Ritu: Hi everyone. Welcome to the Big Unlock Podcast. My name is Ritu Oberoi. I’m the managing partner here at Damo Consulting and co-host of the Big Unlock Podcast. A very warm welcome to all our listeners to Season Seven. Today we are very thrilled to have with us Andrew Porter. He serves as a key leader at Wayne General Hospital, where he’s driving forward initiatives focused on operational excellence, patient-centered care, and sustainable growth for a community-based health system. Andrew has been instrumental in advancing strategic priorities that strengthen access, improve outcomes, and enhance workforce resilience. Looking forward to a very in-depth and engaging conversation. Welcome, Andrew. Thank you.

Andrew: Thank you for having me.

Ritu: Would you like to add anything to that introduction, or shall we get started?

Andrew: I’m on y’all’s time. I’d just like to say it’s a privilege and an honor to get to chat with you all today, and for your listeners to get to know us here at Wayne General Hospital a little better. I’m excited about what we get to talk about today.

Ritu: We usually like to start with an origin story — asking our guests how they got into healthcare, and particularly into this intersection of healthcare, administration, and tech. If you can tell us a little about your background and how you came to this role, we’d love to hear that.

Andrew: Of course. It’s a winding path of how I ended up here, so I’ll give y’all the short elevator version. I actually started working here at Wayne General when I was still in high school — my first job was here as an ER tech. I did that through high school and into college. I initially went the clinical route in my education. I’m a PA by trade and practiced emergency medicine — I continue to do that to an extent even now. I did some teaching and education along the way, earned my doctorate in medical sciences with a focus on healthcare administration, and then the opportunity came along to return to my hometown to practice emergency medicine. I was able to bring that education and administrative leadership skill set with me, and the rest is history. My board of trustees put faith in me to be the CEO here at the hospital, and here we are today.

Ritu: Thank you for sharing that. You have this professional triad of clinical experience, administrative experience, and a strong commitment to academics. Which part is your personal favorite?

Andrew: I had an accounting professor once who described it beautifully using the analogy of a three-legged stool. Professionally, I have a clinical component, an academic component, and an administrative component — and for me personally, each one of those legs makes the other stronger. Continuing to work on the front lines in healthcare gives me a much better sense of the needs of the community and the pulse of my staff. There are so many times that being in the emergency department, interacting with staff at that level, allows me to catch something that could turn into a significant cultural or logistical issue before it becomes a larger problem. The adjunct teaching keeps me sharp on what the research is showing and where best practices are headed in five to ten years. Having that academic hat on makes me a better administrator. I know the practical challenges, but I also bring the academic perspective to the table. Together, all of that helps me drive our system using best practices, while keeping today’s financial challenges in mind, maintaining a strong strategic plan, and staying nimble — because the healthcare world today is essentially completely different from what it was a year ago.

Ritu: I like that analogy — it really helps visualize exactly what you’re saying, that you have to keep all three things in balance and each one makes the others stronger. Thank you for sharing that. Andrew, I wanted to hear more about Wayne General, because you operate in this challenging community hospital environment. What specific operational or financial levers have had the biggest impact in maintaining both quality and sustainability? We’ve been hearing from other health system C-suite leaders that it’s always a resource crunch and you’re constantly having to do more with less. Beyond AI, what’s top of mind and how do you face those challenges?

Andrew: A little more detail about our organization: we are the sole community hospital for our area, serving a population in excess of 50,000 people given our rural geography and how far our reach extends. We’re county-owned — which may be unique to some listeners — meaning we are actually a political subdivision of Wayne County. Even though we don’t receive any taxpayer funding, we have been financially sustainable for many, many years. At the end of the day, the reality is that we really try to embrace the idea that we’re the people’s hospital. We are owned by the people of Wayne County. We have the nonprofit designation, and I describe it to people this way: 365 days a year, our goal is high-quality patient care. We’re not a for-profit organization answering to shareholders — we answer to the people. But to meet those needs, you have to have money, so at the end of the day it’s still a business. It’s a unique business model, but you still have to get cash in the door. For small hospitals like ours, there’s been so much transition since COVID. We went through an EHR transition during that period, which is always a very big undertaking for a smaller health system. Navigating how that intertwines with the revenue cycle has been a big challenge. For a small community hospital leader, the name of the game right now is being conservative with finances, valuing our independence, and keeping the financial side right up there with patient care — because to offer a high level of patient care, we have to be in a good financial situation.

Ritu: Absolutely. Taking that further — where do you see the most practical near-term opportunities for AI and automation? How far along are you on that journey? We hear a lot about ambient documentation, voice agents, and digital front door technologies, since clinicians are still cautious about AI for diagnostics and clinical decision-making. Where is Wayne General with those technologies?

