Engineering the Future of Care: Modernization, AI, and the Resilient Systems Shaping Healthcare Technology

Speaker A: Foreign.

Speaker B: Welcome to the Leader to Leader podcast, a Chime foundation series where explore the forces shaping healthcare's future. From breakthrough innovation to the realities of leading through complexity. I'm Russ Brandsell, uh, your host and the president and CEO of chime. Joining me today is Anupama Ambi, Senior Vice President and Managing Director for Healthcare at Kyndryl. Anupama brings more than 25 years of IT leadership experience to this conversation, guiding some of the most complex modernization and transformation initiatives in healthcare. At UH Kendall, she leads teams that deliver technology and managed services across hybrid cloud, AI security and resiliency, driving modernization that not only is sustainable, but strategic. Anupama also co leads Kendall's Global Customer Partner Guild, advancing professional development and collaboration across industries, and has long championed women in technology throughout her leadership. Anupama, what a great pleasure to have you on the program. Welcome.

Speaker A: Thank you, Russ. And thank you to the entire CHIME community here for the warm welcome. Healthcare has always been deeply personal to me and quite frankly, that's the reason I've dedicated my career to it. After more than 30 years in it, I remain as energized and optimistic as ever about the power of technology to transform patient lives and the caregivers who support them every single day. Um, I truly feel like we are standing on the cusp of a true revolution in healthcare and very excited about how we can fundamentally reshape how we deliver care to our patients and our caregivers. I do believe there's a tremendous promise of shifting how care is delivered, experienced and measured. I'm honored to be here with you, Russ, today. Thank you again.

Speaker B: So welcome. Um, I will tell you, I'm not sure I've ever felt as much complexity and both confusion and optimism, not just in health care, but in technology at a macro level. Um, I've just been enamored over lunchtimes, I've been watching CNBC and just this complexity conversation about AI and we went from we don't need data centers because of cloud, now we don't have enough data centers and now we're not going to have enough data centers. We're not going to have enough power to generate all this, um, technology with AI and it just, it's making my head explode. And you have been on the forefront of this for years in trying to help people navigate, whether that be multi cloud environments or even just this modernization concept of infrastructure and governance. I, uh, love to hear from your perspective of this. What is modernization mean right now? How are organizations even defining what it means when the future Looks really cool, but really unknown all at the same time.

Speaker A: Um, I really love that question. Um, it's something that we talk about constantly just in the last few years. One of the things that I love about the concept is it's not tied to a technology outcome anymore. While I have full respect for technology and the technologists that I work with on a daily basis, modernization to me in a healthcare context is how can we use technology to change the way that care gets delivered and that becomes the wireframe of how we do things. For a long time, modernization in healthcare, it meant digitizing paper. We've heard about how the electronic medical records have been modernized. That's something that we hear about constantly. We talk about how do you bring AI to a tech stack or an application workflow. But now what we're hearing from health care systems and leaders is how do I use every opportunity to modernize technology to improve how care gets delivered? How can I free up the clinicians time with administrative burden? How can I free them up to be able to bring the human touch back into care? Is something I hear about constantly. Let's talk about the latest hot topic. AI. Success today does not mean modernizing an application stack and declaring that I've used an algorithm or an LLM. Success today means has that AI, has that LLM embedded within a workflow. Help m me give 10 more minutes to a patient, have a conversation about what's really bothering the patient versus sitting in front of a computer typing into the, you know, um, the emr. So to me that is fundamentally very exciting because I think the wireframe is now about how do you bring the human touch back into health care and give that time back to the caregivers and how to help patients get to the specialist care they need much, much faster than what they do today.

Speaker B: Yeah, I love the way you finished that off much, much faster than we do today. That seems to be a theme as I to digital health leaders from, uh, really around the globe. The pace at which technology and its impact, as you put it into healthcare, is changing is so, I mean, rapid doesn't even do it justice. It's just what you thought today might be different tomorrow. That's how fast it's moving. We used to think in cycles really of years. Now it's matters of days. Sometimes even during the same day, something might fundamentally change. What are you seeing digital health leaders do to keep up with this modernization pace and maybe even drive the pace?

