The State of Healthcare IT from an Accomplished CTO [Interview]

Posted by David Condra, Founder on June 8, 2016

The role of CTOs in hospitals is constantly evolving to meet fundamental clinical, operational and financial business objectives. Today’s most successful CTOs are more involved in every level of communication, from the frontlines to the C-suite. They need to be able to articulate their goals and visions for new technology to a diverse range of stakeholders and prioritize buy-in as an essential part of any implementation.

A recognized national healthcare information technology leader, Paul Caracciolo, spoke with us about his experiences in the field and provided insight into the current state of healthcare technology. Paul has more than 20 years of experience in roles such as CTO, CIO and information security officer in large healthcare organizations such as Duke and Stanford. Get the full scoop in the interview below.


Were you always interested in IT specifically in the healthcare industry? What are the challenges that appeal to you?

Paul: I have been in healthcare since the 1980s. It is a very challenging industry. Healthcare IT is especially complicated. For example, it can take over 150 applications to run even a small hospital. And oh, by the way, you also have to meet government regulations, manage security and ensure privacy.  I guess you could say I like a challenge.

What is the biggest difference between 20 years ago and today in your role as a CTO?

Paul: While many changes have been made regarding technological advances, the biggest change is the role of the CTO. They have become more engaged with operations; they are not sitting in a silo. CTOs are now involved on the frontline, viewing hospital operations firsthand to determine the best ways to adopt technologies to improve workflows.

What is the biggest trend you’re seeing healthcare systems embrace in terms of IT?

Paul: In the past, there were standalone call centers that people would call to make appointments. Now, many services are connected. Call centers are integrated with EMRs and patient self-service for patients to get prescriptions, lab results, make appointments, and so on. From a workflow perspective, there is a lot of connectivity between nurse call, EMRs and other technologies. Interoperability is key to doing all of these things.

Do you think nurse call is necessary in its current form?

Paul: Nurse call is becoming an old-school term. It is just one of the spokes in a larger communication network. Companies are integrating and developing more advanced capabilities.

With all these advances, when you are looking to replace a nurse call system, how do you assess what to replace it with?

Paul: There are many possibilities when it comes to new technologies, and the decision on which system to purchase depends on the digital road map and the goals of the care facility. Many hospitals purchase technologies without thinking about how they fit into the bigger picture. Then, the technology becomes a dead end.

A new system should not be purchased because it is the shiny object that is drawing your attention now. The system should help you accomplish your goals in two to three years. Technology systems are a long-term commitment. It is more of a collaborative relationship; it’s not what you need now, but what you will need to work for several years into the future.

The importance of open source technology is not obvious to some. Can you explain why it is necessary?

Paul: Open source mentality means that the technology can connect easily and there are not proprietary standards that make it impossible for one vendor to connect to another. In the past we have seen big companies not embracing open source because they want to control the standards and want customers to buy exclusively from them. I try to avoid systems like this. I think it is important to be able to connect everything. Open source programs like Linux are key.

How can hospitals implement technology that increases interoperability and move the industry in a new direction in the interest of the greater good?

Paul: It is important to break down the silo mentality and get everyone, especially the end users, on board with the technology that is going to be implemented. It is easier to do this now as opposed to 20 years ago because of the pervasive nature of technology – everyone uses technology. The chip in your smart phone is more powerful than the computer that was on your desk 10 years ago.

The people who need to adopt the technology should be the people who are involved in building it. I have gone on rounds with physicians once a month and partner with doctors to ask how they are using devices, how they would like to see things change and if they have any new ideas. Partnering with people on the frontlines is vital because they are the ones who are ultimately using the systems. They need to be involved from step one. It’s a partnership. The technology should help them achieve their goals; it should not simply be pushed on them.

Nurses are usually ahead of the IT department when it comes to knowing what they want. If nurses do not have a system that can do what they want, oftentimes, they will find a way to do it themselves. For example, at a hospital where I worked previously, nurses wanted a secure text messaging system, and they were not getting one from IT. They got one themselves and started using it. IT needs to be aware of the latest trends, and a lot of that comes straight from the nursing staff. It’s not about trying to convince them to use new technology, but finding out what fits in with their needs.

What is the most excited development regarding big data in healthcare?

Paul: The most exciting development is being able to have a data warehouse or a repository that you can start managing patients from multiple angles. For example, we are starting to get data on people’s health when they are not in the hospital or at a doctor’s appointment. They can be out and about or at home.

Patients can show their doctors what their heartrate has been in the last 60 days from their FitBit. We have never had a window into people’s health at these times before. That data coming in and being correlated is a real leap forward in terms of disease management.

The challenge is extending the network out to people through the cellular network and being able to incorporate it into their health record. I think this capability will be mainstream within the next two to three years.

What advice do you have for millennials who aspire to become CTOs in the industry?

Paul: Spend a lot of time in a hospital: Volunteer, see how things really operate, how hands-on nurses and doctors are with patients, how things go to the lab, how you get results, and what technology is used and needed. Being a CTO is not all about data and technology; it requires being in the field and engaging.


We are glad we got the opportunity to speak with Paul and gain insight on these important conversations. What are your thoughts on the state of healthcare IT today? Tweet at us @amplionalert with your thoughts.

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