Andrew: About a year ago, I very distinctly remember having conversations of the nature of: we don’t want to get left behind. So we took a hard look at where our pain points were — but we weren’t going to go out and try to fix problems with AI that didn’t exist. We said: let’s look at the issues we’re actually having and see if AI might be part of the solution. A good example is the ambient documentation and AI-assisted documentation space — that was one of the first areas we went down that path, and it’s been very positive for us. We’ve had it active in a substantial way for about two months now, so it’s still a little early to have a complete picture of the financial implications around improved documentation. I will tell you, the timeliness of documentation has absolutely improved. But for me, the biggest factor has been provider satisfaction. Even some of our later-career providers — who are sometimes resistant to new technology — have tremendously embraced the use of AI for documentation assistance. I would argue that has added longevity to certain providers, and while I don’t yet have a way to quantify this, I believe it’s also improving the patient experience. Instead of the provider feeling rushed to get back to the keyboard and complete documentation, medicine now becomes more what it was intended to be — an intimate, conversational interaction between the patient and their physician or provider focused on the patient’s needs that day.

Andrew: So AI-assisted documentation is what comes to mind first as something we’ve implemented and are seeing really positive early results from.

Ritu: I was having a conversation a few months ago with one of our C-suite guests, and they mentioned that one important benefit of ambient documentation is that doctors are vocalizing more — and that’s great for patients because they love to hear more. Because the system is capturing everything in the background, providers are actually saying things out loud that they might otherwise have just thought, and that really helps.

Andrew: That’s a great point, and putting my clinician hat on — it’s so easy to see a patient and say something like, “I think you have pneumonia, we’re going to run a couple of tests and get a chest X-ray,” and then move on. With ambient documentation, you’re naturally encouraged to be more detailed in that conversation because you know it’s going to be populated into the note. The conversation becomes: “Here’s my concern about what we may be dealing with. I’m going to order X, Y, and Z tests. Here’s what I’m looking for. This is the initial treatment plan.” And the way I have my AI-assisted documentation tool set up, every time I go into the room it timestamps it — which is an additional encouragement to make sure that every 30 minutes, every hour, or whatever is appropriate, I’m reassessing the patient and providing updates to them. So while it may not have been the original intent, it also increases accountability — making sure you’re having those detailed, appropriate conversations with the patient and their family and checking in on them regularly. Personally, those have been some of the real positives for me.

Ritu: Going along those same lines, you mentioned some of those physicians were from an older generation and more resistant to technology. Let’s talk about change fatigue and the barriers to digital transformation. How did you break down those barriers and get everyone on board?

Andrew: For us, one of our more experienced clinicians had actually heard that this technology was becoming available. We let him do a little research, look at different vendors, and participate in the selection process — and then we let him be the first user for a couple of months. He really became our champion. The sell was easy after that because when this particular person — someone who hates technology and wishes we could still do everything on paper — starts telling his colleagues, “This is as close to charting on paper as we’re probably ever going to come again. It’s decreased my workload. I’m not staying hours after my shift or coming in on my days off” — that carries a lot of weight. So for other organizations, finding that champion early on and giving them real buy-in to the project was really key for us.

Ritu: Basically, have the change driver be someone who has a personal stake in the change and can genuinely influence others around them.

Andrew: And realizing that the right agent of change may not be the first person who comes to mind. It doesn’t need to be the newest graduate clinician. It probably needs to be someone more senior, because your senior medical staff will have those long-standing relationships with colleagues, and the trust they carry operates on a different level.

Ritu: Looking ahead, what do you believe will differentiate the community hospitals that thrive from the ones that struggle to survive? Resources are always going to be scarce. What are the key factors that will keep Wayne General — and community hospitals in general — on the path to sustainability?

Andrew: We have a saying in medicine: you often don’t want to be the first to do something, and you don’t want to be the last. For us, that meant while we may not be the very first to try something, we do want to stay on the cutting edge. If we see a product or solution that has worked for others and makes sense for us, we’re going to consider going down that path. The AI vendor market has opened up so many opportunities for relationships and solutions. One thing we’ve been very fortunate with is our relationship with Eko Health, who make the Eko stethoscope. We’ve partnered with them on various research projects using their Sensora AI tool for heart murmur detection, and that’s been a great relationship. That gets into the space of how we use AI to increase access to care — bringing a level of technology and sophistication to a population that historically would have been years behind what could be offered in a large metropolitan area. We’re passionate about bringing that cutting edge of care when it makes financial sense and when we have the capabilities to support it. We’re proud of that relationship and look forward to the research that will come out of that partnership.

