healthsystemCIO Weekly Roundup: Guerra on Weeding, Bhaskaran on Informatics, Kelly on Ambient AI, and More

Letter from the Editor

Staying Out of the Leadership Weeds

Occasionally, my reading jumps from topic to topic with no apparent connection. More often, one book leads to the next. That happened recently when I moved from a wonderful Abraham Lincoln biography to one on Jefferson Davis. I wanted to see what was happening on the other side.

In Lincoln, we see a leader close to perfection, but not quite there. At the start of his term, Lincoln spent far too much time dealing with office seekers and those requesting small favors—matters many around him felt were beneath his pay grade—and not enough time on unfolding issues.

His anterooms, halls, and staircases “swarmed with office-seekers,” and for weeks he devoted 12-hour days to receiving them. Pressed by secretaries John Nicolay and John Hay, he tried to impose visiting rules—limiting callers to brief late-morning windows on designated days—but the system often collapsed under the crush. One newspaper even ran an engraving of lines of petitioners outside his rooms, emblematic of the time such audiences consumed. Lincoln told Sen. Henry Wilson, “They don’t want much, and they don’t get but little,” even as he continued to grant broad access to job- and favor-seekers—a workload his aide John Hay later described as a “general sea of solicitation.”

Interestingly, although Lincoln complained about this, he later admitted it kept him in touch with how people felt about his administration and the issues of the day, allowing him to gauge how far he could push his policies without getting too far ahead of the population.

So, in meeting with all these people, Lincoln did what he liked, though perhaps not what he should have been doing with his time. We all tend to slide toward what we enjoy, even when it isn’t what our role requires in the moment.

On the other side stood Jefferson Davis, a man temperamentally unsuited for his role. While Lincoln knew the job was to keep a shaky coalition together by compromising and cajoling, Davis was haughty, imperious, and inflexible. He took offense easily, then dove headlong down the rabbit hole of back-and-forth squabbling, never forgiving or forgetting a slight if he could help it. He made many enemies and wasted tremendous amounts of time on issues that only hampered his cause.

Davis often turned strategic disagreements into personal quarrels with his most important allies. His long-running feud with Gen. Joseph Johnston climaxed during the Atlanta campaign, when Davis complained of Johnston’s evasive dispatches. He also waged a pamphlet-and-letter war with Georgia Gov. Joseph Brown over the 1862 Conscription Act and state exemptions, a “ritual struggle” of bitter correspondence that weakened cooperation across the Deep South. Even his vice president, Alexander H. Stephens, broke with him over conscription and the suspension of habeas corpus, publicly siding with Brown and denouncing Davis’s centralizing measures. After First Manassas, Davis formally dismissed P. G. T. Beauregard’s battle report as impractical, a rebuke that deepened their estrangement.

He was also notorious for spending countless hours on minutiae that could have been delegated to staff or cabinet secretaries, yet he held on to these issues like grim death. Author William C. Davis writes of one instance, “Too ill to go to the office, he worked at home, and took refuge in the petty details in which he always found sanctuary from the great issues he could not solve.”

And therein lie some major leadership traps.

Recently, I heard Shark Tank’s Kevin O’Leary talk about how Steve Jobs and Elon Musk have the rare ability to filter out such noise and focus on the signal. They stay on task and focus on what matters, while the rest of us mortals get distracted—and gravitate to work better left to subordinates. We sometimes revel in the minutiae because it’s where we’re comfortable, where we have control.

Sometimes we revert to tasks we loved in a previous position—tasks that should have fallen out of our portfolio upon promotion. When we move up, we may be in a position to elect to retain something (“Oh, I’ll still do that”), but there are only so many hours in the day, and tasks improperly retained can crowd out new ones that should be assumed. While those who now report to us could and should take on those lower-level functions, if we eschew the work that rightly belongs to our new role, there’s no one to pick up that slack.

And keep in mind: when you do this, everyone knows it; everyone sees it. The people who should be doing that work feel they aren’t trusted. They also question why you feel the need to hold on so tightly. They know instinctively that whatever you’re supposed to be doing isn’t getting done—and that kills morale.

What’s a telltale sign of this? Do you usually skip the first two or three items on your to-do list and jump to number four because it sits squarely in your comfort zone? Do you leave the true leadership work for the end of the day because you’ve run out of hiding places? Of course, by then, you’re running on fumes.

Leadership takes discipline. When you take on a new role, you have to step into new duties and give up the old. You have to offload the small stuff to support staff and direct reports so you can focus on the big picture—so you can chart a course rather than fill the gas tank. There is so much good that comes from delegating and empowering. Only when everyone, including you, is working on the right things can it all come together—and your shop run the way it should.

Related Reading:

Find this column online

Thoughts on this piece? Drop me a line aguerra@healthsystemCIO.com

Featured Interview

Mayo’s Bhaskaran Outlines Playbook for Making Tech “Stick”

Edwina Bhaskaran, Chief Clinical Systems and Informatics Officer, Mayo Clinic, outlines an approach to making technology “sticky” by anchoring adoption to simplicity, timeliness, workflow fit, and measurable outcomes. She details modular training matched to roles, enterprise change-capacity planning to reduce fatigue, and rigorous portfolio rationalization—including decommissioning and pilot discipline. Bhaskaran cautions against one-size-fits-all “80/20” decisions and urges AI deployments that redesign processes rather than layer tools, ensuring clinicians feel change is shared, purposeful, and responsive.

