Rohit: Hi Angelo, welcome to The Big Unlock podcast. We’re so happy to host you, and thank you for taking the time to join us today.

Angelo: Thank you, Rohit and Ritu. It’s an absolute pleasure. I was delighted to be invited. I’ve listened to some of your episodes—you have a fantastic program. It’s an honor to be part of what you’re doing here.

Rohit: Thank you! That’s awesome. I’m Rohit Mahajan, Managing Partner and CEO at Damo Consulting and BigRio, and also the co-host of The Big Unlock podcast.

Ritu: Angelo, welcome. Absolute pleasure having you here. I’m Ritu Roy, also a Managing Partner at BigRio and Damo Consulting, and co-host of the podcast. We’re looking forward to an invigorating discussion today.

Angelo:  Thank you again both for the invitation and the opportunity to speak with you today. I really like what you’re doing with this show. I think it is speaking to issues that are so important right now in healthcare, in innovation, in healthcare management.

So, it’s a tremendous pleasure. I can tell you a little bit about who I am and what I do, and then we can jump deeper into the conversation. But my name is Angelo Zo. I am trained as a pediatric cardiologist and still spend a little less than half of my time in clinical practice. And my clinical practice includes patients from prenatal life all the way through to adulthood who have primarily congenital forms of cardiac disease, but also acquired forms of cardiac disease.

And my clinical practice keeps me very busy. It’s a very interesting field. It’s a field where we have many applications of technology, which I think are really interesting. It’s a—pardon me—a field that includes some procedural medicine, some diagnostic medicine, and we work very closely with other specialists, including surgeons and anesthesiologists and clinical care physicians.

So, it really is a fantastic type of clinical practice, and it’s one that many people may not be familiar with, but is a really important part of what we do in the realm of children’s healthcare.

The other part of my work is as an administrator. So I am the Chief Medical Officer for what we call the Duke Health Integrated Practice. So I am here at Duke University Health System, which is based in Durham, North Carolina.

The Duke Health Integrated Practice—you can think of it as the faculty practice of our health system. It’s actually a bit more than that. We have about 4,200 physicians and advanced practice providers—so our nurse practitioners and physician assistants are counted within the faculty practice as an important part of what we do.

And we really are the specialty practice of the health system. We have another organization that manages primary care as their primary book of business—no pun intended. Primary care, primary book of business. So that is not part of my purview, but I work very closely with that organization. That organization has its own Chief Medical Officer, but I’m the Chief Medical Officer that interacts with our 18 clinical departments—everything from pediatrics to internal medicine to OB-GYN to radiology to surgery to dermatology, et cetera.

And I help to develop strategy—primarily for our ambulatory platform—and also implement and operationalize clinical innovation procedures that help us improve access, that help us open up our door, so to speak, to new patient populations, to new areas of practice—whether it’s medical or surgical, or diagnostic or procedural. So I have a broad responsibility here and a broad engagement.

And I think the final thing I would say is that our health system is associated with—obviously—Duke School of Medicine, which is a fantastic medical school, always considered a top-tier medical school. So we have a very significant mission around education, around training, around research, and around advocacy. And all those functions are directly connected to the clinical mission. So everywhere we practice medicine, we also want to innovate. We want to do research. We want to teach. We want to educate. And we want to advocate as well. So even though my role is primarily a clinical leadership role, I get to work with other leaders in all those other areas, which makes my job really multifaceted and really exciting.

Rohit:  That’s awesome. Thank you for that introduction, Angelo. You know, it’s been quite a journey for you. You’ve been with this health system for a long time, so would you like to share your journey with the audience? Like how did you get started? What interested you, and what are some of the new things that you are working on? And also, talk to us a little bit about the patient population in the local area.

Angelo:  Sure. No, I’d be happy to. So in terms of my journey into healthcare and healthcare administration, it actually started quite early when I was finishing up my fellowship training. I was offered the opportunity to build a branch of our academic pediatric cardiology practice away from the mothership, so to speak—to build essentially a large satellite office.

So very soon in my career, I got involved in practice building, practice management, and healthcare administration. Within about a year, I took over the medical directorship of this practice, and over the course of about 10 years, grew the practice from a very small operation with just a couple of physicians seeing a few dozen patients a week, to what is now a very large, multi-specialty practice that has about three dozen medical and surgical specialists coming in and out of our doors, seeing thousands of patients a week.

Very proud to have been part of this project from its initiation, from its conception, and through its phases of growth. Along the way, I had very significant hands-on training with executive leadership, with management, and also with day-to-day clinical operations, which became an area of interest to me.