Ritu: As you’ve explored AI on your own — and you mentioned you’re always doing research — what do you feel are some of your personal favorite areas you’d like to know more about? And where do you think the biggest change in healthcare is headed in the next year or so? Crystal ball?

Andrew: Putting my administrator hat on — something is going to have to change in the revenue cycle space: coding, billing. There has to be some relief at some point for our hospitals, because the current model is enormously complex. I’ll be very honest — I by no means fully understand the revenue cycle, let alone a layperson trying to make sense of it. And just the timing alone — how long it takes from when a patient is seen to when the facility receives payment — you’re often looking at 30 to 60 days at minimum. I really hope that health systems and payers can come together and find solutions with AI in coding, billing, and that whole arena. That would be huge for everyone. So while it may not be a crystal ball prediction with a definitive endpoint, that’s Andrew’s hope for what will happen.

Ritu: That’s a tough one because it involves so many players and everything is so fragmented. To build something that can communicate across all of them — that’s the barrier we’ve been hearing about from everyone. Everything is so siloed. Unless there are protocols that allow components to talk to each other — maybe with agents from each side communicating and speeding up the process — maybe that’s the future.

Andrew: That would be incredible.

Ritu: Maybe that is the future. It’s been a great conversation. Thank you so much for joining us on the Big Unlock Podcast. It’s been a pleasure having you as our guest. Thank you so much, Andrew.

Andrew: Thank you. It’s been an honor.

Ritu: Hi everyone. A very warm welcome to all our listeners to the Big Unlock Podcast, Season Seven. Today we are very happy to have with us Dr. Bharat Sutariya, who leads Oracle Health’s clinical AI strategy. My name is Ritu, and I am the managing partner at Damo Consulting and co-host of the Big Unlock Podcast along with Rohit. Today Rohit is not here, so I’ll be in conversation with Dr. Sutariya. Dr. Sutariya is a senior healthcare leader at Oracle Health, shaping the next generation of digital platforms and how data and AI are transforming care delivery at scale. At Oracle Health, Dr. Sutariya is focused on enabling a more connected, intelligent healthcare ecosystem, and his work sits at the intersection of platform modernization, interoperability, and the emerging role of AI in re-imagining healthcare delivery. With that, I’ll hand it over to Dr. Sutariya. Welcome to the podcast. Thank you for being our guest today.

Bharat: It’s a pleasure, and thank you for the warm welcome. I look forward to our conversation.

Ritu: Thank you so much. If you’d like to add anything beyond the introduction, we’d love to hear.

Bharat: Sure. I’ve been fortunate to be at the intersection of healthcare and technology for over 25 years. I’m an emergency physician by training and practiced for 26 years — initially in Detroit, where I trained at the Detroit Medical Center and led much of the digital transformation there. Then I moved to Cerner for 17 years, did a short stint with Deloitte, and joined Seema’s executive leadership team at Oracle Health a couple of years ago. I’ve had the opportunity to witness healthcare’s journey from paper-based practice, through read-only systems, to heavy EHR documentation, and now — what I would say is the most exciting era — where we are on the verge of delivering the vision we’ve always had: allowing clinicians to practice better, patients to generate better outcomes, and the healthcare ecosystem to reach a more sustainable path. I am more bullish and excited than ever.

Ritu: Thank you, Dr. Sutariya. We always love to start with an origin story, and doctors’ origin stories are really fascinating. We always ask: what led you to tech? Being a doctor is such a full-time job — how do you manage to combine your interest in technology and medicine? Tell us a little more about that.

Bharat: What led me to tech is a relentless focus and impatience to improve healthcare — all the way back to residency, when I simply would not tolerate the green-screen CRT machines delivering lab reports, the printers not working, things just not functioning. I’ve always had very little patience for things that don’t work, and I believe patients and providers deserve better. I’ve always looked at technology as the most scalable answer to that problem. That’s what got me into technology from the early days of residency, then leading tech transformation at Detroit Medical Center, and onward from there.

Ritu: Tell us a little more about your time at Cerner, because you had a front-row seat to both the promises and limitations of large-scale EHR systems. They were supposed to make things better, but interoperability — which was always promised — was never fully there. What lessons do you bring to Oracle Health, and how do you think you can improve on that?