News, Articles & Columns

Your Epic Analysts are Building the Wrong Things (And It's Not Their Fault)

John Lee, MD, Clinical Informatics Specialist at The MetroHealth System, argues Epic implementations often digitize legacy dysfunction by replicating prior workflows, creating technical debt and wasting native capabilities. Analysts aren’t at fault; comfort-driven requests and go-live metrics are. Lee urges reframing from “how” to “why,” prioritizing outcomes, data capture, and clinical decision support. He calls for leadership commitment, governance, and optimization so Epic becomes a platform for transformation, not a faster version of yesterday’s EMR.

Houston Methodist Pharmacy Services Embrace Innovation and Virtual Care

Houston Methodist's Michael Liebl, Director of System Clinical Pharmacy Services, and Daniel Metzen, Senior Director of System Pharmacy, write that the organization's pharmacy program leverages virtual technologies to strengthen medication safety. Integrated camera platforms capture accurate home medication and allergy histories for ED admissions—piloted at Cypress Hospital and expanding systemwide—enabling safer reconciliation and discharge instructions. The model adds family or translators but faces challenges in noisy triage areas and with mobile devices. Next steps include virtual product-preparation checks, witnessed medication wasting, and on-demand pharmacist consults, with contingency plans for platform reliability to sustain patient outcomes. (published on Roberta Schwartz's blog)

Partner Perspective: Drawing on Global Experience, Heidi Health’s Kelly Offers Advice on Optimizing Clinician AI Adoption

Dr. Thomas Kelly, Co-Founder & CEO, Heidi Health, outlines a playbook for clinician AI adoption: build a cross-department council of super-users, design specialty-specific workflows inside and outside the EHR, and measure activation—not licenses—with explicit exit criteria before scaling. He urges seeding train-the-trainer materials, starting with high-friction tasks beyond notes, and preparing governance for emerging regulation. Done well, adoption delivers capacity gains, documentation improvements, greater throughput, and clinician sentiment.

Possible Approach to Implement a New Information Security Framework

In this piece, Derek Pizzagoni, former CISO, Children’s Hospital Los Angeles, outlines a path for adopting a new information security framework. He stresses executive engagement, clear roles, and aligning objectives with business goals while presenting ROI without fear-based tactics. After securing support, identify stakeholders, form a working group and steering committee, and educate staff through materials. Embed security in mission and culture, budget with finance and HR, and sustain momentum via gamified training, recognition, and investment.

When Bigger Wasn’t Better: Addressing the Failure to Scale in Healthcare Data Teams

Jeff Clark, AVP, Enterprise Operational Intelligence, Advocate Health, and Holly Hallman, VP, Data Architecture and Analytics, Children’s Health, examine why healthcare data teams fail to scale. Using discrete-event simulations, they show that role specialization, handoffs, and ticket-driven queues inflate wait times—despite equal capacity—per Kingman’s formula. They advocate full-stack delivery teams, a single value-prioritized backlog, minimized approvals, and modern SQL-centric platforms enabling secure, end-to-end ownership. The payoff: faster, business-aligned analytics delivered through composable, use-case–driven data products.

H-ISAC Report Warns of State-Criminal Cyber Alliances

An emerging blend of nation-state services and criminal gangs is reshaping cyber risk for large U.S. health systems, a new report from H-ISAC warns. It details Russian safe harbors for ransomware crews, North Korea’s crime-as-statecraft, Iranian proxies, and China’s contractor ecosystem—each accelerating attacks and obscuring attribution. Recommended actions include patching, MFA, segmentation, tested backups, vendor-access monitoring, and DDoS playbooks. Leaders should institutionalize threat intelligence, rehearse downtime procedures, and validate EHR/EMR continuity to sustain clinical operations during disruptive incidents.

Laboratory Data Standards for Interoperability

Authored by ONC’s Sara Armson, Senior Health IT Specialist; Molly Prieto, Principal Deputy Director, Office of Standards, Certification and Analysis; and Steven Posnack, Acting Assistant Secretary for Technology Policy and Acting National Coordinator for Health IT, this ASTP/ONC report reviews laboratory data standards across the testing lifecycle. Grounded in research, it identifies barriers—local codes, slow updates, weak incentives—and recommends certified health IT, public-health lab modernization, TEFCA participation, and aligned incentives to advance nationwide interoperable exchange.

Enterprise Imaging Leaders Gain Ground, KLAS Finds

Health systems are reshaping enterprise imaging lineups as experience shifts. AGFA rebounds to Best in KLAS with VNA and XERO Viewer, while Fujifilm and Merge top VNA performance. GE’s Universal Viewer improves, but support issues remain. Sectra’s bundled VNA is widely considered; Visage’s viewer often replaces front-end PACS, with a VNA in development. Cloud adoption is advancing (12% live, 4% signed, ~29% planning). Provider-led expansion adds POCUS and scopes; pathology lags; most viewers are referential.

Annual Sponsor Updates

Virtual Agents are Everywhere—Yet Not All Are Created Equal: Why Artera for Autonomous AI Agents

Overheard at the Doctor's Office

A senior medical office worker training a new employee on how to do something on the computer:

"I did this the long way for years because no one ever showed me."