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Will the Chief Digital Officer Role be Key to Healthcare’s Future?

August 5, 2018
by Heather Landi
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As many healthcare organizations are in various stages of their digital transformation journeys, executives at leading health systems and hospitals are increasingly adding chief digital officers (CDOs) to their senior leadership teams.

According to a survey from PwC (PricewaterhouseCoopers) in early 2016, only 6 percent of the top 1,500 global companies had chief digital officers, at that time. But, the CDO is an emerging and fast-growing executive role in healthcare, as hospitals and health systems are looking for a key leader to manage overall digital strategy and the consumers’ digital experience. St. Louis-based Ascension, one of the largest U.S. health care systems with 153 hospitals, recently hired Eduardo Conrado as its first chief digital officer, charged with steering the health system’s digital strategy and accelerating digital initiatives. Conrado comes to Ascension from Motorola, where he recently served as chief strategy and innovation officer.

In a press release, Ascension president and CEO Anthony Tersigni, Ed.D., said the move to hire Conrado was in response to rapid changes impacting the healthcare industry. “As our industry and our ministry rapidly transform, new technologies and companies are disrupting the market at an ever-faster pace, and leaders are beginning to fully embrace digital solutions to unlock innovation and drive productivity, connectivity and engagement,” Tersigni stated.

Many health systems are tapping digital leaders from outside healthcare. Aaron Martin, chief digital officer at Seattle-based Providence St. Joseph Health, previously worked at Amazon. The key, many industry experts say, is that the healthcare CDO needs to have clinical and organizational understanding to succeed.

Given the ongoing focus on this role, Healthcare Informatics Associate Editor Heather Landi spoke with Hillary Ross, senior partner with the Oak Brook, Ill.-based executive search firm Witt/Kieffer, about the growing importance of the CDO role in healthcare, what skillsets are needed and the CDO’s relationship with the CIO and other C-suite leaders. Ross leads Witt/Kieffer's healthcare IT practice and specializes in the recruitment of senior-level physicians and other clinicians. Below are excerpts from that interview.


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

What is driving healthcare executives to add the chief digital officer role to their C-suite team?

When the healthcare landscape changed from fee-for-service to fee-for-value, and health systems started looking at driving value, I think that is what precipitated this. When you start looking at value, healthcare organizations started looking at patients as consumers, and consumers have a lot of choices in the market right now. Consumers go online to shop for their houses, their mortgages, their cars, their groceries, and they also have choices in their healthcare. Healthcare is beginning to recognize that patients have choices, and much of what they can offer a patient doesn’t just have to be within the four walls of the hospital.

Hillary Ross

Everyone says healthcare lags behind other industries, and we’ve definitely seen that with this role. The CDO has been in other industries for a long time, and now healthcare is starting to look at it as well. When we talk about this CDO, we’re really talking about the person that is going to be responsible for digital transformation across the healthcare ecosystem. It’s a critical business-focused role.

What are the key skillsets that a healthcare CDO should have?

It’s really about a confluence of experience and personal style. Personal style is critical to this position because this person is a change agent, their role is to take a health system’s belief system and change it. Their role is to bring digital automatization to the health system. It’s very much a forward-facing role more than an internal role. In terms of skillsets, ideally, this person would have experience leading digital transformation and have an understanding of the obstacles and challenges to deploying digital health as well as innovation and commercialization, and also have a background in technology.

We’re also seeing the rise of consumerism in healthcare. How does that intertwine with the CDO role?

The chief digital officer is focused on and obsessed with the patient and in creating choices for the patient, as well as patient engagement and patient experience, to keep existing patients and to drive new patients to the organization by connecting with them digitally and giving them choices.

Consumers’ expectations are changing, and they are used to having choices. Someone shared a story with me that brings this to life. A patient had a check-up with her doctor, and the doctor wanted her to get a heart exam. The doctor said it wasn’t covered by insurance and referred the patient to a facility that does heart scans at a cost of $250. She called her local hospital and found out that the hospital charges $450. She then went online and Googled “affordable heart scan” with her zip code and up popped a hospital 10 minutes from her house that was offering heart scans for $49. This story shows that patients are consumers, they are savvy, and they are going to start expecting more information and more choices. Hospitals that recognize this can drive new patients, keep patients, and ultimately drive revenue, but, all the time keeping their eye on the importance on the patient and excellent clinical care.

Are you seeing a lot of commonality with the roles and responsibilities of the CDO across organizations?