Bharat: I had the pleasure of working with Neal Patterson, Cerner’s founder, for nearly 15 of my 17 years there. He always stated that healthcare is too important to stay the same — meaning it needed to evolve, and faster. That was always the focus at Cerner. Cerner started as a lab company, grew into an inpatient EHR, and then into an enterprise EHR over the years. What most people don’t appreciate is this: if we had taken the way people practiced on paper 20 to 25 years ago and simply made it electronic, EHRs would actually be quite efficient. But what we don’t often talk about is 20 to 25 years of regulatory compliance, new evidence in medicine, and the overburdening of data — all of these movements stacked on top of EHRs, combined with EHRs becoming increasingly administrative. That is what led to the burden people talk about. It’s not the EHR alone. Take E&M coding, for example — it’s quite burdensome, and many times clinicians perceive that burden as coming from the EHR, when in reality it’s the E&M coding system, the medico-legal documentation requirements, or some other external task. All of it gets compounded into an EHR issue. That’s why I’m excited about the future, because I think we have much better answers going forward.

Ritu: Thank you for that insightful answer. Oracle Health is now representing a shift toward a more unified, platform-centric model. What fundamentally changes when healthcare moves from fragmented systems to a single data and workflow layer? And what do you think will get harder before it gets easier?

Bharat: There has been quite rapid adoption of AI and modern technology over the last couple of years in particular, and we made a different bet than most of the industry. The industry largely took a bolt-on approach — keep the legacy foundational EHR and bolt AI on top of it. That’s the industry norm. At Oracle, we took a different approach: AI is too important and transformative a tool to treat that way. In addition, we had the opportunity — because of Oracle’s full stack — to leverage everything from the foundational database and Oracle Cloud OCI infrastructure, through the AI layer, to the modern application layer. So we decided to reconstruct not just the EHR, but the entire healthcare tech ecosystem across provider, payer, and life sciences, to achieve a connected ecosystem vision. For us, AI is embedded into the EHR — or you could say the EHR is embedded inside the AI. There is no bolt-on. While that requires significant resources to build what the market has had for three or four decades of legacy EHR, we’re taking the bigger bet to transform the whole thing. That does require investment, but it gives us a significant advantage to innovate without legacy constraints. The industry’s bolt-on approach is having early success, as is ours, because we are still scratching the surface of what AI can bring to medicine. Where you will see differentiation going forward: we’ve already deployed AI agents on top of our legacy Millennium EHR, but we’ve just released a brand new Oracle Health ambulatory primary care EHR that is AI-embedded, cloud-first, and truly native. It looks and behaves radically different — with far fewer menus and clicks, because AI is always present as your companion with a human in the loop. The biggest movement for us is transitioning from a system of record — which is what most EHRs have been — to a true system of orchestration and workflow. That is the transformation we are leading toward.

Ritu: I totally agree. The bolt-on approach can only lead to incremental change. If you’re looking for transformational change, you have to build with AI first in mind. That’s something we’ve talked about in our voice agent webinars — companies expect more from AI but don’t see that transformation because they’re using it as a bolt-on solution, which only delivers that incremental 10 to 20% productivity gain. AI can let you do things fundamentally differently. So what are your thoughts on invisible AI versus clinician-facing tools? We’re hearing a lot about ambient and how doctors feel free to just talk directly to the patient without the documentation burden in between. Where is the real value creation happening today?

Bharat: The biggest near-term value is in reducing what I would call high-volume friction — the tasks that typically cause clinician burnout: documentation, chart review, ordering, and all the follow-up tasks. What we’ve now demonstrated with Oracle Health’s clinical AI agents, each built for these specific purposes, is that when you deploy them with access to the full chart context, you do significantly reduce that burden. We’ve seen it in time saved, clinician satisfaction, a reduction in pajama time, and even better patient interactions — because clinicians now have more face-to-face time rather than hiding behind a keyboard. And for us, outcomes aren’t only about process measures like time saved. We’re also tracking truly clinical and financial outcomes: did patient care improve? Was the provider able to see more patients efficiently? Was the patient happier with the interaction? Those things that really matter are where we’re now transitioning. Even in these early days, focusing on high-volume friction, AI has already been tremendously helpful.

Ritu: Would you say ambient has been one of the most successful use cases of AI so far? And where do you see it going further?

