Technovation Podcast: HCA Healthcare’s CIO balances AI innovation with operational stability at scale

HCA Healthcare senior vice president and chief information officer (CIO) Chad Wasserman recently was interviewed by Peter High for an episode of the “Technovation” podcast, which features conversations with top executives and thought leaders at the intersection of business, technology and innovation.

As CIO of one of the nation’s leading healthcare providers, Chad leads HCA Healthcare’s 8,000-plus Information Technology Group (ITG), embedded in clinical care delivery across 191 hospitals and 2,500 ambulatory sites of care. He oversees global IT strategy and a broad portfolio including infrastructure, cloud, automation, enterprise systems and more. His team plays a vital role in supporting care delivery, improving operations and advancing digitally enabled innovation across the enterprise.

In this episode, Chad speaks about leading a technology agenda at scale while keeping patient care at the center. He shares why “operational quiet” is the foundation that makes artificial intelligence (AI), data and digital transformation possible, and how workforce development for his team combines technical training with immersive hospital experiences to help technologists remain connected to patients.

Read on for summary highlights from the discussion, and tune in to the podcast for the full conversation.

Listen to the full “Technovation” episode:  How HCA Healthcare’s CIO Balances AI Innovation with Operational Stability at Massive Scale

Key takeaways:

• Technology as part of the care team — IT is embedded in patient delivery, not separate from it.
• Meditech Expanse — New cloud-based EMR brings standardization and data to leverage AI.
• Ambient AI reduces clinician burden — Real-time transcription into EMR improves clinician time and patient experience.
• Operational excellence enables innovation — Operational quiet and self-healing infrastructure are prerequisites for scaling AI.
• Data as product — Productized, governed data is foundational for scalable AI and automation.
• Human-centered workforce development — Hospital immersion programs build empathy and stronger solution design.

Q: Chad, would you provide a bit of context on the business of HCA Healthcare?

A: Our organization was started in 1969 by two physicians, a father and son, Drs. Tommy Frist Sr. and Tommy Frist, Jr. At the core they were innovators with a vision for combining medicine, compassion and hospital operations at the highest level. Those tenants still guide us today.

Over the last 54 years we’ve grown to more than 310,000 colleagues and 100,000 nurses. Our 191 hospitals are surrounded by ambulatory surgery centers, urgent care centers and physician practices. In total, we serve well north of 2,500 ambulatory sites of care.

From a technology footprint perspective, that provides a lot of fun challenges for us, but also a tremendous sense of pride that we support 44 million annual patient encounters a year — and not always at the best time in their lives. We take great pride in the significant responsibility of treating our patients to the highest level of quality possible.

Q: Give an overview of your role as Chief Information Officer. What’s in your purview?

A: We cover traditional IT including software engineering, enterprise architecture, service management and operations, and we work to maintain “operational quiet” (more on that later). We are an 8,000-person tech organization, and we view technologists as part of the care team; not at the bedside but close to it.

Network engineers, security architects, access managers — they all enable delivery of care through some aspect of technology. We’re the hub of the wheel for  technology delivery to HCA Healthcare’s clinical, administrative and operational processes. Above all, our responsibility is to patients and the mission — we constantly emphasize this and take that responsibility very seriously.

Q: As an enabler of care, how is your team organized so it reflects and embeds into the business?

A: With such a large footprint, we have important considerations around what we centralize versus localize. We have a significant IT presence where our hospitals are located, and those local colleagues take great pride in what we do. At the local level, we encourage regular rounding to clinical areas such as nurse stations to build relationships and provide fast support for any number of technology needs.

We’ve centralized resources where we need to drive significant standardization, such as network, cloud and cybersecurity, so we can maintain these systems at a higher level. That centralization provides enterprise capability and helps ensure those standards are adhered to in a fairly intensive way.

Q: Reflect on how the company has changed since you joined 30 years ago.

A: I joined in 1996 when we were implementing our EMR (electronic medical record) system — the “brains” of the hospital. I spent the first five years traveling weekly to facilities around the country and learned so much about day-to-day operations and the humanity of hospital work. I saw firsthand the important role that technology plays in our facilities.

A lot has changed since then: macroeconomic shifts, policy, industry, technology. But our focus on delivering the highest level of patient care remains constant. That’s what we center our technologists on day in and day out. Again, they are part of the care team.