I was eventually offered the opportunity to take on a new role, and that role was as the Vice Chairman for Clinical Practice for the Department of Pediatrics. And in that role, I took what I had learned at the local practice level and brought it to an entire department, and became the operational and strategic leader for everything we do in our Department of Pediatrics, which includes about 250 or so clinical faculty, another 50 or so research faculty—primary care, specialty care, diagnostic care, urgent care, emergent care, inpatient, outpatient—all different aspects of our care.

I did that work for a little less than a decade, and I’m actually moving away from that role now, because last year I stepped into yet another role as the Chief Medical Officer for the Duke Health Integrated Practice. So I’ve been in that role now for a few months, and I hit the ground running when I took on the role—immediately, as in my first day on the job—had to help with some challenges we were going through as an organization.

It’s been very exciting, in just these first few months, to begin to see the opportunities that I will have. In terms of—you know, you asked about some of the things that we’re working on—and we’re going to talk today about some clinical innovation, and that’s been extremely exciting to work on.

Rohit:  That’s awesome. Yeah, so that leads us right into our next topic. What are some of the clinical innovations or challenges you’ve faced that you were able to overcome? And what are some of the digital health programs you’re getting involved with? Anything you’d like to dive into and share more about?

Angelo: Yeah, fantastic question. So, my first day on the job, I had to address the audience of our entire practice—all the clinical leaders from across the health system—and I told them that I saw my role as Chief Medical Officer as one who is there to support clinicians in their day-to-day work.

My platform rested on the idea that I want to bring aid, tools, and tactics into the practice that actually help people do their work. In the last few years, we’ve been facing workforce challenges—people feeling burned out, disillusioned, like cogs in a machine. I want to bring the joy back into the practice. And I think the way to do that is to allow physicians and other clinical providers to spend as much time treating patients as they can.

So we’ve identified areas where we can innovate—where we can bring technology to bear to improve the experience of delivering care for our doctors, nurse practitioners, physician assistants, and other clinical personnel.

One thing we’ve done—something very concrete and in partnership with a very innovative healthcare technology organization—is apply what’s called ambient listening technology. And we’ve done this in a way that’s been thoughtful, in response to a specific problem: how can we alleviate our clinical providers of some of the burden? In this case, the burden of documentation.

We know that physicians and other clinical providers today spend a lot of time in front of a computer—often while they’re in the room with a patient. This can make people feel like their job is data entry. We don’t want the job to be data entry—we want the job to be managing patients. We want it to be engaging. Spending that face-to-face time matters, because we know so much of diagnosis comes from the history, from having an in-depth conversation and hearing the patient’s story.

Yes, we can do a lot with diagnostic testing, but at the end of the day, it’s about engagement with the patient. That’s how we build a differential diagnosis. That’s how we begin to form our assessment and plan.

So what we’ve done is bring this ambient listening technology into the clinical encounter. The tool records the conversation between the clinical provider and the patient, and from that back-and-forth, it creates the encounter documentation.

It may seem like a simple evolution of the standard tape recorder-to-human-scribe model, or even having a human scribe in the room. But this is truly the modern version. The conversation is filtered through a natural language processing algorithm, and the finished product is something that’s usable as clinical documentation.

This has been a very exciting opportunity for us to leverage technology at the point of care and remove some of that documentation burden.

Rohit:  That’s a great use case—one of the hottest we’re seeing in many health systems, Angelo. Tell us a bit more.
You mentioned some metrics before we started. How do you measure the success of this wide-scale implementation? And you also said it’s integrated with the EMR/EHR system. These are critical for those still thinking about this.
Many have already taken the plunge with varying degrees of success, but you’ve really embraced it and rolled it out broadly. Any key takeaways from your experience that were instrumental?

Angelo:  Yeah, fantastic questions—thank you.
I’d start by saying our pre-implementation data was both qualitative and quantitative.

From a qualitative perspective, we were literally hearing from our doctors, nurse practitioners, and clinical providers that they were losing the joy of practice. These are people who’ve invested so much time and energy into becoming clinical providers. They want to engage with patients—that interaction is a special opportunity.

But over the last several years, we’ve created systems that make them feel disconnected. These electronic health records require tons of digital input—typing, checking boxes, clicking through screens.
At the same time, we’ve opened the door to patient interactions outside the visit. They’re now answering after-hours messages, doing telemedicine and telehealth visits, which are great but can also add stress.

So it starts with qualitative data. Are our people enjoying their practice? If not, we have a problem. We saw workforce challenges—many physicians and nurses left during the pandemic. We need countermeasures.