Bharat: Absolutely. Ambient as an assistive technology in healthcare delivery is probably the single best technology I’ve seen in my 25-plus-year career in terms of rapid adoption — and not just rapid adoption by one or two physician groups, but across the board. Every physician group you give access to embraces it, and they use it with a high degree of sustained adoption. That’s because it adds real value. It captures documentation fairly accurately and keeps the human in the loop — the draft is presented to the clinician, who validates it before committing it to the chart. But while many startups in the industry consider that the endpoint, at Oracle Health we view it as the beginning and the foundation. For example, our ambient agent, while creating the note draft and listening to the conversation between provider and patient, is constantly monitoring that conversation. Did the physician say something about orders? “Mrs. Jones, I’m going to order X, Y, Z lab tests for you. I’m going to renew your prescription.” The agent extracts the clinician’s intent and queues up orders, prescription refills, and follow-up tasks — including referrals and prior authorizations. If Mrs. Jones needs a knee replacement, the agent understands in that moment who the payer is, whether prior authorization is required based on eligibility and coverage criteria, and if so, it retrieves the authorization criteria, pulls all the relevant information from the chart, fills it automatically, and presents it to the clinician for review. If more work is needed, it goes to the queue. The ambient conversation is directly connected to the automation of a significant downstream task, done more accurately. That’s our journey — millions of agents spinning off in the background based on that ambient conversation, continuing the care journey forward.

Ritu: So you’re saying it’s going to move beyond just being a note-taker to actually taking the next step — listening and acting on what’s discussed?

Bharat: It’s already there. It’s already happening.

Ritu: Most health system CIOs and CMIOs we speak with are now genuinely overwhelmed by the pace of innovation — something new seems to emerge every single day. How should they think about sequencing platform modernization, AI adoption, and operational transformation without creating decision fatigue within their organizations?

Bharat: Let me offer a few key points. First, start with the end in mind. Be clear about the outcomes you’re trying to achieve, and recruit the right solution for that. Second, don’t look at AI as a collection of a hundred individual vendors. Look for a partner who can help you establish a platform and services framework capable of solving hundreds of problems over many years. Those are the two axes I think are most important. What I see in the marketplace — even within our customer base and beyond — is that tens, sometimes hundreds, of startups and AI companies are approaching health system leadership from every direction with different point solutions. Each of them genuinely has something to offer and can solve a specific problem. But the challenge is: how do you bolt ten or twenty different AI startups into your ecosystem? Every model requires data, which means you’re extracting and sending data to various external environments and then managing the cybersecurity, data privacy, and compliance implications of each one. AI has already proven itself enough that every health system should accept it is part of their journey. So you might as well embrace it and start forming a trusted partner framework — identifying which partner or set of partners can help you establish an AI infrastructure within your organization, connected to both your clinical and enterprise systems, to achieve clinical, operational, and financial improvement. Think from a partnership perspective. Then think with purpose — what are the highest-impact starting points? What has already been proven in the marketplace? Adopt that, but don’t wait for the next wave to perfectly emerge. Some degree of experimentation and piloting is important in this space, and in AI the pilot cycle is measured in days and weeks, not months or years, because that’s how efficiently you can deploy an AI agent and get to outcomes.

Ritu: Do you see a tension there? In most industries, the mantra is innovate fast and fail fast. But in healthcare it’s almost the opposite — you have to play it safe and not take chances. How do you reconcile those two?

Bharat: You raise an important point. In virtually any other industry, a parts-per-million error rate might be acceptable. In healthcare, it is not. So you absolutely must have guardrails — and that’s exactly why you need a trusted partner and platform with appropriate governance built in. While you may be doing early adoption of innovation, you need the right guardrails, the right governance, and the right metrics to ensure absolute patient safety. You also need to be able to test high-risk scenarios in a non-production environment. But here’s the opportunity: there is so much improvement to be made on the operational side of healthcare that you can safely deploy AI to solve a significant number of operational problems and gain efficiency before you move toward higher-stakes clinical applications. That gives everyone a meaningful runway to get started in a big way.

Ritu: Where we’re seeing most implementations right now is in the digital front door — before the patient even reaches the clinical setting. But do you think the guardrails and safety factors you described will keep humans in the loop longer? AI is progressing so rapidly — we’re already hearing about AGI, and we saw with Project Strawberry that some organizations are pausing releases to give the industry time to assess vulnerabilities. Do you think the human-in-the-loop model can hold, or will AI leapfrog that?