My top three learnings reflecting upon those 30 years:

1. Listen to those closest to the work. I find it so valuable to visit our divisions and hospitals and learn from the work we do every day.
2. HCA Healthcare is an organization of execution discipline, and leaders at the highest level can go deep on technology.
3. Relationships matter, so don’t make your first conversation with a stakeholder about a challenge we’re trying to solve in our ecosystem.

Q: How do you harness data to drive better patient outcomes and operational excellence?

A: Running such a large business with more than 300,000 colleagues, we have well north of a million devices. Every one of them produces data, and that data is a strategic asset. We have harnessed the data exhaust from all the variables of our business to create an operationally excellent environment. At every step of the way, we look to lever data to make it actionable and ultimately land an improvement either from a clinical, operational or administrative perspective.

We’ve elevated data into Google Cloud (GCP) and are building a data-product strategy with our Chief Data Officer and Chief Transformation Officer. Data-as-product is required to unlock the value of AI, automation and analytics. For an organization of this size it’s not a simple endeavor, but we have one of the largest healthcare datasets to optimize care for millions of patients a year, so it’s a responsibility.

Q: Tell me about the collaboration between tech and the business, and the fruits of that collaboration.

A: About a year ago we created the Digital Transformation and Innovation department (DT&I), led by Dr. Mike Schlosser, our Chief Transformation Officer and a neurosurgeon, with a small tech committee including our CEO and CFO. DT&I is a product organization that evaluates and implements ideas against our strategic imperatives, particularly for AI and digital transformation.

ITG executes the engineering work in close partnership with DT&I. We maintain a balanced portfolio across clinical, administrative and operational domains and have begun to see momentum in data, AI/generative AI and analytics. This work is going to elevate the operations of HCA Healthcare.

Q: How is AI being used and what excites you most?

A: Two immediate examples: ambient clinical documentation and AI for software engineering. For ambient technology, physicians’ conversations with patients are captured, processed and transcribed into EMR notes — with the clinician as human-in-the-loop to check the note. This reduces administrative time, allowing clinicians more time with patients.

For software engineering, we’re piloting generative AI tools and seeing meaningful gains and opportunities for our engineers, our business and our patients. We’re very excited about it, not only in terms of efficiency for our colleagues and velocity of getting our work to market faster, but also elevating quality and the security aspects of software engineering. And, of course, we’re leveraging these tools responsibly within our quality and cybersecurity frameworks.

Related article: (Forbes) HCA Healthcare, One Of The Largest Healthcare Organizations In The World, Is Deploying Generative AI

Q: How do you approach workforce development and upskilling for such a large team?

A: As you might imagine we run heavy technology training, including multi-day vendor and partner training events. But one standout training opportunity is our Healthcare Connection program — a week-long hospital immersion for 10–15 colleagues who shadow nurses, visit radiology, observe OR/robotic surgery and more, going through every corner of a hospital. They meet with leadership and colleagues afterward to share learnings, which builds empathy and helps technologists understand the impact they have on patients. More than 1,500 ITG colleagues have gone through it in 15 years, and they very quickly become connected to the culture of HCA Healthcare.

Q: Other trends you’re excited about?

A: Operational quiet is critical to innovation. We have a significant number of vendors and other partners bringing ideas to the table, and we emphasize mission alignment so they understand how focused we are on patient care. When my feet hit the floor in the morning, I am focused on making sure we are delivering care at the highest level. I want our partners to feel that same intensity as they onboard.

For this reason, I’m excited about AIOps — using AI to monitor infrastructure and create self-healing mechanisms so we avoid operational noise and remain ahead of incidents that could affect patient care. Given the critical nature of the work we do, I think that’s an incredibly important area.

We also have the largest technology project in the history of the company: Meditech Expanse, our new EMR system that runs on the cloud (GCP) and is replacing the EMR that I implemented when joining the company 30 years ago. Expanse brings standardization and data that will be a platform to make the most of AI and improve the clinician experience. So, Meditech Expanse is tremendously exciting to me.

Related article: How HCA measures success after 43-hospital EHR rollout

Listen to the full conversation and additional insight from Chad on the Technovation podcast.