On the quantitative side, we look at “signal” data—engagement with the EHR: login times, time spent in the system, responsiveness to messages, how quickly notes are closed, and whether they meet patient expectations.

We also track provider ratings. We ask questions like: Did your provider listen? Know your history? Speak clearly? Explain things well? These bridge qualitative and quantitative—they’re numeric but reflect the experience.

If a provider has low ratings, we drill down. Often they say, “I just don’t have enough time with my patients.” And it’s not just visit length—it’s quality.
Those were some of our pre-implementation metrics.

Another key part of our approach: bringing our performance engineers to the practices. We call them performance excellence engineers. They’re incredibly skilled at turning data into actionable information.

But in recent years, they’ve been working remotely or from centralized offices—not their fault, it’s how we structured things.
We’ve found that when you put them at the point of care—whether it’s the OR, ED, primary care, or endoscopy suite—they really begin to understand the work. That’s when they can help translate practice data into something actionable.

This is classic business school 101—Toyota production system. Bring the people doing the work into the improvement process. We had drifted from that. Now we’re returning to it and seeing the benefits

Ritu:  That’s awesome. Dr. Angelo, I was at a conference recently where Abridge—one of the main players in the ambient space—shared that 81% of notes didn’t need to be edited by doctors. That led to a huge jump in satisfaction. Are you seeing similar numbers?

Angelo: Ritu, this is a very interesting question, and it’s interesting for a number of reasons. First of all, full disclosure — we are using Abridge, so that is our partner in this space. One thing that’s been wonderful about that relationship is they’ve craved our feedback about the product.

They want to iterate, and that’s why they were such a natural partner for us — we share that DNA around innovation. They want the product to keep getting better and better as we use it.

To your comment about 80% of the notes not requiring editing — this is a really interesting data point that we are looking at. We’re actually tracking the number of times notes do or do not get edited, and there’s a signal in both directions that we need to be careful about.

We need to be careful about the people who never edit their notes — because that’s one kind of story — and also ask about the people who are always editing their notes.

I can tell you that in my practice — and I have more than 20 years of clinical experience — and as someone who likes his notes done a very specific way, I’ve actually been quite happy with the quality of the content.

And when I have edited, it’s been primarily not to correct factual errors, but to change the language to better match my personal style. So it’s really been more about the aesthetic of the note rather than the content itself.

I’ve found the content to be quite good. And when it hasn’t been good — this is the other nice thing about it, Ritu, you mentioned earlier that it’s embedded in our EHR — we can provide feedback immediately.

So if I see a note that didn’t come out the way I expected, we have a chat box — we can go right into it and talk directly to the development team and say, “This is why I don’t like this note.”

We can also see the stems — the original stems of our conversation — and how the natural language processing model created the note from those stems. And again, having that direct pipeline to the developer has been critical.

Just a few weeks ago, the Abridge team came to us. They did an extensive two-day site visit — and again, they wanted to hear directly from us, from our doctors, from our clinical providers — how they were engaging with the technology, what was working, what wasn’t.

With very rare exception, most of our people have said — and I hesitate to use the term “game changer” because everyone uses it and it’s almost lost meaning — but this has been disruptive in the best possible way.

This has enhanced our practice. I’m able to close my notes. I’m able to leave the office at the end of the day not having to go home and work after dinner, or work in my pajamas, or while I’m trying to do something else — wanting to spend time with my kids, or being taken away from my hobbies and interests.

This is allowing me to close the books at the end of the day, feeling good about the quality of the content.

And again, so much of the upside is that ability to spend time — and we’re really interested to see how we improve on that one key metric: Did your provider spend enough time with you? I’m going to be really interested to see how that improves with the implementation of this technology.

Ritu: Yeah, so in the same conversation they also mentioned that some of their physicians are seeing Russia traffic for the first time, which can be, you know, good or bad depending on how you look at it.
So to your point about being able to close the notes and go home — that’s really good to know.

Angelo: I think it is. One thing we really like about this technology is the modularity. You can use it for certain elements of your note and not others. You could use it for the entire note if you like, and that flexibility has helped adoption.

If you’re really good at documentation and only want to use it for your history of present illness, you can do that. We’ve encouraged everyone to try it, and almost universally, people have at least given it a shot.
Most who’ve tried it have stuck with it — and we’re tracking that with metrics. We know what percentage of users only tried it once, how often it’s being used across different note types, etc. We’re seeing very strong onboarding of the technology. We’re not at the plateau yet — we’re still ramping up — but it’s exciting to see adoption growing.