Bharat: That’s where careful governance and guardrails are essential, because no one can afford to simply wait. The question is how do you keep moving forward while doing so safely. I think establishing clear frameworks helps — for example, if something is purely administrative and doesn’t directly impact patient care or patient safety, it could potentially be automated. That’s the invisible AI piece. You just need the right metrics to confirm it’s achieving the intended outcome. You can do that very safely on the operational end. But the moment you inch toward anything that assists — not even makes — clinical decisions, then transparency becomes paramount. The AI must show why it’s drawing a particular conclusion, and it should be assistive and presenting facts with full transparency to the clinician rather than acting autonomously. For example, in our new EHR, every time a physician logs in, an AI-driven summary is immediately generated — one that knows the patient, knows the reason for the visit, knows the physician, and has access to the entire longitudinal record. It constructs a concise summary a clinician can consume in one to two minutes, versus clicking through fifteen tabs over ten minutes on a complex patient. But critically, we’ve embedded metadata tags throughout that summary. Anywhere there is critical information, the clinician can hover over it and see exactly where it came from — and with one click, the source document loads with the relevant text highlighted. That’s AI driving clinical efficiency in a way that’s also transparent and safe. We’re fortunate to have the full Oracle Health AI infrastructure stack combined with three to four decades of clinical system development experience. We understand the clinical significance of every data element and its metadata. A lab value isn’t just a lab value — we understand what abnormal, high, and low mean, the standard deviations, and the source context, because we’ve been living with that data on the Cerner side for decades. Combined with Oracle’s capabilities, that puts us in a stronger position to deploy AI safely.

Ritu: You made very good points — retrieval-augmented generation with traceability back to the source, and the importance of context because you have so much surrounding information to interpret each value accurately. That was a very insightful answer. Time has flown by and we’re almost at the end of the podcast. What are your predictions for the next year? If we had this conversation again in a year, what would we be talking about?

Bharat: I think we’ll be talking about the next chapter — moving away from documentation and truly into orchestration. That’s the big shift. And AI shouldn’t be creating work; AI needs to do the work. I think we’ll see more successful examples of that. At the end of the day, all of this only matters if our clinicians and patients feel they’ve gotten time back, are doing fewer repetitive tasks, and feel there’s a safer path toward better healthcare. That’s the north star. Health systems should feel they can operate a better care delivery model. Providers should feel they’re delivering safer, better care while remaining personally satisfied — not overburdened. And patients should feel that the health system they’re visiting, powered by AI, is delivering a genuinely better experience. That’s the north star we’re working toward.

Ritu: Thank you so much, Dr. Sutariya. It’s been an absolute pleasure having you on the podcast. Thank you for making the time to speak with us today.

Bharat: It’s my pleasure. Thank you for a great conversation.

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

Ritu: Hi everyone. A very warm welcome to all our listeners to Season Seven of the Big Unlock Podcast. My name is Ritu, and I’m your co-host along with Rohit, who is missing from the podcast today. We are very happy to have with us Linda Stevenson. She’s the Chief Information Officer at Fisher Titus Health, where she leads enterprise technology strategy for a community-based health system. She has over 30 years in healthcare IT, and has worked across organizations like Cleveland Clinic, Cerner, and regional hospitals. Her work has focused on integrating core systems, particularly EHR and telehealth. She’s especially passionate about advancing innovation in rural and community health systems where resources are constrained but impact is critical. We are really looking forward to our conversation today. Welcome once again, Linda, to the podcast. Thank you for being here.

Linda: Thanks for having me.

Ritu: I gave an introduction, but feel free to add anything you’d like or if you feel I missed anything.

Linda: I’ll give you a little background on me and my organization. Fisher Titus Health is a rural healthcare organization in northwest Ohio, in a town called Norwalk. We’re a 100-bed hospital facility — not a large hospital, but we offer a lot across the full span of a patient’s life, all the way from birth to end-of-life care, including nursing home care, skilled nursing, and home health. We also have a large physician practice group, so we really do span a wide range of care delivery areas. I talk about doing more with less — that’s what happens in rural healthcare. We are technically a rural healthcare organization, and our job is to figure out how to do things for less money but still achieve the same outcomes and access the same technologies as larger organizations. I love being in rural healthcare because I get to work on very challenging and creative solutions. And as of the beginning of March, I am now also the COO of the organization, handling not only the technology group and cybersecurity, but also all of our ancillary services, facilities, and environmental services.

Ritu: Wow. Congratulations — that’s great to know. As I was reviewing your profile, I realized you have somewhat of an unconventional background for someone in this position. We would love to hear your origin story — what brought you into healthcare and how you got to where you are today. I remember when we spoke, one thing really hit me: you said you have to reach out and ask for things, you can’t just sit back and wait for people to tell you what to do. You have to be confident in your own abilities. Tell us a little bit more about that.

Linda: I started in healthcare as a biller, typing bills on a typewriter back in the day, before all the automation we have now. I found that my passion was asking questions — I was always asking why in that department. The technology team noticed that and said that’s the making of a good analyst, and brought me into technology for the first time very early in my career. I had no computer background from an education standpoint — my degree was in business management. I used to joke it was a useless degree, but I found it certainly helped me later in my career as I moved into project management and building stakeholder relationships across the organization. From those early analyst days, I moved into project management, data security, and then progressively larger EMR implementations. I worked on the Epic implementation when it initially rolled out at Cleveland Clinic, and then had the privilege of working for Cerner — Cerner at the time, not Oracle Health — for three and a half years, really learning what the vendor side looks like through their IT Works division. And here I am as CIO years later. I always tell people: if you’re not sure, say yes. Every single opportunity I said yes to, even when I was afraid or thought it might not be my job — every single time, it opened another door and taught me something new that got me to where I am today.

