HIMSS26 Ep#6 Technology Is Not a Governance Problem It Is a People Problem

Host: Thank you all for joining today's podcast. Uh, I have with me Isaiah Nathaniel, CIO and SVP at Delaware, uh, Valley Community Health System, as well as cio, uh, executive advisor for national association of Community Health Systems. Um, Isaiah is based out of, uh, Philadelphia. Uh, he is joining us today to share his uh, thoughtful insights on how he is driving digital transformation, use of AI, responsible AI and how he is focused on improving patient care, patient outcome and patient experiences. So Isaiah, welcome to our podcast. Thank you for joining us Jay.

Isaiah Nathaniel: It's a pleasure to be here to be with the Intuitive team, uh, doing this podcast. I look forward to the conversation that we're having today and I look forward to expounding upon both community health, but how companies like Intuitive can help in that digital transformation area and how do we journey the patient on truly whole person care.

Host: So Isaiah, you have been in this space for quite a while and um, you know, we are all right now expediting or accelerating the transformation across the board, especially in the current macro and microeconomic circumstances, plus the government funding, uh, challenges that are there. I truly believe that technology is going to be the key driver to improve the patient care in the difficult times. What are the core principles do you follow in your journey for transformation for Delaware Valley Health System?

Isaiah Nathaniel: That's a great question and I like the way that you put it. As far as technology going to beat the enabler versus the tractor is specifically in community health. And I can talk about the 54 million patients that community health centers see across the country. We're 1 in 7 in the entire country, but in rural health we're 1 in 3 with a cohort of 365 FTEs throughout our entire movement. And what I'll say is the core principles of that is trust. Trust that starts at the provider. Now you may be saying, Isaiah, that has non technical acumen to that answer, but it's the core core of our ecosystem which is trust. Trust from the provider, trust from the health system, and then trust from the technology that it's going to work when you need it to work. So we can throw all these acronyms out, but if you don't have trust, the technology can't support the system in the way that it needs to be. The second thing I would suggest is you have to have conversation and the principle of collaboration when we're here at conferences like HIMSS 26, we're talking about artificial intelligence. Thing that excites me about it is co design, co development, that human and M elite making sure that it is built with you, not against you, so that we can have the right technology in front of the provider when they need to provide that excellent care. And then last and finally has to be security. Without security in any digital transformation plan, it's going to fail. It's going to fail tremendously. And we can't have that happen.

Host: No, absolutely. And it aligns very well with number of technology, uh, leaders that I have talked to, uh, who I have a lot of respect for. Ah, very well aligned there. Now, if you look at clinical, um, applications and EHR and you know, any technology that touches patients, lives. Right. I believe that we are in a time that everybody's aware that transformation and modernization of these systems can lead to something greater good. How do you see that in your environment? And how are you driving the transformation leading to some meaningful outcome for patients?

Isaiah Nathaniel: I say this all the time, that my job is to remove access barriers by way of technology, not introducing them. And I think that hits home to where you come from, which I know you put a lot of emphasis on, is that core person and understanding that journey that they have in the ecosystem of health care. I'm coming from a primary care perspective, but I'd be remiss if I didn't talk about the hospital or the subspecialty and knowing that where we start with that patient in primary care, they have to go to the other parts of the healthcare system. And so this ecosystem, going back to some of the principles of not only trust, but understanding interoperability and a data strategy that can ingest that data, uh, from an EHR perspective, but also extract that data in the same fashion when we get to discrete data elements and making sure that what is happening for that patient journey is the right interaction with the data, with the system. And that goes all the way from ehr, population, health systems, AI scribes, medical tools, digital devices, all around understanding that if we do it the right way, understanding that this is only one interaction of that patient on the journey and knowing that that data has to go other places, it makes it a true digital health ecosystem.

Host: Have you brought on the actual, you know, nurses, the practitioners, the clinicians and the staff that supports the overall operation, the entire supply chain, right from, you know, ordering gloves to the, you know, the lab supplies to the medicines and things like that? Have you actually brought them on board with your vision on what you're driving at Delaware Valley? Um, in terms of technology transformation?