Rohit: Yeah, shifting gears — I know we haven’t touched on this yet, but Angelo, what are your thoughts on value-based care? Is that something your practice is actively thinking about?

Angelo:  It’s very important—and it’s part of what we’re trying to do. I’ll tell you, in this part of the country, the Southeast United States, I think the move toward value-based models—bundled care and similar approaches—has been slower.

When we look at our colleagues in the Northeast or on the West Coast, we see folks who’ve been very innovative and progressive in this space. We’re certainly trying, and I think there are a number of reasons why adoption has been slower here—probably more than we can cover in this conversation.

Nevertheless, we’re very excited about the opportunities to improve care efficiency and reduce costs. We’re looking at how to bundle services in a way that clearly shows value—taking that classic formula of quality divided by cost. We believe our quality—the numerator—is very, very high. Now it’s about shrinking the denominator and reducing costs.

There are ways to do this that may involve technology, but also some analog solutions too.

We work very closely with payers and are really interested in what they have to say. Over the past few years, we’ve built strong, bilateral relationships with payers to understand what’s on their radar in terms of quality and performance metrics. At the same time, we want to hear from our own clinicians—what’s important to them?

Sometimes that aligns with what payers are looking for, and sometimes it doesn’t. But when it doesn’t, we have strong enough relationships that we can go to payers and say, “Hey, this matters to us.”

For example, our pediatricians have raised concerns about adolescent immunization rates. A payer might be more focused on vaccines in the first year of life or among older adults—like meningococcal, pneumococcal, or RSV vaccines for seniors. But we’re hearing from our team that teens aren’t coming in for pre-college immunizations.

In most cases, payers are at least willing to have that conversation.

We’re also thinking about how to clearly demonstrate our value proposition—especially with so many large employers moving into Central North Carolina. With the research triangle and three major universities here, this region is growing fast.

We want to make sure that when employers include us in their health plans, we can go to them and show the value—whether it’s for hip replacements, organ transplants, or more common services like primary or preventive care.

Historically, large academic medical centers haven’t always been great at cost containment. But we’re learning. We’re identifying opportunities, especially around clinical operations. There’s a lot of potential for efficiency there—and when you focus on that, you can truly begin to lower the overall cost of care.

Ritu:  That’s awesome. I would like to ask you about AI education and the trustworthiness of AI. Did you face any barriers from your physicians on those regards? Sometimes we see that physicians can be reluctant to try new solutions. There was a New York Times article that showed when ChatGPT was diagnosing on its own, it was much better. But when the physician came in, they brought in their own biases, and it actually did worse because they didn’t trust the AI and took it in a different direction. How have you made sure everyone is educated and had the right context within your organization for such a wide rollout?

Angelo:  Again, fascinating question. We could spend a whole podcast on just this. We have certainly needed to address this issue, but I’ve been pleasantly surprised that most of our clinical providers—physicians, advanced practice providers, physician assistants—have asked questions in a very thoughtful way. They’re not necessarily showing hesitancy, but they are trying to keep pace with developments in this area. They want to ensure we’re good stewards of the technology.

They’ve asked questions like, “What are we doing with these recordings? Are we using patient data to improve the system? Are we training the language models with our information?” They’ve also wanted to know about the process for obtaining informed consent. And yes, we are certainly asking for permission every time we use this technology, in every instance.

One thing I’ll mention is that we have a very robust structure here for digital innovation. We have several teams, and one that focuses specifically on AI. They’ve done great work ensuring our faculty are educated on basic terminology around AI, natural language models, and generative AI. Most people feel they have amazing colleagues providing these educational materials.

Another key step was the pilot program. Before rolling out anything, we did a well-thought-out pilot. We tested a few technologies and opened it up to a large number of clinicians across the entire system. This was incredibly beneficial because during the pilot phase, which lasted several weeks, clinicians provided us with feedback. We conducted pre-, intra-, and post-pilot questionnaires to evaluate all the technologies and assess what worked and what didn’t.

During the pilot, we also did a lot of education. We had review modules, town halls, and went to all 18 of our clinical departments to answer questions. Our data and IT teams, including many doctors, were also part of those conversations. That was a huge benefit because when you have IT leaders who are also physicians, it builds a lot of credibility with the clinical audience. I think that was key to winning people over.

Rohit:  Yeah, I’ll chime in with another one, Angelo. We’ve all been hearing about agentic AI, and how agents are the next big wave in generative AI. We’re currently working with several clients to define use cases for implementing agents in the workplace, as they’re talking about creating a new digital workforce that includes both humans and agents. Any thoughts on that?