Ritu: That reminds me of something I read — just jump into the pool and figure the rest out as you go.

Linda: That’s exactly how the COO role came about. The gentleman in that role was retiring, and I just went to my boss, the CEO, and said: put my hat in the ring. I have no idea what I’m doing, but I’ll figure it out.

Ritu: Awesome. So Linda, you’ve seen the full stack of hospital operations — from billing all the way to IT leadership. How has that shaped your view of what a CIO should prioritize today? Should it be innovation? Cost control? Operational reliability? Tell us about your priorities and how you balance these competing demands.

Linda: The easy answer is: yes, it’s all of that. I don’t think we can choose one thing, and I think that’s both the challenge and the beauty of what we get to do. At the bottom line, it’s about partnership — partnering with all the other leaders, whether nursing, finance, or operations, to understand the challenges they face. In some areas the challenge might be optimization or productivity improvement. For example, our therapy departments are struggling to recruit right now. They simply cannot find therapists. So how do we use technology to allow the therapists we do have to work faster while still delivering the same quality, so they can see more patients? It’s not about wanting to reduce headcount — we can’t even find people to hire. In other areas, the question is how to cut costs, through things like application rationalization: really honing in on using the solutions we already have better and getting the most out of our investments. And then there’s automation — some of it is simply about making lives better, whether that means giving patients better access to care or giving providers tools to reduce stress and burnout in their day. It really is all of it, and you just have to understand your audience.

Ritu: You’ve talked about bringing Fisher Titus back to Most Wired status. How do you ensure that’s based on measurable clinical or operational outcomes rather than chasing shiny objects? At VIVE, we heard everyone going after AI just to make it look good.

Linda: I’m a very practical person. About two years ago when everyone was still asking “what’s your AI strategy,” I’ve been around this industry long enough to know that AI is just another tool. We’ve had lots of tools — cloud was a buzzword for a while, EMR was a big thing. Lots of things come and go. Yes, this one might be a bit more impactful than some we’ve seen in the past, but the way I look at it: I don’t have an AI strategy. I have a strategy. The organization has a strategy, and we have a technology strategy to support it. That strategy may or may not involve AI — it depends on the need. I look at it from a practicality standpoint, going back to what we just discussed: partnering with leaders in each area to ask, what problem are you trying to solve? Then we look at whether there’s an AI solution, and whether it brings productivity improvements, cost savings, time savings, patient satisfaction improvements, or quality care improvements. All of those are measurable. That’s the conversation we have: here’s what we’re trying to solve, here are some options, and here’s what we think we can achieve.

Ritu: What we’ve heard from other C-suite leaders is that this has to be cross-functional — you have to build buy-in and partnership across the organization. Are you finding the same at Fisher Titus? And how are you tackling AI literacy, given that every couple of days there’s a new release and it’s hard for anyone to keep up? You said you’re not chasing shiny objects but focusing on strategy — yet you still have to know what’s out there. How does anyone keep up with this pace of innovation?

Linda: You try, right? There are a couple of factors. On one hand, our leaders need AI education to help them understand the basic things they can already be doing to make their lives easier — whether it’s ChatGPT, transcription tools, or other things that can lighten their administrative load. They often don’t grasp those as readily as they understand a vendor coming in and saying “I can solve all your problems with this new scribe solution.” So there’s a parallel track: here’s how you can help yourselves, and here are some broader things we can bring to the organization. At the same time, we have to temper the vendor conversations. Every vendor comes in with shiny objects, and I have to help them understand our strategy. We’ll look at what they offer, but it may or may not fit into the direction we’ve chosen, because we want integration across the whole — we don’t want 30 different scribe solutions or 20 different quality solutions. Vendors are generally receptive to that once you explain the why. You have to spend time on the why — educating them on how powerful these tools can be when done well, versus just buying something random.

Ritu: I think buy-in is the key. Once you have that trust, things move forward. Without it, it gets really difficult.

Linda: And isn’t that the key — trust? They need to trust us and we need to trust them. That’s something we’ve been building for years. It’s not a new thing.

Ritu: You’ve worked both inside health systems and with vendors like Cerner, so this question feels very pertinent. Where do you think the industry still overestimates interoperability, and where are we still fundamentally constrained by vendor ecosystems? Most of these ecosystems remain fairly closed, and now everyone is asking how AI is going to suddenly change that. We heard the recent announcement from Epic about building AI agents into their workspace. What are your thoughts?