Organizations are trying to figure out this role; much the same way they tried to figure out the chief information officer (CIO) role 20 years ago.  Organizations had a director of technology, someone who ran the “break and fix shop,” and then emerged a CIO and that role has really expanded and evolved over the years to become an extremely critical and key leadership executive. Technology enables the strategic goals of an organization, and the CIO leads that.

Much the same way, organizations are now trying to figure out how best to position this [CDO] and who best to lead it, and it will be a process. We see some organizations combining this role with other roles. In my view, this role is huge; digital is here to stay and it requires full focus and attention. I don’t think combining the CDO role with other roles is the best approach, it will dilute the importance of digitalization.

What are your thoughts on the appropriate reporting structure for this role?

It should be reporting to the CEO, ideally, and a peer to the CIO. The best model is a tight partnership between the CIO and the CDO. In terms of partnership with other senior leadership, as well, this person really sits at the intersection of clinical, technology, marketing and senior leadership. It’s a very collaborative role to drive that organizational change.

How does the emergence of this role impact the CIO role?

Some organizations will combine the role with the CIO role, but I think it should be separate. The CIO is a critical component of an organization; the CIO runs information systems and oversees applications, clinical systems, revenue cycle, human resource systems, security, the data warehouse, and sometimes, analytics. And then to add digital transformation to that role, [the CDO role] is not going to garner the full-time support that this role needs, and it will end up being one-off innovations, like a cool app here, or a telemedicine program, which is all important. But, you need really need someone creating a digital strategy, leading that strategy, implementing it and driving these changes. It’s a full-time role. The whole next wave of patients are Millennials, and they are driven by digital. For organizations that want to position themselves well for that next wave of patients, digitalization requires full-time attention.

Are healthcare organizations looking outside healthcare to recruit for these CDO positions?

We’re seeing healthcare organizations now looking for leadership outside of healthcare, and it’s interesting to watch those organizations and how those leaders outside of healthcare are navigating. Certainly, if you recruit outside healthcare, there is a going to be a learning curve for those executives. Do they speak the language of healthcare, and do they understand the intricacies; reimbursement, readmission, length of stay, hospital business operations? Those executives can transition, but it will take time and it will take strong healthcare leadership under them to help them with that transition.

Many times, we’re asked to produce slates of these candidates that come from within healthcare and outside healthcare because they want to compare and contrast. Generally, we’re seeing healthcare leaders will end up selecting those candidates from within healthcare because they can hit the ground running and they know how to navigate the hospital and understand their issues. But, there are those organizations that are looking to really innovate and shake things up, and they think those leaders outside healthcare can bring that innovation and fresh look. Those executives might have different ideas on consumer engagement and will focus on translating those ideas to healthcare.

The bottom line is, healthcare is all about the patients and being clinically excellent. And the difference is, when you look at leaders outside healthcare, it’s about profit and the bottom line. It’s a different mentality and focus. Anyone that comes from outside of healthcare, this CDO, is going to have to be mission-driven and passionate about the patient.

Do you have any predictions about the next emerging role in healthcare?

This role will be it. A talented CDO will be the best person to identify those next great ideas in healthcare; that’s why this role is so important.


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Industry Leader Drex DeFord on Leadership for Innovation: “Time to Embrace Your Inner Weirdo”

October 22, 2018
by Mark Hagland
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At the health IT Summit in Seattle, industry leader Drex DeFord speaks of the need to “feel uncomfortable” in order to lead change

In his featured presentation at the Health IT Summit in Seattle, being held at the Grand Hyatt Hotel in downtown Seattle, and sponsored by Healthcare Informatics, healthcare IT industry leader Drex DeFord shared with attendees on Monday lessons learned from a professional lifetime innovating in IT. Speaking of lifelong learnings of lessons around leadership, DeFord, who has been an IT leader both on the military and civilian sides of healthcare, told his audience that sitting in discomfort, and getting others to sit in discomfort, is not only a good thing; it is in fact essential to creating innovation. In other words, as DeFord put it to his audience, “It’s time to embrace your inner weirdo.”