Speaker A: So, um, having worked across multiple industries, healthcare is different. We are dealing with the life Unlike dealing with a device. And so keeping that context in mind, I see that there is a central tension that every healthcare CIO is living right now, which is how do I balance doing and bringing the right modernization to the fold versus the security that is required to be able to do it in the right way? So, um, I think this is what every CIO is thinking about. And, um, I'm actually fascinated by this because it's the balance that they need to drive. And so one of the key things that I'm seeing is we don't treat stability and innovation as two different things or opposites to each other. I'm, um, definitely seeing leaders saying, how can I actually do it together? There will always be a track that is focused on protecting the environment, optimizing what we do, securing the environment. Um, but I'm also seeing another track where there is very clear focus on how do I use these technologies and move away from doing pilots to prioritizing the right use cases that can help drive the outcomes for care delivery practitioners or patient experience. Um, the other thing that I'm seeing is the leaders in healthcare are incredibly intentional about sequencing versus parallel tracking. They're not anymore about modernizing everything at once. It's very deliberate. There's a process of prioritizing in partnership with the business. I think that's the key word here. Um, I've always believed that the practitioners who are closest to the work know how we can actually improve the work. And so this partnership between it and the business has become really, really important. Um, and then there's the third piece, which is a fundamental shift that I feel strongly about is in the past, security was this thing which sat on the side. They were the community that policed it operations or, you know, the business. I am seeing that shift change, and they are working along with it and along with the business. It's not merely a compliance checkbox. And that is something that I've seen change, which is how do you drive these deployments in a very safe and secure manner? And the partnership equation has changed completely. So, Russ, these are three things that I'm seeing, uh, change very rapidly in how there's a balance between how do I roll out the programs, quicker, faster, better yet, balancing with security.

Speaker B: Yeah, uh, it is a very complex world we're living in. Uh, just recently, I got to go out to California to El Camino Health System, which is where the first EMR was developed. All the way back. It started in 1965. It is amazing that it's been 51 years to getting to this point. But what was interesting is one of the early developers was there and I think he's 92 years old now and he was talking about their number one concerns were about security and sustainability and resiliency of the system. And that even in 1960, 65 they had discussions about security and the system can't go down and, and we joked about it as a kind of a big group of people doing this commemorative event that really nothing has changed other than the actual technology. In 51 years, healthcare is still healthcare. The dimensions of cyber and operational resiliency is still just as strong as it was over 50 years ago. So from your vantage point, as you see these organizations really, uh, it is pure dependency. It's not more dependent, it's pure dependency now on these systems. And even just as much as you've helped a lot of people through that, not necessarily equipment sitting on their location, these are Now Cloud and third party SaaS solutions that they're really just consumers. I'd love to hear your viewpoint of how you're seeing all these dimensions collide with each other other.

Speaker A: So um, I think we need to recognize that the stakes in healthcare are unlike almost any other industry. And what I've seen happen in healthcare is all the M modernization of just the last 10 years. Whether it's the medical devices, whether it's the you know, infrastructure, application ecosystem, um, you know, hybrid, multi cloud, uh, the SaaS solutions. I mean it's, it's only getting to become more rather than less. And so fundamentally the definition of parameter security has changed. It's no more about building this little wall around your environment. It's truly about how do you make sure that you can have a uh, security and resiliency architecture strategy which can take that into account for third party management, whether it's uh, partners and vendors who provide software. And so security is no, it's, you know, you keep hearing about the phrase about zero trust, right? It spreads across partners, vendors. Every API connection that you establish has to now be looked at very differently. It's a completely different risk profile. And so the new dimensions that we are seeing emerge fall into a few categories, right? First is third party and supply chain risk. Now this is extremely sophisticated for health care. I'm seeing my uh, CIO and ciso, uh, colleagues in hospital systems start to focus on some of these. And it's not just about compliance checks anymore. It is far more than that in terms of making sure that they know how the security and the compliance is working. I think that is One complexity. The second is operational resilience. Um, and there is a, now a distinct discipline about how do you have that versus cybersecurity. Um, I think there are sufficient and more frameworks now in the world in terms of how do you do this in a more systematic way. Um, what I'm fascinated by personally is not just how do you prevent, there's no such thing as we'll prevent an attack. I think the question is how do you prepare for one and how do you detect it quickly and how do you automate the way that you can recover faster? And so I've seen some of that become very um, relevant, um, with the more recent uh, activity that we've seen in just the last 60 days around how artificial intelligence is going to get you more intelligent about your security controls. I think we've um, seen a lot of activity about starting to prepare for that. Um, then there's the third piece about AI related risks, which it's out there and it's not something we can stop. Um, I feel like the PACE question is really a risk question. And what I'm seeing some of the great leaders do differently is use the data, establish a governance model and leverage partnerships to make that risk calculus, um, you know, much more confident and figure out remediation and prepare for the future. So it's embrace what's coming, prepare for it, leverage some of the partnerships that you may have to be able to change it. And this is a constant change. Russ. Right. The framework that was relevant even a month ago for security and compliance is changing because the threat actors are changing, uh, the way the attacks are happening are changing.