Isaiah Nathaniel: The answer is yes. The answer is I can't have a strategy without adoption or it's a failed strategy and so for me it's important before I put it down on paper that I'm having the conversations with the ordering that the current specialist, I'm having the conversations with the nurses, having the conversations with the doctors and saying how can I make your life better? When we look at statistics and say primary care sees on average this amount of patients per day 24 to 21 and then we say how do I make that quick in a 15 minute touch point or 11 minute touch point. But let's go also to the front desk where I'm saying I want our time to provider to be seven minutes. How do I do the revolutionizing and intake management and the previsit? So absolutely my strategy has all key stakeholders a part of it, putting their little effort into it and then we can all adopt it the way that it should be.

Host: No, I look patient, I uh mean physician and uh, nurses burnout and fatigue is a real problem. Right. Uh if you are helping them scribe the notes and if you're helping them you know, ambient AI or you're helping them uh, reduce the time they would spend on the paperwork. Nurses shift handover, right? Like that's another big problem. So lot of those business outcome focused solution, I think that's really what in my view is the key driver and a true outcome of a transformation. Now all of this transformation as you see everything is labeled with AI. Uh right now AI is nothing new. AI has been there for many many years, at least few decades. But today the use of AI is actually making into end user adoption. Right now that leads to two part equation. One is genai and agentic AI. Uh how this workflows and business logic that is now getting incorporated in the patient's journey and second is to make that AI work. Well how are you fixing the data? Because it is not an AI problem. AI is the uh, generally it's a tool to drive the outcome. It's a data problem. So how are you handling the data? Obviously in provider world the data is not very unified and not in a single uh system. There are so many uh, third party vendor system of records that you have to rely on where data access may or may not be an option. How are you solving the data problem then AI problem and then what are the key outcomes you're delivering on gen AI? Agentic AI.

Isaiah Nathaniel: That's a really good question. I'm going to break it down in a couple of different parts. I'm going to start with data overall. So one of the things that community health we are data rich so we're not lacking any data because we ask these certain levels of question at each and every visit. So what I say to that data point is that oftentimes we have to make sure it's presented the right way. So you have to navigate what data you actually have, then you have to present it to the right EHR field or the right uh, opportunity for the provider to have an actionable uh, encounter with it. So that's the data piece. The other piece to this conversation which is really critical is the journey of that. And what I say in the journey about that when we're talking about AI and the generative models is you have to understand what is being captured that you want automation to. So starting with use cases, starting with understanding machine learning is the step before any AI. And then the last piece to that is the consumerism of AI is really transforming um, healthcare in a way that we have to pay attention to it specifically from the generative piece. ChatGPT perplexity. Some of these tools that natively people are diagnosing themselves and then coming to the clinic or the community health center saying hey, ChatGPT told me I have this diagnosis. How do you reconcile that? We want that information, we want to ingest that specifically when we're looking at the de identification of that particular piece of information, putting it into a clinical decision support system and then making the agentic AI a part of the outcome that then the provider can say yes or no, uh, this is the quality outcome I want to do. So when we're talking about that, we allow it. We say we will allow that pieces of information. We want to make sure when we bring it in that it comes out with the right outcome that the provider is suggesting more so than the technology. Because you're right, this technology has been here before. But what you have to do is make sure it's the right one for your system, your strategy with the right set of data and that goes into how you plan and you strategize on deployment. Some of my aforementioned questions.

Host: Yeah, no. And again, um, what matters the most? The cmmi, uh, levels out there? Um, lot of health systems are now focusing on, hey, how do we leverage AI to improve the quality of care and improve the reimbursements and improve the patient journey and how we can drive the adoption at scale right now. Have you seen people, uh, open to adopt? You know, Jenny I or agenti, when you talk to a nursing staff and say, hey, you don't have to type this and take 15 minutes, it's going to write it on its own and you're just going to say yes. Are they open to that? Are they, are they anxious or are they uh, having. You're getting a lot of pushback on that.

Isaiah Nathaniel: One of the things I'm going to say, I'm smiling so much because it depends, it really depends. Some of them are so gung ho or wanting this technology. Some of them are like, I'm about to retire, I don't want to learn something new. So it's like you got these two different stratospheres up a Venn diagram, uh, looking at how do we bring this into the organization. What I try to do is I try to get some early adopters, those that are passionate, some of the ones that are coming out of school, they're really passionate about technology. I try to get them into this early adopter phase and then I try to move them into beta groups, alpha groups and then let's get them into production. All the while they're being uh, collegial and telling their colleagues, hey, this saved me a couple minutes. Hey, I got to go to my kids soccer game or dance practice or basketball game because I use this technology and then make some competition. You're talking to a former basketball Division 1 athlete here. So I try to create a little bit of friendly competition with the tools that I deployed. Now I know I won't get everybody, but if I continue to use that early adopter, adopter to a production, um, strategy that's been really successful in how we've been rolling out some of the things, the new technologies.