Angelo:  It’s an area that’s going to grow exponentially. Right now, we’re testing the ability to use AI to screen inbound messages. As I mentioned earlier, one of the outcomes of opening up digital access to our patients is that we’re receiving thousands of messages per day. That’s a good thing—we want our patients to communicate with us—but it’s a lot of work, real work.

We have an AI innovation research team working on models that can review these messages and sort them into categories. For example, distinguishing between a message that just says “thank you for the great care” and one that says “I need a prescription refill” or “I need an urgent appointment with my orthopedic surgeon.”

The next stage is not only sorting these messages but starting to build at least the skeleton of a response. This is a really complicated problem, even for humans to do. But what’s exciting is that we have people who recognize that this is another way to alleviate some of the clerical burden on our clinical teams. If we can reduce the number of messages that require human attention, we can focus on the urgent ones. The others are still important, but they’re not as urgent. If we can triage this, it will be incredibly helpful.

And to your point, Rohit, I think the future will involve a synergy between human and technological capital. If we can create that synergy, perhaps people won’t lose their jobs but will take on new kinds of work. That’s the future I see.

I’m old enough to remember the early days of the internet, and the doom-and-gloom stories that came with it. What we’ve learned is that we need to approach these tools with an open mind and recognize that we can use them responsibly if we choose to. It’s about figuring out the most responsible and applicable use cases, and being good stewards of the technology.

I’m encouraged because many people in the space, especially those applying these solutions to healthcare, really understand the practice of healthcare. That’s why partnerships with institutions like Bridge, or technologies like Copilot, are so important. When you have a strong clinical-technological partnership, amazing things can happen.

Rohit: Angelo, would you like to share some closing remarks?

Ritu:  I think we need another podcast for more questions! But Angelo, thank you for being such a great guest and providing really insightful answers. We’d love to hear your closing thoughts.

Angelo: This was a fascinating conversation, and again, I love what you guys are doing with this show. I hope we can convene again at some point. I’d love to come back.

In closing, one thing I’d leave the audience with is that these feel like incredibly challenging times, but we can do incredibly challenging things in response. Sometimes, the most amazing road to success is when you’re pressed and facing obstacles. The tools we have today have amazing potential. We just need to be good stewards of that potential—thoughtful stewards of it.

We shouldn’t be afraid. Instead, we should continue to ask the fundamental questions and think of the future as a synergistic one, where we combine the best of our human capital with technological tools and innovation, figuring out the next step forward.

I believe in the idea of abundance. I think we have a future full of great potential, but it’s a matter of deciding how we engage with that abundance. How do we take the tremendous potential of natural language models, generative AI, and other technologies, and apply them thoughtfully, rationally, and in a way that speaks to the needs of those moving these things forward?

In our case, we listened to what our people were telling us about their work and realized that the only way to really move forward is to change the work itself. We can provide support, offer a shoulder to cry on, or an arm to hold in times of distress. But when we change the fundamental nature of the work, that’s when we begin to truly change people’s engagement with it and make them feel supported, with a clear way forward.

Doctors are resilient. We don’t lack resilience. What we need are tools to help us engage with the work by changing the terms of the engagement.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

 Q. Hi Dwight, welcome to The Big Unlock podcast. My name is Ritu Uberoy, and I’m one of the co-hosts. We’re very happy — this is season six, and we’re glad to have you back. Delighted to hear new perspectives, especially on AI and your initiatives at your new organization. Let’s get started with your introduction and then dive into a few topics.

Dwight: Great. Really great to meet you and be here, Ritu. I’m Dwight Raum, Chief Digital Information Officer for Rochester Regional Health. We are a health system with about nine hospitals in Western and Northern New York. We span the spectrum from large, urban acute care hospitals to small, rural regional hospitals.

We also have a large ambulatory practice throughout the region, and we really take care of patients from birth to death — and every aspect of healthcare in between. I’ve been with the organization just over a year.

Before joining Rochester Regional Health, I was in the startup world for a short time. Prior to that, I served at Johns Hopkins Medicine as the Chief Technology Officer and Interim CIO. I’ve been in healthcare for quite a long time. I really came up as a technologist, which is increasingly unusual in senior IT leadership roles. But I’ve truly enjoyed my time in healthcare — the mission really calls to me.

 Q. That’s a very interesting introduction, Dwight. It seems like you’ve seen all three aspects of technology and implementation — being at Johns Hopkins, which is a world-renowned teaching hospital, then moving to a startup, and now at Rochester. What was your role at the startup, and what did the startup do, before we get into your current role?