Speaker B: It's interesting because uh, we used to have this, what I call a tactile field to technology, meaning I had to be able to go touch it. It had to be a data center, blinking lights, wires, network equipment. Now it infrastructure is everywhere. It is not a tactile function anymore, even though there is some of it that way. When we talk about our infrastructure, our infrastructure is in the cloud, it's in other organizations, it's hosted somewhere, whatever the case may be. And there is no more. Just the walls of the hospital. The care environment's everywhere. And so it creates a much bigger risk profile, as you said, for these organizations to try to be uh, able to manage. But at the exact same time we're hearing now, especially through our Digital Health Most Wired survey, that the opportunities with the infrastructure actually create an ability to actually predict future risk, to have a proactive approach in this. I'd love to hear Your thoughts on how these new and exciting technologies and opportunities give us the ability to really create a proactive, predictive model.

Speaker A: Russ, that's such a powerful reframe of how infrastructure was treated. Even until a few years ago, um, infrastructure was seen as something which is a black box. It just needed to work. It was ticking. It needed to work, we needed to manage it, we needed to maintain it, and quite frankly, nobody wanted to hear about it. Um, in the last few years, with all this modernization we've heard of, um, I believe infrastructure is now becoming an intelligent asset. It's such a powerful concept, uh, which I'm really excited about coming from the world of infrastructure and applications. Um, let me explain why. If you look at data, uh, and the data flows on these systems, with all these capabilities coming from an application perspective or an AI perspective, your networks need to be far more intelligent and connect across the ecosystems, whether it's the data centers, the endpoints, the devices, the medical devices that the patients use, the endpoints in the hospitals that are used to actually treat patients, all those devices we know of. And so, um, it's just fascinating how that has changed because the infrastructure that we built, that we thought was very robust and it worked like a song, now is not ready to embrace the change that is required with AI and some of the devices that are coming into play. Um, healthcare organizations are looking at this from a very different perspective, and I'm seeing them do several things. First, observability. Um, I think this is one of the biggest challenges a CIO has, which is how do I establish full visibility across this hybrid ecosystem because there are things I can touch and feel within my data center. Great, I get it. How do I now build that observability across the cloud, these SaaS platforms, um, I don't believe that that problem has been cracked fully, but I do see that that's a big area of focus. Second, uh, automation. This is not just to reduce the manual work, but how do I actually improve the speed to detect and respond. I mentioned this in the case of a cyber event. So it's minutes to seconds, it's not months to days anymore. That's superiorly fascinating. Uh, um, I just spent time in a security network operation center, and, um, it's amazing how this whole concept of a security operation center has changed. Third, readiness of infrastructure to meet the needs of tomorrow. Establishing that is super critical because, um, we've invested in the infrastructure, it's robust, you can extend the lives on these devices. But on the other hand, when you walk into a hospital and you're looking at all these modern devices, whether it's the workstation on wheels, whether you're looking at imaging devices, patient monitoring for nurses. One little blip on the network, which was great until even six months ago, brings the hospital system down. Then finally, I think this notion of integrating data and breaking down the silos in traditional IT across infrastructure, app data security, um, and clinical operations, um, is something that I'm starting to see become a very real uh, concept. I think it's gone from concept to how do I actually make this real? And um, so for me, bringing this back to infrastructure, I think it's how do we make sure that our infrastructure is intelligent, as able to support the needs not just of today, but the tomorrow is really the conversation I'm hearing more and more these days

Speaker B: as we become more automated, as we think about AI and the fear of losing jobs. It's interesting to me the success of all this work, this transformation really still comes back to leadership skills. And you've been doing this for a while and you've uh, led some pretty big scaled transformation initiatives. It does still come back to some guiding principles. And what are your guiding principles that you've held lead some of these programs that yes, have a technology component, yes, have an automation component, but in the end it really still depends on people and collaboration and getting to an endpoint. How have you taken your approach in leadership to really work on those priorities and keep them as priorities?

