Next in Digital Health
The chief digital and information officer discusses navigating the expanding CIO role, managing technology portfolios, building data commons, and approaching AI with deliberate oversight.
George T. ‘Buddy’ Hickman is chief digital and information officer at Roswell Park Comprehensive Cancer Center, based in Buffalo, New York. A digital health executive with more than 30 years of experience, he has led technology, data analytics, biomedical engineering, and cybersecurity initiatives across academic health systems, critical access hospitals, and federally qualified health centers. Hickman is a past board chair of CHIME and HIMSS and a recipient of the CHIME/HIMSS CIO of the Year award.
I've been in my current role for about two years. Before coming here, I did two interim CIO jobs where I was holding all things IT together and playing a significant role in the recruitment of the next person who would take the permanent role. Earlier in my career, I spent a dozen years consulting for firms like PwC and Ernst & Young. However, I also have served as CIO for over two decades in mostly academic health science centers and am grateful that I was allowed to step into the role at a fairly young age.
The sum of my career has been in healthcare. I knew before I graduated undergrad—my schooling was in industrial and systems engineering—that I wanted to work in healthcare so as to be a part of the care mission. So, my first job out of school was doing just that, and I've stayed with this mission thereafter. When the opportunity with Roswell Park Comprehensive Cancer Center presented, and looking at the cancer cure mission of the organization, I was compelled to join. It is one of the nation's oldest cancer centers, among the first to receive the designation of Comprehensive Cancer Center from the National Cancer Institute, and many remarkable cancer cure advances have occurred here.
It can feel complicated as the job clearly has gotten bigger and broader. The way technology is evolving, and the pace of that change today compared to 20-30 years ago, is remarkably different. If you take a look back, one executive probably dealt with all those technology-related functions you named. And today, if you go to a community hospital setting or a smaller site, you've probably still got one person trying to manage all of those different disciplines.
It's funny, I remember in the early ’90’s when there were articles saying that “CIO” means “career is over.” You still hear that now because of the role’s ambiguity. The conversations back then described the CIO as somebody who was very focused on operations, efficiency, and technology rationalization, and there was doubt about whether the CIO could play strategically in the boardroom. Well, I'm glad to say they were wrong because clearly the role still exists and has proliferated. Today, with the ambiguity of the role relative to other similar roles and with so many paths of technology advancement, the work remains a remarkable challenge. I’m beginning to see more executives with combined titles like my dual role as digital and information officer. We are in serious dialogue about bringing in a chief AI and data officer, combining those roles to ensure that we're covering both related needs, yet with a broadly competent executive who can capably cover more ground at our scale.
There are two fundamental concepts that come to mind here: Shared governance and portfolio management. Shared governance means the senior leadership team get together and agree on principles that help define what is important and guide how they’ll make decisions together about technology and data investments. Those guiding principles can give you an immediate filter about what it is you're going to spend your time and energy on.
Regarding portfolio management, we live in a world of supply and demand. The flood of good ideas and technologies that cause us to respond to every query that we get is endless; we could spend our whole day doing nothing but reacting and putting requests into a queue. Instead, we need clarity that comes with the fact that we are living with finite supply, and that we must set up the structures and guidance to make decision making easier as a shared leadership team. Another facet of that work is expecting that a business case is developed by an owner for each investment idea. The owner outlines the benefits that are going to come to the organization and what the costs are to deliver that. Then any respective business case competes with other business cases to come into an agreed portfolio.
If in some cases the demand is too great to say “no,” and you're very careful about how you measure and you're following the core principles, you might have that inkling of a chance to increase the supply side through funding and resources. Obviously, you’ve got to have a record of successes to get organizational trust and an open dialogue about when it's time to adjust or course correct. But I'm glad to say here at Roswell, putting all that into place and watching this executive team be willing to have that trust with one another and work on that agenda together has proven to be highly effective.