DeFord, president of the consulting firm Drexio Digital Health, delivered a presentation entitled “Relentless Innovation: Everything I Know About Innovation Was On Display at Burning Man,” sharing insights across decades of experience in the armed services and in the healthcare industry, encouraging his audience of healthcare executives to take risks and upset the accepted order of things in order to push for clinical and operational transformation in healthcare. He spoke from four decades of experience, beginning when he enlisted in the Air Force as “a farm kid from Indiana,” through to his pursuing first an undergraduate degree, and then resigning as a commissioned Air Force officer, pursuing a master’s degree in informatics, becoming a healthcare IT leader in the Air Force, and eventually a CIO in civilian hospitals, including Scripps Health in San Diego (three years), Children’s Hospital Seattle (three-and-a-half years), and Steward Health in Massachusetts (14 months), and then into consulting.

Drex DeFord

At every turn in his career, DeFord made unexpected choices, even choices criticized by others at the time, for their being too unusual. And, dipping deeply into his own personal narrative, DeFord told his audience, making unexpected choices has been true of his thought processes from the very beginning. “I came from a very big extended family,” he told his audience. “I was an only child, but had tons of cousins on both sides of my family. And I was a farm kid from Indiana—and one of the first even to graduate from high school. And I wanted to go to college, but didn’t have any money, so I enlisted in the Air Force; and that was a weirdo thing to do in my farm community. Then I found that I was unusual in the military for not coming from a military background,” he recalled.

DeFord further broke molds by pursuing a civilian undergraduate college after his time as an enlisted member of the Air Force, and coming back as a commissioned officer, whereas most Air Force officers had gone to the Air Force Academy or entered through the ROTC in undergraduate college. Next, he ended up, following service in Desert Shield/Desert Storm, in an Air Force hospital, in the IT department. That, too, was seen as an unusual choice; but it opened up new horizons for him. “We built web pages before web pages were a thing. And we were beta testers for Mosaic. And we deployed the first EHR [electronic health record] in the DoD. That was a weirdo thing, too.” Next, DeFord decided to pursue a master’s degree. And, he said, “That’s much more normal now, but at the time I did it, I got pounded for being a weirdo for getting a master’s degree from a university health informatics program.” But he found the experience—at the University of Alabama-Birmingham, in healthcare informatics—to be precisely what he needed to move to integrate certain types of formal learning into the healthcare IT experience he had already obtained.


Integrating Data Sources for Successful Care Delivery

The advances in and availability of data from disparate sources create new opportunities and frontiers in care coordination for complex patients. These can range from mobile health/Internet of...

At this point, DeFord paused to note that, “While I’ve been a weirdo across my entire career, one of the things I discovered in the Air Force is that I was allowed to be a weirdo in certain areas, as long as I showed massive compliance to other norms. My uniform was always pressed, my shoes were always shined, I blew away the physical fitness test every time. And I found out that it was OK to be a weirdo if you got stuff done.”

Next, he recounted, as he was graduating from the UAB health informatics program, he got a call from Jackie Morgan, M.D., a flight surgeon, a colonel, and the surgeon general of that Air Force region, who ran the health informatics program for that southern-U.S. region. Col. Morgan had to fight to get DeFord named to that director position, as he was a captain, and the position’s description was tagged to the lieutenant colonel rank; but, he recalled, she felt he was just the right person for the position. And, in that position, he said, “I came up with the idea that we should take money from the hospitals, pool it, and create centralized IT systems. Sounds logical, right? But at the time, we got a lot of grief for it, and that generated a lot of frenzy, and at one point, the Air Force Surgeon General, the top guy, had to get involved, and Jackie Morgan said, you’re going to have to present what you’re doing, ‘cause it’s got everyone in a tizzy.” But DeFord’s presentation to a cadre of senior officers turned out to be so successful that the Air Force Surgeon General determined that that model should be implemented Air Force-wide, and the AFSG asked him to come to Washington, D.C. and help his colleagues implement the plan across the Air Force.

Once again, DeFord made an unexpected decision, asking first to work at an Air Force hospital on the front lines, in order to fully understand the implications of the implementation plan. “What would a weirdo do? I said, ‘No, I want to eat this dog food!’” he shared with his audience. Thus, he spent 23 months at Travis Air Force Base, which had the Air Force’s second-largest medical center, and then after that time, moved to Air Force Command in Washington, D.C. as chief technology for Air Force Health (a global enterprise spanning 78 hospitals).

Following his time in the Air Force, DeFord then spent over a decade in civilian hospital organizations—Scripps Health, Seattle Children’s, Steward Health in Massachusetts; and after a brief time helping to establish a vendor platform, has been happily and successfully consulting for the past three-and-a-half years.