Speaker A: Um, the guiding principles for me, um, are probably something that evolved over time. I think if you had asked me the question five years ago, I would have spoken like a true technologist. For me, the first thing that I see now is clarity before momentum. Before you decide, you ask your team to move fast, I think you need to make sure everybody, top to bottom, are clear, they understand why they're doing what they're doing and where are they in the peace parts of trying to get the end job done. And as much as it may seem like that is easy, it's really not. And so particularly in large organizations like us and the partners that the companies that we work with, um, there is always room for ambiguity. That is something that I see is the first principle that we need to, um, bring clarity to. It's not enough for a bunch of executives in a boardroom to be clear about their mission. You need that to go all the way from top to bottom. The second principle is psychological safety. Um, coming from the world of delivery and coming from the world of having driven multiple programs of Change, um, when I look back in my career of 30 years, there's always been changes. There's been some technology disruption or the other. It just happens to be AI today. It was something else five years ago. With that change, we need to be able to establish an environment and a culture where the teams feel like they can talk about what's challenging for them. Decisions will need to be revisited. We will need to have the brevity and the ability to say what we did for the last 10 years is not going to work and we need to change it. It's okay to raise your hand, it's okay to raise the issues and the, in fact, you want to encourage that before they become a crisis. Uh, the other key principle I would say is when I now drive programs, I stay close to the ground. And I think I said this earlier, which is the ground for me is the caregivers and the patients. The ground for me is not just the people who do, um, you know, hands on keyboard work. And so staying grounded and rooted to how the work you're doing impacts the lives of the patients allows you to have a purpose and keep you, you know, keep you motivated every day. And the fourth piece is every work stream you drive. Ah, small, medium, large impact, high impact initiatives has to be connected with the mission and the purpose of health care of your company. I end by saying we need to protect the teams. Um, I call it initiative overload. There's a lot of technologies out there in IT these days. I mean, when you close your eyes and you wake up in the morning, there's some new product, there's some new company. And so protecting the team from overload and stopping the work that does not matter is as important as running major transformations. I think we get all excited about initiatives, but we don't do the job of, okay, what do I stop now so I can create the bandwidth to be able to execute on the one or two transformations? Um, I think these are the things that come to mind. Russ and I'll leave us with the biggest job I've felt as a leader in these transformation is decisiveness. Um, these transformations come with a level of risk. They come with difficult decisions. Sometimes it's okay to have an imperfect decision, but it's not okay to delay a decision. And so I would say, um, these are sort of my principles, my learnings that have applied so far.

Speaker B: You've thrown some absolute pearls of wisdom out on this. And I mean, just the concept of creating psychological safety and space for that is probably one of the greatest Failure points in some organizations, when they do these major technology initiatives, they forget to take the people with them. Uh, we hear about that all the time. Uh, you obviously have learned and garnered wisdom over time. Uh, what do you do for you? What, what do you do to create personal and even organizational resilience at. With this accelerated pace? How do you take care of you?

Speaker A: Um, that's a great point. I'll be, I'll be lying if I say that there haven't been moments which have been, I, uh, would say great. You know, there haven't been that many moments where I've had failures. There have been moments when it's not always been graceful. And so when I look back at some of those lessons learned, um, I believe some of the best, um, moments have come from failures and learning from them. And I think that's a really powerful concept that most of us undermine. Um, and personal resilience and organization resilience are kind of deeply connected. Um, for me, what has kept me going is being grounded to the purpose is really important. On the hardest days, when something fails, whether it's a major program or, you know, somebody has not been able to deliver on something which has got, you know, major impact, or somebody made a mistake, or the goal post keeps shifting, I think it comes down to how does this work matter and am I married to the work that I am m doing? I think that for me has, uh, kept me going for so many years, and particularly in healthcare. I, um, think it's never hard to find that purpose. Um, it's never hard to find how the work that I do counts. And this has not failed me, at least in the last 15 years that I've been closely connected to healthcare. Um, I've also learned to reframe this phrase called change. And what does that mean? Um, when timeline shift. Every morning there's a new release of AI something. Um, I think I used to take the attitude of why is this happening to me? Why me? I think, um, the way I think about this now is what is this actually telling me? And how can I adapt and how can I bring my teams along to adopt and adapt to this change? And so coming back to organizational resilience, I would say that the single biggest investment that we can make is not just in our people's capacity to learn, but also in. And of course we need training programs, we need to train them, etc. But how do you really foster a culture of curiosity where it is safe to say, look, I don't know this yet, but let me figure out how it works. So I, I think that for me is um, uh, you know, something that I feel is really important, especially when, you know, you as a leader impact large teams.