Linda: All the EMR vendors are building AI agents — they all have it at various stages of development. The ERP vendors are doing the same. Interoperability has been a conversation since about 2008 when Meaningful Use first started coming out. It’s frustrating because Fisher Titus has engaged with every opportunity to be interoperable where possible. We’re connected to CommonWell, to everything through the HIE — all of it. But that doesn’t mean the information flowing through is in a form that clinicians can actually use. That’s where we still struggle. As a rural healthcare organization it’s especially challenging, because unlike a large integrated system like Cleveland Clinic or Mayo Clinic that has all specialties and services within their own walls, we don’t. We refer a lot, so interoperability is critical for continuity of care. But not all information flows through traditional interoperability channels. A great example: maternity records. A delivery record or a nine-month care plan for a patient is not coming through on a CCDA. We still fax paper records back and forth to outside OB physicians. Interoperability still has a long way to go.

Ritu: That’s what we’ve been hearing from everyone. Even with telehealth — we expected it to drive deeper EHR integration, but we’ve still seen patchwork systems and ongoing problems with embedding telehealth into core clinical workflows. What has your experience been?

Linda: It’s very patchworked. We try to connect wherever possible. I’m actually on the board of directors for Ohio’s state HIE, and I’m very proud of the work Ohio has done — building a really robust HIE that goes well beyond just sending CCDAs, including data exchanges for population health initiatives and supporting state Medicaid. The more you can get involved at the state level, the more you can help shape the bigger picture. Working with fellow CIOs and leaders to ask what we can all do better — that’s where the real conversation needs to happen. And then taking that up to the federal level, so we can ask for exactly what we need rather than having proposals come from people who have never actually worked in healthcare.

Ritu: We’ve been hearing from other health systems and CIOs that they’re driving innovation through internal innovation arms or venture studios. Does Fisher Titus do any of that?

Linda: No. At a rural hospital you generally don’t see that. My entire IT team is 35 people — covering help desk, technology, clinical analysts, informatics, trainers, cybersecurity, everything. That’s our scope. We’re not doing a lot of in-house development. We work through vendor partnerships, and I strongly believe in developing strong relationships with those vendor partners to drive innovation.

Ritu: Linda, we saw that you recently submitted a brief for the Senate Health Committee. Tell us more about that — we would love to hear about your role.

Linda: What a wonderful experience that was. Last summer I had the privilege of going to the Senate Health Committee to talk about rural healthcare, cybersecurity, and the risks facing all of us. Every healthcare organization is exposed to this ongoing onslaught of cyberattacks. But rural healthcare has such small budgets and limited resources that it’s really hard to keep up and protect ourselves — and all organizations are connected through us in one way or another. We’re a link in a chain, and if we’re weak, the entire healthcare chain is weak. I was really trying to highlight that challenge: the difficulty of recruiting cyber professionals, the cost of managing third-party vendor risk. It was a great opportunity to speak up, and actually I’m going back to Washington this week to speak with the Healthcare Sector Cyber Working Group at an all-hands meeting. I’ll be on a panel there talking about these ongoing challenges.

Ritu: That’s great — really important work. I read the briefing you submitted and thought it was very well written. You made some really strong points. I’ve been watching a show called The Capture, and it’s shown how easy it is to use deepfakes to get into systems. Just like you said — once they find the weakest link, that’s all they need. The entire chain has to be strong.

Linda: One of the things I focus on so much is connection and networking, because who in this day and age can do it alone anymore? There’s just too much. Connecting with people like you, with my peer groups, and with CHIME — who also supported me through that Senate Health Committee process — those relationships are invaluable. Vendor relationships too. As leaders we have to stick together to raise the tide for all.

Ritu: Exactly. Time always goes by fast and we are almost at the end. Any forward-looking final thoughts you’d like to share? Where do you think this is all headed, and where do you think we’ll be a year from now?

Linda: I think it goes faster than we think it will, and it’s really hard to keep up. A year from now the conversation will look very different — we’re already starting to see the shift in what AI can actually deliver and what it will actually cost. My final piece of advice: take a deep breath. Think it through. Don’t rush into a million shiny objects. Stick to your strategy and focus on where technology will genuinely benefit you. And don’t forget to take care of yourselves — when we work at this pace, it’s really important to stop, regroup, and refocus on your own health.

Ritu: Thank you, Linda. It’s been a pleasure having you on the show. Thank you so much.

Linda: Thank you. Great to see you.

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