Looking back at the trajectory of his career, DeFord told his audience, “In the end, I decided that the best thing to me was to embrace ‘weirdness.’” Indeed, to put that statement into context, he said this: “The folks in this room who have worked with me have heard me say this many, many times: ultimately, a good part of being an innovator is being comfortable with your uncomfortableness. There are a lot of weird aspects now to our industry. All this stuff that is happening right now with telehealth; all this with disruptive entrants in healthcare. I spent a lot of time working as a consultant, working with the Cedars-Sinai Accelerator, for example. It’s a really uncomfortable industry to work in. Every day, some new thing is going on,” he said.

“So as an innovator in healthcare, in order to innovate, you have to become comfortable with uncomfortableness. What’s more,” he said, “you have to be comfortable not only with your own uncomfortableness, but also, you have to become comfortable making other people uncomfortable. You have to challenge people. I wrote an article on LinkedIn, about antibodies to change,” he said. “It’s almost as though we have people in healthcare whose sub job description is, activating antibodies to change. And for me, I realized that those two things kind of applied to me early on.”

DeFord also spoke about the collaborative innovation he saw firsthand at the Burning Man festival in the desert this summer, in which participants work for the greater good, and come up with innovative ways to solve in-the-moment group effort challenges.

Following his presentation, DeFord spoke one-on-one with Healthcare Informatics Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Things are moving forward so fast now. What would your message be to CIOs and CMIOs at this moment in healthcare, as they’re being asked more and more to become change leaders, not just technology experts?

A lot of it just boils down to, don’t be afraid of change. You’re probably already very involved, as the CIO in your organization, in seeing the change coming. You see the customer experience in lots of different organizations, and then you go back to your own organization and have to roll your eyes at the unwillingness to change. So, don’t be afraid to change. I think we’re moving into a time where 75-80 percent of the CIO’s job now is the people and process part, no longer the technology part. How do I help people understand where the organization should go, strategically speaking? And help people figure out what the underlying problem is, and help them realize that it involves process change?  Unfortunately, often, you wind up with CIOs who have fallen into the rut of being CTOs who are so overwhelmed by the day-to-day technology issues that they are marginalized and are no longer at the big table.

How do you light a fire under CIOs, to help them become true change leaders in their organizations, in that context?

If you’re not in the right position, you may need to think about whether you need to stay. You may be in an organization where you’re always going to be marginalized, if you started out in a particular role and are viewed that way. And if you move, make sure you’re perceived correctly. We’ve gone from this model of business and clinical people coming up with their business and clinical strategies, and IT’s job is to make it go faster; but we’re moving to a situation where the CIOs are at the table to begin with. That becomes a big part of the job, and that makes other people uncomfortable.

One of the biggest challenges, which industry leaders have been talking about for years now, is the shift in the role of the CIO from being a technology manager to needing to become a true strategic leader in the patient care organization.

Yes. The strategic need now is about the people and process stuff, and about the business and clinical model we should be creating. Where do we compete and not compete? It’s about organizational strategy. The movement from fee-for-service payment to value-based care is a game-changer, and is definitely happening, and will continue. The only question is at what speed, and a lot of that will depend on who’s in office, etc. But we’re going there. We’re talking about it in terms of the CIO role, but we also need the CFO and all the other leaders thinking strategically about how to create better care for patients and families. If you have an army of people who think like that in your organization, you’ll end up being the acquirer, not the acquired.




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Head of IBM Watson Health Steps Down, STAT Reports

October 22, 2018
by Rajiv Leventhal, Managing Editor
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The head of IBM Watson Health, Deborah DiSanzo, is leaving her role, STAT News reported late last week.

According to the report, “The circumstances of DiSanzo’s departure were unclear, but Watson Health has been seeking to rebound after a series of stumbles. IBM executives have said they have bet much of the company’s future on its success in healthcare, and improving Watson Health’s standing in the industry is seen as crucial to that effort.”

IBM Watson, an artificial intelligence supercomputer, was launched into the world of healthcare just a few years after it won in Jeopardy! against record-setting champions in 2011. Watson Health, a unit of IBM, was launched at the 2015 HIMSS conference and employs thousands of people.

DiSanzo was brought into the company in 2015 to be the general manager of Watson Health, and according to the STAT report, will be succeeded by John Kelly, senior vice president for Cognitive Solutions and IBM Research, who will step into DiSanzo’s role in an acting capacity, current and former employees told STAT.