Speaker B: Yeah, that, that concept of introspection and self awareness over time, even like what you talked about earlier, how have you matured and you think of some things now in less technology terms than now in human change terms, that's some great introspection as you, as you look as a leader. And you've done an amazing job of being a visible champion for women in technology. And uh, I take this one a little personal because I am a very, very proud dad of uh, an amazing young adult leader who is an executive in healthcare technology. And so I get to see her all the time. And she's had some great mentors in life that are people just like you who pour into them. When you think about this next generation, when you spend time with young leaders who are trying to figure it out, um, what do you look forward to? How do you help define that next generation and pass on what you think you should pass on? But just as importantly, probably some things you don't pass along, um, because it maybe is not as applicable or maybe it doesn't apply to them. I'd love to hear your approach to the next generation or is what we refer to at chime the now generation.

Speaker A: Uh, to me I think the next generation of leaders in our industry will not just be defined by their ability to drive technology change. I think that's a given. Right? I think technology changes rapidly and um, the leaders are going to need to keep in touch with that, which means you're constantly having to learn and upskill yourself. But I think the qualities that we need to be able to build with the next generation and to some extent within ourselves is how do you drive and lead through ambiguity? You really don't know what's going to happen a year from now. There's a lot of promise. And so how do you build a culture and how do you build your own skill set, which is dealing with that ambiguity and being comfortable with knowing that that's how it's going to be for a while. Then how do you do that? With confidence and humility. I think humility is, um, very core to this. Um, the pace of change in healthcare technology isn't going to slow down. Whether it's AI or genomics or ambient technologies or digital therapeutics. I think there's going to be lots and lots of change and that will keep shifting. My view is what will separate the great leaders from the good leaders is not just the mastery of single or multiple technologies, but their capacity to keep learning, keep asking hard questions, um, and centering around the mission, even when the environment is uncertain. Now what does that mean? In my case, I actually have a battery of mentors who are kids from college. They teach me things all the time, and I am okay to admit they're smarter than me. Um, and it's really fascinating how some of these new technologies can help us reshape things. Now, back to women in technology. Um, I would push back a little bit on the way we are framing this technology in the past, because I think now we need to drive. No doubt women need confidence, need access, need sponsorship. There's no doubt about that. But I think while that matters, I think we need leaders, women or men, who can re examine what leadership credibility looks like. The qualities that I feel like historically, uh, conferred authority in an industry or in a system have changed. Um, yes, you need to be assertive. Yes, you need to have a tolerance for risk. But it's more than technology dominance now. And the qualities of being able to transform change, empathy, systemic thinking, and the ability to build coalition is something which will become a differentiator. And, um, even though they seem like they're, uh, simple concepts, I think women by design have grown up with building these skills, and I feel like they are going to be very good at dealing with some of these demands in the workplace. However, I kind of want to end this by saying, whether it's women or men, I believe that the time has come. Not just to say that, hey, we need more women leaders, or we need more women leaders at the table, but it's, how can we redefine the table itself to change the way leadership is being defined?

Speaker B: Wow. And upon. The wisdom you've poured out today has been absolutely amazing. I mean, I would love just to be able to recap all this. There's a few things, you know, our information now, our data is the most intelligent asset we've ever had. I mean, just that content and psychological, uh, safe places and reverse mentorship. I mean, I'm going out and find myself a young mentor that can push my brain a little bit because I am definitely one of the old dogs. And so I would definitely recommend, uh, this for people. Thank you so much for your insights today, not just on transformation and technical excellence, but really the human side that you brought to this. At the same time, that's unbelievably valuable. And thank you so much for what you do for our community and for Chime.

Speaker A: Thank you so much, Russ. I'm honored to share, um, my journey with you and your listen to your perspectives and, um, it's just wonderful being part of the CHIME community recently, and I look forward to some phenomenal learning and collaboration with the group.

Speaker B: Thank you. And hey to our listeners. Thank you for joining us for this episode Chime's Leader to Leader podcast. To hear more conversations with digital health leaders, Visit us@chimecentral.org Media or at Spotify, Apple, or wherever you get your podcasts. Till next time, stay safe, Stay curious. Keep pushing the boundaries of digital health to create safer, smarter and more resilient care. For now, stay safe. God bless.