Dwight: Sure. It was technically a joint venture between Independence Blue Cross and Comcast. The startup was called Quil Health at the time. We were trying to build an in-home monitoring system that would allow seniors to age in place.

That consisted of various IoT sensors placed throughout the seniors’ homes. From those sensors, we ran AI models to anticipate and predict certain behaviors and patterns. Insights were drawn from the data and shared with caregivers.

It was a really interesting idea — just struggled to get it across the line, if you know what I mean. But I think it had tremendous potential. It actually speaks to the opportunities we have with signals and AI, and how that can really transform the way we provide care.

Q. Yeah, that’s very interesting. We had a webinar yesterday where we were presenting some case studies. One of the case studies we were going to present — but didn’t — was for Cherish Health. They do something very similar, radar-based. They have a device used in senior homes that can detect falls, go through walls, and anticipate events using AI.

Dwight: Yeah, I mean, the technology has evolved certainly over the last several years, and radar fall detection has really improved. But I still think there are a lot of challenges — in terms of privacy and getting over that technical hurdle for seniors to adopt and use the technology with trust.

Those are still barriers that aren’t easily overcome, even with the technology in place.

Q. Absolutely. Okay, great. So tell us a little more about your role at Rochester Regional Health — what the digital landscape is like there, your experience with generative AI, and some of the initiatives happening at your organization.

Dwight: Absolutely. As I mentioned, we’re a nine-hospital system. We’re mostly on one EMR — we’re an Epic shop, single instance. We do have some smaller EMRs, but we’re slowly but surely moving everything into a single instance.

In terms of initiatives, I’d group them into a couple of categories. The first is optimizing the system and the engine of care delivery we already have. That means ensuring throughput, doing so in a safe and high-quality manner, and providing access to our patients.

The second part is really transforming how we deliver care — shifting from a traditional fee-for-service model to a much more risk-based, value-based model. We’re focusing on treating patients for their outcomes instead of on a transactional basis.

That shift brings a lot of changes — not just in how technology works, but also in how our operators and clinicians provide care. It’s a transformational change for the system.

A lot of credit goes to our CEO, Dr. Chip Davis, who’s really leading that charge and planning for the future. When 2030 comes around and CMS starts to pay more earnestly based on value, I think we’re going to be very ready here in Northern New York to take on that challenge.

Q. In terms of the Clinical Access Center — is it a unified center? We recently worked with Sentara on a huge multi-year project where they brought everything into one place. Now they’ve implemented AI on top of that to handle call routing.

We did a webinar on their case study, and they shared something interesting — because of the AI they implemented in the call center, they can now predict when call volumes will be lower. That allows nurses to take flexible time off, which has been a big plus for them.

Dwight: I think that’s a great comparison for us. We do have a unified call center, and we are absolutely using AI for call routing and predicting high call volumes, etc. We’ve really been able to drive efficiency using AI in the call center.

Our call center is located right next to our command center, so we’re constantly looking at overall system operations — understanding volume, where to shift resources, where to move patients, and so on. Combining that with the call center is incredibly powerful.

Our call center isn’t just receiving calls — we’re also driving outbound traffic. And the third leg of the stool is that we’ve just rolled out a digital front door on our website — a robust digital experience for patients. It offers capabilities for patients to serve themselves, schedule appointments, and find the closest care options. We’re really trying to cover the full experience and serve patients as consumers as best we can.

Q. For the digital front door, do you have AI as well? Like virtual chatbots? How does that work?

Dwight: We’re not deploying chatbots in a very robust way at this point. Honestly, I’m not sure I see them as a strong tool for care delivery. There’s probably some limited front-door use for chatbots, but I don’t think they’re a great solution overall.

That said, our digital front door does provide access to direct virtual care. Patients can usually get an appointment within an hour or less — they’re able to see a provider almost right away. So it’s really about combining access with technology to deliver care where patients are, in almost real time.

Q. So. Sentara mentioned they use something called Edia for the AI part of their call center. Do you know which AI implementation you’re using?

Dwight: Yeah, we’re a customer, and there are embedded AI tools within Genesys — that’s what we’re using.

Q. So, how big is the technology component at Rochester Regional? And do you see a role for a Chief AI Officer? That’s a hot topic these days — ethics, governance committees, Chief AI Officer roles. Would love to hear your thoughts.

Dwight: That’s a broad question — let me take a shot at it. In total, we’re about 400 people in our IT organization. I might have had a bit of a Freudian slip earlier — I’m very much trying to reorient the organization to think about AI, but more broadly, innovation.

