificial hearts now that last as long as we want to live; homegrown organs and tissues and things that [make us] go, “Okay, why should somebody have to die, because they don’t have a transplant available?”

I think care itself is going to advance to a level that we don’t understand. Well, we do it now. People do all kinds of testing. I did a cancer guard recently. I just did a genetic methylation test to find out what I can’t absorb in my body. I didn’t even know what that meant a year ago.

And so I think healthcare is going to become so advanced that what we understand as healthcare will be radically different. And I do think health systems [and] health providers will be operating at a level of care that we don’t even understand. What we think is healthcare today is what we’re going to provide for ourselves through AI, through agents, and other things that most people today go, “No, there’ll be a human in the loop.”

No, there won’t. I’m sorry. It’s not going to happen. The other part of this is then that means the entire ecosystem around us becomes part of the wellness care model, which we will not even understand. It’ll just be part of the way we live our lives.

Perlman: It’s part of the fiber then, at that point. So are you optimistic?

Branzell: Unbelievable. Unbelievable. I think about my children as an example. I have zero doubt that what they’re both doing today—really productive jobs, well-paying jobs—might not even exist in five years.

And so, I tell them all the time, “You better be learning something new, you better be challenging yourself, because you’re going to have to change.” But that means everybody has to change. Doctors will change. Nurses will change.

Okay, picture a world. You really don’t believe in 20 years—pick 20 years so it’s safe—a vast majority of radiology is going to be done by AI, if not all. Maybe not interventional. But normal radiology, which means yes, it’s going to vastly reduce the number of full-time employees we need. But that may take 15 years, may take 10 years. How are you going to get it to rural care? How are you going to get it to the middle of Africa? That’s actually what AI can do for us.

Perlman: You’re right. Well, Russ, thank you so much for taking the time with us. I’ve really enjoyed it. We’ve been here with Russ Branzell, the president and CEO of CHIME, and it’s been a wonderful conversation. I look forward to seeing you back on the North American front.

Branzell: All right, my friend. It was an honor.

Perlman: Thank you.

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