Host: So you mentioned about security. Right. That's a biggest problem that I see with adoption of AI and how we are centralizing the data. Right. Um, and I don't feel that all major healthcare providers are geared to deal with any security issues that will come with adoption of AI. Today we are worried about 2 and 3000 applications and 20,000 VMs. In next two years or three years there's going to be few million agents in each organization and there uh, are going to be agents which are non persistent. The agents are going to come up and go down and the level of security that you're going to have to have is to the next level. How are you coping up with it given that healthcare is the biggest target for all major security attacks and breaches? Right. So how are you uh, handling CyberSecurity as the AI adoption is happening?

Isaiah Nathaniel: It's a very good question. The way that I answer that is if you don't pass our security requirements, it doesn't even get to my desk for review. And that's you got to have your SoC2, your high trust. We use our section 1557 coordinator to look at the models to make sure there's no bias or your hallucination record. And once you pass that, then it's a thoughtful conversation of how do we co develop, uh, co design and then bring that out to the foreground and proof of concept, then we get to production. But privacy and security is a top priority for us because guess what I can't afford to do. I can't afford to have my providers in a space of mistrust. Uh, they can't renegotiate that trust with the patient when they're in that room if we've lost it. So I put that really, really high on my list. It's what keeps me up at night. I would be remiss if I didn't say it, but it also gives me confidence to know that if I have a culture of security, we will put the right tools in and make sure it has the right guardrails around it. So when developing these types of solutions and that's what, you know, the conversations that we have in intuitive and all the things that you guys do, you guys put security first and you guys say, listen, we understand that patient journey because we were patients once ourselves. So how do we generate tools that have security first and then delivers on the best proof of concept use cases?

Host: So, um, governance and compliance. Right now governance word is pretty big and wide, right? You talk about data governance, you talk about AI governance, you talk about governance at the process level in healthcare. Right. To avoid discrimination, avoid any form of uh, um, sort of misactions. Right. Um, how much technology is helping solve governance problem today across the organization?

Isaiah Nathaniel: None.

Host: Okay.

Isaiah Nathaniel: Not one technology solution is solving a governance issue. Uh, um, because it's not the technology's problem.

Host: Yeah.

Isaiah Nathaniel: It's the organizational problem. Right. And change management. People don't like change or they're not adapt to change. So when we're talking about governance, yes, I can put you in a strong governance committee model and that's fine. But oftentimes it fails because the people, the change are not ready for the adoption of what the technology is trying to introduce. So I kind of say that tongue in cheek, but I actually do mean it that governance, if you don't understand what it should be, you're not going to get the outcome that you want because of human involvement in that process.

Host: I see that you are helping next generation of CIOs. You being yourself being one of the youngest CIOs in healthcare that I know of, um, what's the message you are giving them? Like somebody who's aspiring CIO, who may be a CTO or a CISO, wanting to be a CIO and you run the cohort last year him M. CIO Connect or CIO 100. Uh, um, uh, mission. What's your message to your fellow peers as well as the, uh, people that you are inspiring to, um, rise up to become a cio?

Isaiah Nathaniel: Yeah, that's a good question. Um, what I would suggest, or what I would say to answer that question is part of my philosophy. Is I rather a slow no than a fast yes. And what I mean by that is take the time to do the due diligence on anything that you're doing. When you're in a, uh, seat like mine, the buck stops with you. And don't be so concerned with pleasing everyone that you fail the organization and the mission of, uh, providing truly high quality health care with the right outcomes and in a secure and private fashion. Because if you get to the seat and you lose it because you're trying to please everyone, then you've done a disservice to the patient. That's on the end of every one of your decisions.