So, how do we bring technology and new ways of thinking to transform the tools and experiences we deliver?

To your specific question — do I anticipate us having a Chief AI Officer? The simple answer is no. I don’t think that makes a lot of sense, quite frankly.

What we have done is create a Center of Excellence for AI. It’s a group of the right people who need to be at the table to do two things. First, there’s the “pull” — a lot of demand from our operators who see new tools and ask, “Hey, can I get this?” We need to be thoughtful about privacy, contracts, ethics — all the right teams are part of the COE to address those questions and respond responsibly to that pull.

But there’s also the “push.” AI has been evolving at an incredible pace — even in just the last 6 to 18 months. It’s impossible for any one person, or even our providers, to keep up with it all. So the second part of our AI COE’s responsibility is to articulate what’s possible — the art of the possible.

We’re maintaining an initiative list of opportunities we think are ripe for AI — places where we can deploy capabilities, whether it’s LLMs or machine learning, to have an immediate or significant impact.

Q. And for all your AI implementations, are you planning to stay within Epic, since they’re building their own AI tools? Or are you looking to integrate outside solutions too?

Dwight: I think we’ll always look at what we already own first. Epic is a chassis in many ways — we can plug in different Epic modules and activate them. So yes, we’ll definitely start there.

But that doesn’t mean we’ll only look there. As I mentioned earlier, Genesys offers incredible AI capabilities — that’s an example of something outside of Epic but still integrated into our environment.

So no, this isn’t going to be an Epic-only play. But there are definitely some low-hanging opportunities within Epic that we’ll evaluate, ensure they provide value, and then activate them for our providers.

Q. Okay. I’m just mulling over your answer because other CIOs and CTOs we’ve been talking to feel the need for a Chief AI Officer, for the same reasons you mentioned—trust, governance, and the pace of change. It’s difficult for one person to keep up. Some believe you need a dedicated person whose job is to look at that landscape, understand what’s happening, and decide what’s best for the company. Just playing devil’s advocate here, trying to look at both sides.

Dwight: My reaction is, if we were in the business of developing AI ourselves, I would agree. But we’re not. We’re a system focused on serving our patients. Our priority is patient care, and we’ll use AI to support that. I do think it requires a collection of experts. From legal, privacy, and algorithmic safety standpoints—maybe a Chief AI Officer could be the lightning rod that brings that all together.

But honestly, we’ve come up with a methodology that works well for us in the COE. It allows us to bring together those experts and, more importantly, align their interests. Even if you have a Chief AI Officer, they still have to orchestrate all the soft power and influence that drive real change. In my view, the AI COE approach forces that to happen from the start.

Q. Yeah, that’s a very astute observation. That’s exactly what we’ve learned in our webinars—it can’t be mandated; everyone has to buy into it. It’s a behavioral change, especially with these new tools coming in.

The other point of view I have, which came up in a webinar yesterday, is that the EU has passed a law mandating AI training for any company using AI. What do you think about the training landscape? Are all your employees getting AI training?

Dwight: No, we haven’t mandated broad-based AI training yet. That’s likely to happen depending on the tools we’re using. We talk about it a lot as leadership. As we approach deployment of smart ML models for diagnosis or therapies, there will be very targeted and intensive training around each one.

Q. So as of now, people just learn on their own? Both—like LLMs or ML tools.

Dwight: So, as I said, I’ve personally hosted several webinars across the organization to provide baseline information about how tools work. But we’re not yet offering formalized training. The challenge is that healthcare is very busy and, in many ways, understaffed. Capacity is a real concern. We have to be cautious and ensure training is impactful.

My sense is that as opportunities become more acute, and we identify specific use cases, we’ll do more. We’ve also deployed an AI policy that specifies what is considered safe use for generative AI.

Q. In your hospital environment, do you have people using ChatGPT and possibly uploading data without realizing it could become public or used to train the model?

Dwight: That’s been part of our internal communications campaign—clarifying what’s appropriate. It’s hard to police, and I can’t say for certain it hasn’t happened. But we’ve provided guidance and education. A lot of people don’t realize that unless you opt out, anything you type can be used to train the model.

Q. Exactly. Okay, great. So, Dwight, talking to multiple CIOs and CTOs, the main generative AI success stories we’re hearing fall into two categories: scribing and ambient. What’s your experience with either, and do you have a success story?

Dwight: Honestly, we’re a little late to the game. We’ve just started our pilot for Ambient Digital Scribe. We’ve done early testing, and it’s clearly a win for providers. It helps reduce pajama time and after-hours documentation. But these tools are also incredibly expensive, so we’re evaluating ROI—how to unburden providers while sustaining the investment financially.