If we don't grow, we die, right? That’s fundamental in the business lifecycle. We always have to be thinking about the growth side and not solely focus on the cost management side, and therein is the balance. We are considering additional bricks and mortar for other outposts to deliver our mission. We think of that in the context of how the volumes and revenues that come with that growth are specific to the missions we serve. Also, we think about sponsored clinical trials and other work that provides growth on the research side and with additional research sponsorships. So, growth is key for the business and survival.
At the same time, one cannot act without constantly examining where something needs to be from a cost structure standpoint and then make those adjustments. Margins are just too tight these days for some of us. We’ve had pressure on the research side in the last several years that trickled down from the federal government and other private organizations who provide research funding. The payer climate is more challenging than ever on the clinical side. The challenges don't go away, so the balancing conversations are constant.
One of the early principles I remember from my consulting days is that tacit knowledge is worthless, and it’s the same with data. Certainly, the data game changed remarkably in the last decade given the sorts of tools that are now available to allow us to manage data from various sources, triangulate that data—or as a friend of mine likes to say, "interrogate the data until it speaks.” That's the game now, whether it's for evaluating the clinical enterprise, the revenue cycle, or our research. When more data comes together as with a commons, greater opportunity comes along with it.
Very, very carefully. On the clinical enterprise or care delivery side, the culture of healthcare is organized around “First, do no harm,” so risk management is woven throughout our business. Contrast that with scientific discovery, where the game is about innovation and stretching beyond what we may have imagined yesterday. For us, AI works in those two different camps.
When I arrived here, we wrote our first AI policy. I took the time to survey some colleagues because AI policy writing was still fairly new, and we needed to do some benchmarking. In time, we published that policy, an effort that included surveying others like us and even dialogue directly with the National Institute of Standards and Technology (NIST). Then comes the matter of determining how you internalize policy by what works for the organization. Hence, we just finished drafting our first revisions to the AI policy, and the first carve out had to do with the difference in those two camps. For example, if you're using AI for basic science and computational research, and it has no leanings toward clinical use, that AI risk management care should fall to the rubric of peer review that research already uses as a standard of practice. Alternatively, when that research moves to the clinical side—meaning translational research or in the form of a clinical trial—the AI needs the same risk management oversight that we give anything coming into the clinical enterprise.
We have a number of AI use cases in play, and they have gone through our executive risk management review. Our board members frequently ask questions about where we are with AI. Sometimes a member will note something they read regarding downsides that are occurring with AI and express a very sincere form of worry around AI’s potential for harm. We are being appropriately careful. To return to your base question, for today, we are much more likely to do AI-assisted applications with human overread and risk oversight than run toward autonomous agents.
When I was teaching at the CHIME CIO Boot Camp, we always had a reading bibliography for whatever success factor we were teaching. From an industry thought leadership standpoint, my content would carry a goal of getting the CIOs to read what CEOs are reading and to look in that direction for leadership guidance. Beyond that, I find myself still today quoting authors like John Kotter and his eight-step model for leading change, most anything written by John Maxwell, and a few others.
When I get up in the morning, I give myself 30 minutes of quiet time with a cup of coffee, not doing much of anything but being still. It sets me up to process what's coming in the day ahead to allow myself to get ready for the game.
I'll mention two. One lesson I learned in my early days at PwC from a long-term mentor is that when you're selling an idea and the audience says “yes,” stop talking.
The other leadership lesson came from my mom. When I was 7 or 8 years old, my mom asked my younger brother and I what we wanted to be when we grew up. My brother said, “I want to be a pony.” And being the older big brother, I said, “You can't be a pony when you grow up.” And she looked at me and smiled and said, “You both can be whatever you want to be…when you grow up.” We can be what we want to be “when we grow up,” and depending on our stage of life and what we're doing, continually reinvent ourselves.
Vizient Senior Director, Intelligence
As a senior director on the Intelligence team, Andrew Rebhan leads thought leadership and content creation for digital health research at Vizient. In this role, he keeps members up to date on the latest technology trends and how to plan for new, disruptive forces and innovation entering the health care industry. Areas of interest include artificial intelligence, consumer medical technology,...