Host: Yeah, absolutely. Trust comes with responsibility. If you know the system is trusting you to make critical decisions, you better make sure that you are responsible about it and not rushing through it. So that's a great, uh, point. Now, your success, uh, is tied to everybody around you, right? Starting with your, your immediate team. But end of the day, we are in business of providing care and we are call it. While we are leading with technology transformation and innovation, we are supporting the clinical staff and especially the nurses. Right? That's the backbone of every health system. What's your message like? You know, I know you're very big on gratefulness, right? And, uh, you always make sure to call out the people who helped you in your journey. What would be your message to all the nurses and clinicians and the support staff, uh, at Delaware Valley and the larger, uh, more community health systems?

Isaiah Nathaniel: I'll pause and say something that has guided me very clearly is a statement that I developed. Together we achieve. Apart from that, we selfishly proceed. And my message to nurses, IT folks, operations, everyone, providers, administrators, everyone in this movement we have is that we have to do it together. The ecosystem of arrogance, um, in the wrong context of it, then we're going to fail. And we can't fail. So together we achieve. Apart from that, we selfishly perceive and they have my commitment to do this together, not leaving them behind.

Host: Predictions. And again, this is a video recorded. So we will check on these predictions three years from now. Right. Um, the world is moving so fast. So three years prediction, right? Not 5, 10, 25 years. Three year prediction. Um, use of AI, um, in clinical procedures and processes. Um, what do you see the maturity to get to in next three years?

Isaiah Nathaniel: The way that I would answer that question clinically, what do I see in three years? I see not one computer in an exam room. I see providers walking in with either wearables or audio that is equipped in the entire exam room that is capturing everything that's being said both from the provider to the patient. I see the proper video ecosystem that could diagnose a burn, diagnose, um, a heart. I see digital scanning in the room next to it. I see labs being drawn just by saliva or some other newer technology. I really see a ecosystem of simplicity where the provider is facing the patient just like I'm facing you two today. And the technology is non existent to them and their ecosystem of space. And then they get to go home at night and have a great day. We have the quality outcomes, the revenue is generated from those sufficient and efficient visits. And last but not least, the technology is proving out to be the best that it should be. With all of the modern technology that we have on this floor at hims 26 that you guys have developed. And I look forward to seeing that come true.

Host: Would you let a robot, uh, do a surgery on you in next three years?

Isaiah Nathaniel: Personally? Personally Answer is yes.

Host: Okay.

Isaiah Nathaniel: If the error rate of a robot is less than 5%, the answer is yes. Where a human would be 10% or more, I say yes. I think coming from a basketball perspective, Jayson Tatum came back in less than a year from ACL tear and I see that as getting only, only better. I just think about Penny Hardaway. If he had this technology today, where would he be? Probably in the hall of fame.

Host: Absolutely.

Isaiah Nathaniel: Grant Hill.

Host: Yes.

Isaiah Nathaniel: All these type of things. So the answer is yes.

Host: Okay. And, um, you have kids.

Isaiah Nathaniel: Yes.

Host: Okay. Would you want them to be in healthcare and become a doctor or a, uh, clinician or create a healthcare tech startup?

Isaiah Nathaniel: Absolutely. And my daughter is on that track right now. She has already identified. She's a sophomore in high school and she wants to do, she wants to be a doctor. So, uh, the answer is yes. And I'm going to push her to do that. My son and my other daughter, um, they're in the sports right now. So I don't know what they were majoring, but at least I have one that wants to be in healthcare. And I think it's rewarding and fulfilling. And that's sort of, if I can go back a moment, Jay, that's how I got into healthcare it, because I was in just traditional it. And my mom said the passion that you have for helping people and using technology to do that, you should be in healthcare it. So I think my mom, I want to pass that legacy down to some of my children because there's no greater joy of being in health care and in technology knowing that when a provider needed to prescribe or do a lab, that the system worked. And you were the enabler of that.

Host: Yep. Isaiah, thank you very much. Great conversation, very insightful. Good luck to you, your family, your daughter and other, uh, two kids. Thank you again for very insightful conversation. And uh, we'll continue this conversation, uh, and have a follow up session with you in few months. So thank you very much for joining me. Thank you all for listening in to this, uh, insightful podcast. Lot of great thoughts. Um, as I mentioned, Isaiah is a renowned, uh, technologist and somebody who truly means, um, care for patients. So, uh, I hope you find this insightful. Uh, stay tuned and we'll bring some more insightful conversations to you. Thank you all.