Q. Yeah, very interesting. At HIMSS last year, Nuance shared that ambient tools save about six minutes per patient. That doesn’t sound like a lot, but across multiple physicians and patients, it adds up quickly.

Dwight: Absolutely. Over the last 15 years, digitizing healthcare hasn’t been seen as a net plus by most providers. It’s negatively impacted their quality of work. COVID contributed to burnout, but so has technology fatigue. Any opportunity to unburden providers using tech—we should seize it.

Q. Good to know you’re in the early stages and testing. Any other digital programs you’d like to highlight?

Dwight: Yeah, I think, you know, there are several that I would highlight, and I would kind of back it up to a higher level for us. As I mentioned earlier, Chip, our CEO, has really been very much driving transformation. But I think a supporting function there is really innovation writ large, and AI fits into that innovation model as well.

So we’ve really begun to create an entire innovation program for all of RH, where we have two parts to that program. The first is focused on internal performance improvement—transformation and innovation. And then we’re coupling that with an accelerator program to actually take some of those innovations to market, and also to partner with other startups to bring them back into RH.

We’re doing this in a very prescriptive and deliberate way, ensuring it’s aligned with our strategy. So, where we have opportunities or challenges, we’re trying to line up those companies that may actually fit and help us solve some of those niche problems. I’ll give you a really good example of this.

Healthcare is currently experiencing a drop-off in employees, and there’s certainly a challenge in maintaining staffing. Nurses, I think, are the most acute area where we see that. But we’re also in this perfect storm where demand is increasing at a remarkable rate. So that gap between supply and demand—the only reasonable way to think about closing that gap is through technologies.

As you mentioned, AI—and we talked about Abridge as a digital scribe—as one way of doing that. But there are certainly other opportunities in that space. Just scheduling nurses, for instance, is incredibly burdensome right now and leads to tremendous inefficiency. Every little point of improvement we get there pays multiples in dividends.

So as we look at opportunities, a good example is nurse scheduling—can we apply AI to actually improve the speed and efficiency of that process? And the answer is yes. That’s a great example of a strategically aligned innovation opportunity that we’re actively pursuing at RH.

And I can stack up numerous examples like that. We talked about the digital front door and trying to improve access by casting a broad digital net, but also empowering our patients with tools to self-serve and gain access to care as quickly as possible.

It’s those types of activities that we see as the through line from the innovation continuum I was talking about earlier. So while an innovation may start by solving a very acute problem within RH, we believe we can develop those ideas into something that scales across the entire organization—and potentially even goes to market more broadly.

Q. That’s really interesting. The accelerator program—does it include in-house participation too?

Dwight: It does. A great example is a physician in emergency medicine who developed an app called COIST. It’s a heads-up display on an iPad that guides cardiac resuscitation based on ACLS guidelines and documents the process in real-time. We helped develop it, and it’s a great example of internal innovation with life-saving potential. It also eases the provider’s burden in emergency care—and it’s not a problem unique to RH. We believe it has wider potential.

Q. Yeah. So they’ve seen really good success with longitudinal care plans and generating care plans—still with the human in the loop to make the final call.

Dwight: I think especially with LLMs, that’s critical. I don’t see that changing anytime soon. One of my personal hobbies is coding, and I use LLMs all the time. It’s remarkable how good they are, but also remarkable how they hallucinate—just make things up. So I think there’s a definite need for caution and keeping a human in the loop.

That’s why I think RAG implementations have seen greater success—because you can bound them, put guardrails in place, and ground them in truth.

Q. Any challenges you’d like to talk about? What do you feel is your biggest challenge with technology?

Dwight: Yeah, I mean, I think, you know, the financial pressures in healthcare are certainly still very acute. And I think, in a lot of ways, that’s the oxygen you need to really drive wholesale innovation and transformation. So that’s certainly a challenge.

I think cybersecurity is also something that continues to be a top-of-mind concern for any CIO these days. And, for that matter, the accompanying investments you have to make to really tighten things up, so to speak. Mm-hmm.

Those are the challenges I see. And there are challenges around workforce, too—maintaining a team that can really drive and advance the ball is very critical as well.

By and large, I’m an optimist by nature—and a technologist by nature. I actually think there is real opportunity. If you take a step back and look at that gap I was talking about earlier—around supply and demand—and, for that matter, how much we spend as a country on healthcare, I do think there’s good reason to be optimistic about the future and how technology can play a really important role in helping us, as a society, meet the demand of healthcare and actually improve people’s lives.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.