How the CIO role in healthcare has evolved at Northwell Health

John Bosco leads strategic technology initiatives as CIO at Northwell Health, York's largest healthcare provider. And he's seen the CIO role in healthcare change over the last decade.

As healthcare CIO for such a large health system, Bosco faces challenges such as balancing innovation while keeping up with federally mandated IT requirements, finding skilled health IT staff and maintaining good cybersecurity practices. Yet Bosco said he also sees new opportunities for healthcare transformation with emerging technologies backed by tools such as artificial intelligence and machine learning algorithms.

In this Q&A, Bosco describes how the CIO role in healthcare has changed since he took over the position at Northwell Health in 2009. He also shares how he separates hype from reality when it comes to products, and what issues keep him up at night.

How do you think the CIO role in healthcare has changed over time?

John Bosco: I think it's more strategic in that there are a lot of opportunities for IT and for technology to enable and support healthcare transformation, and I think it's the role of the CIO to really bring those to the C-suite and help to educate them and help to promote where we believe technology can change the way that we do things for the betterment of patients, physicians and the rest of our health system. It's being more focused on the big picture issues, understanding where's the organization going and how can IT help to enable those goals and objectives.

The other thing that has changed significantly over the last decade is that employees and the business leaders that I work with on a day-in and day-out basis are much more knowledgeable about technology than they used to be. It used to be the CIO was the only one walking around an organization who really understood technology and had to be the only one that was suggesting ways it could be used. Our physicians, administrators, department heads … are much more knowledgeable in general about technology and how they can take advantage of it.

John Bosco

What challenges does the CIO role in healthcare face today?

Bosco: It's a challenge to be able to stay on top of everything … payment models and care models are changing around the country, so it's important to understand what's changing and how does it impact us and how can we help to lead the way. Then the third sort of leg of that stool is innovation and the fact that there are devices and apps, innovations and medical technologies that are being literally every day. Understanding what innovations are available today and what's coming down the road is really an important part of the role.

What technologies are you paying attention to right now at Northwell Health?

Bosco: It's a lot about how these innovative technologies are going to take hold as time goes along and how they're going to change the model of how we deliver healthcare. One example might be bed throughput in our hospitals. Our hospitals are very busy, so how quickly we can get patients through them is very important to us so they're not sitting in the ER longer than they need to be. There have been bed management programs on the market for a lot of years. Many hospitals use them, big and small. And they operationally help you to move patients through your hospital faster. If we could take technologies that are artificial intelligence-based with machine learning algorithms behind them and we can start to predict, in addition to the actual management of the beds, how likely is it they're going to get admitted, how likely is it they're going to go to the ICU, how likely is it that a patient is going to be discharged over the next few days. If we can start to take something like that, where the technologies we've had all along to help get patients through the hospital faster, and instead move it to a more predictive model and scenario where we can predict how quickly patients are going to go through their hospital stay, then we can drastically improve bed throughput even more.

How do you separate hype from reality when it comes to these technologies?

Bosco: It's not an easy task. You have to do it at two levels. You have to feel good about the company and people that are creating something … and understand a little bit about the technologies that they're using. But then, even if you say 'this is a great startup company, they've got some really cool technology they're bringing to the table,' then you've got to go through the whole process of understanding, once you deploy it even in a pilot fashion, that it really works and that it really addresses whatever problem you are looking to solve.

Payment models and care models are changing around the country, so it's important to understand what's changing.

What is your process for selecting a product?

Bosco: We're looking at something right now where we've got a very small startup company that wants to work with us to accomplish something, but then we've got a couple of big companies that are also doing the same thing. You've got to have a process to vet these and … are we selecting the startup where we're going to have a lot of say in what they develop … or do we want to go with a big one that has deep pockets and a lot of expertise, but we're going to have less influence on the product direction. There are a lot of the classic buy-builds, but then there's a lot of the paradigm of do we innovate, versus are we just buying a product that somebody's bringing to the table. There isn't a cookie-cutter way to do it.

What issues keep you up at night?

Bosco: If you asked all healthcare CIOs what keeps them up at night, certainly they would say cybersecurity is somewhere in the top three, if it's not No. 1. That keeps us all up at night. We know the bad guys are always a step ahead of us and we know that the impact of some kind of a breach can be very significant in terms of cost and reputation. So, we worry about that tremendously.

We also worry about being able to find the talent that can keep up with everything we've been talking about, change, growth and innovation, all things that make for a very fast moving, semi-chaotic environment where people are working really hard and long hours and days. There's a shortage of health IT people across the country as it is, so we've got to put a lot of time and effort into how we convince them that if they want to work in healthcare IT, this is the place they want to work.

*Editor's note: Responses have been edited for clarity and brevity.