Along with the popularity of Watson has come intense scrutiny, especially in the last year. As Healthcare Informatics covered in one of its Top Ten Tech Trends this year, it was a STAT News report from September 2017 that became one of the first major stories detailing how Watson has been performing in hospitals, specifically examining the company’s Watson for Oncology solution.

That piece found that Watson for Oncology has struggled in several key areas, noting that while IBM sales executives say that Watson for Oncology possesses the ability to identify new approaches to cancer care, in reality, “the system doesn’t create new knowledge and is artificially intelligent only in the most rudimentary sense of the term.” And a more recent report, also from STAT, included internal documents from IBM Watson Health which indicated that the Watson for Oncology product often returns “multiple examples of unsafe and incorrect treatment recommendations.”

Last week, IBM also released third-quarter earnings, which showed that revenue from cognitive offerings, like Watson, was down 6 percent from last year, according to the STAT report. To this point, reports surfaced this spring that some IBM Watson Health units were experiencing significant layoffs. IBM officials have maintained that things are not as bad as has been reported, while attesting that its artificial intelligence remain quite popular worldwide.

According to this latest STAT report, “Watson Health has sought to shift its focus in recent months, scaling back a part of the business that sells tools to hospitals to help manage their pay-for-performance contracts. Following layoffs In June, DiSanzo sought to reassure employees that the company was on the right track,” the report noted.

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AMIA to Honor Informatics Leaders

October 17, 2018
by David Raths, Contributing Editor
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Cerner’s Overhage to Receive Lindberg Award for Innovation in Informatics

At its 2018 Annual Symposium in San Francisco next month, the American Medical Informatics Association (AMIA) will honor several informatics luminaries with its Signature and Leadership Awards.


AMIA Signature Awards

• Donald A.B. Lindberg Award for Innovation in Informatics
J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer, Cerner Corp.
Overhage joined Cerner in 2015 with the Siemens Health Services acquisition. Prior to Cerner, he was the Director of Medical Informatics at the Regenstrief Institute and the Sam Regenstrief Professor of Medical Informatics at the Indiana University School of Medicine. He helped create the Indiana Network for Patient Care, which contains data from laboratories, pharmacies and hospitals in central Indiana.

• Don Eugene Detmer Award for Health Policy Contribution in Informatics
Julia Adler-Milstein, PhD, Associate Professor and Director, UCSF School of Medicine
Adler-Milstein is an Associate Professor and Director of the Center for Clinical Informatics and Improvement Research (CLIIR). She is an expert on policy and management issues related to the use of IT in healthcare delivery. Her research assesses the progress of health IT adoption; the impact of such adoption on healthcare costs and quality; and the relationships between market, organizational, and team structure and health IT use. A core focus of her work is on health information exchange and interoperability.

• William W. Stead Award for Thought Leadership in Informatics
George Hripcsak, MD, Professor and Chair, Department of Biomedical Informatics, Columbia University
Hripcsak’s current research focus is on the clinical information stored in electronic health records and on the development of next-generation health record systems. Using nonlinear time series analysis, machine learning, knowledge engineering, and natural language processing, he is developing the methods necessary to support clinical research and patient safety initiatives. He leads the Observational Health Data Sciences and Informatics (OHDSI) coordinating center; OHDSI is an international network with 180 researchers and 600 million patient records. 

• Virginia K. Saba Informatics Award
Bonnie Westra, PhD, RN, Associate Professor, University of Minnesota School of Nursing
Director of the University of Minnesota’s Center for Nursing Informatics, Westra’s research includes terminology development, application, and evaluation; knowledge discovery in databases; predictive analytics for outcomes; and evaluating and deriving new evidence based guidelines from EHR data. 

• New Investigator Award
Jeremy Warner, MD, Assistant Professor, Vanderbilt University
Warner directs the Vanderbilt Cancer Registry and Stem Cell Transplant Data Analysis Team. His primary research goal is to make sense of the structured and unstructured data present in EHRs and clinical knowledge bases to directly improve clinical care for patients, with a focus on oncology. 

AMIA also announced the following Leadership Award winners:

Sarah A. Collins, PhD, RN: For leadership in developing and championing AMIA’s applied informatics recognition program (FAMIA).

Jeffrey A. Nielson, MD, MS, FACEP: For leadership in developing and championing AMIA’s applied informatics recognition program (FAMIA).

Lucila Ohno-Machado, MBA, MD, PhD: For steadfast leadership of JAMIA as editor-in-chief (2011-2018) and decades of commitment and service to AMIA.




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