Robert Slepin is chief digital officer and senior vice president at Markham, Ontario-based SE Health and emeritus CIO adviser at EHR giant Epic. SE Health is one of the largest diversified home health organizations in Canada that includes a dedicated research center, health career college, futures lab and global enterprise. The provider organization has facilitated transformation in the areas of aging, education, Indigenous health and end-of-life care.

Slepin has more than 35 years in health IT. He said a combination of being in the right place at the right time and several key decisions were pivotal in giving him opportunities to gain practical experience in digital transformation and in shaping his career as a healthcare CIO and digital advisor.

Past employers and clients have included Johns Hopkins Medicine International, Stanford Children's, Sutter Health, The Hospital for Sick Children (SickKids), Alberta Health Services, Hamilton Health Sciences, University Health Network and others. His experience includes serving as a health system CIO and as CIO or program director and/or advisor for numerous health information system companies, including ones specializing in EHR, ERP, AI, analytics, digital health and more.

A specialty over the past fourteen years has been advising and helping healthcare organizations to plan, execute, oversee, and realize value and return on investment from large-scale Epic, digital health and enterprise IT projects, enabling transformation.

Today, Slepin is working on a major digital transformation project at his new employer, SE Health. Healthcare IT News sat down with him to discuss aspects of digital transformation efforts that provider organizations don't quite have a firm grasp on to begin with, the primary technologies involved in digital transformation, how to organize such a comprehensive effort as digital transformation, and his transformation effort at SE Health.

Q. What would you say is the most important thing hospitals and health systems should know about digital transformation efforts that perhaps they don't quite have a firm grasp on to begin with?

A. There are so many things hospitals and health systems should know about digital transformation and don't know – or know and don't do – that it is a challenge to call out one thing alone for them to focus on getting a better grasp. Transformation can be extremely complex and complicated, especially the larger and more complex the domain you have in mind.

Accordingly, there is not one thing to be done; there are numerous things to be done and many of them at the same time, and there are local nuances, interacting effects and environmental changes along the way that causes "best practices" not to necessarily work the way you think they will.

Perhaps the most important thing to have a firm grasp on, therefore, is that you cannot have as firm a grasp on transformational programs as you do on day-to-day operations or simpler optimization projects.

By their nature, digital transformations are difficult and unpredictable and will require an adaptive, learning mindset; humility; and curiosity. Textbook approaches won't work off-the-shelf; adaptation is required. Experimenting along the way is necessary for ongoing learning and adjusting course based on real-time feedback.

Digital transformation is an extremely tall challenge especially if you view it in the way McKinsey describes as "the rewiring of an organization, with the goal of creating value by continuously deploying tech at scale" – and considering a need to keep one foot firmly planted in today's operating environment to maintain stability while you simultaneously are shaking things up while reimagining the future.

A critical success factor in leading a digital transformation is the guidance and support of one or more executive sponsors. If the aim is a strategic, enterprise, long-term reimagination of the business, it must be led from the top of the organization: The CEO should be responsible and accountable to create a compelling, clear vision for the direction and collaborate with their leadership team to gain support for the new direction across the entire organization.

Without the active, visible sponsorship of the top leaders of the organization, supported by the board, the process will at best likely be sub-optimal and outcomes fall short. In a worst-case scenario, the transformation will be a disaster and the initiative canceled.

If the aim of the digital transformation is less ambitious, for example, to transform or optimize a business process and not the entire business, executive sponsorship still is crucial. In this case, the sponsorship might not require the CEO to be the cheerleader but rather another member of the C-suite holding accountability for that domain of the business.

Q. What are the primary technologies involved in digital transformation, and who should be leading the way with each?

A. The technologies involved in digital transformation will vary depending on the scope of the initiative. Several examples of technologies that might be involved in transformation include:

• Enterprise applications, such as EHR, ERP and CRM software

• Bolt-on applications, such as third-party software connected to an EHR, ERP or CRM

• Cloud computing, for example, network access to a scalable and elastic pool of shareable resources enabling users to self-provision on-demand

• Platform-as-a-service, essentially a cloud system that includes hardware, software and infrastructure, to develop, run and manage applications

• Digital front door, essentially a patient experience platform provided by an EHR vendor, another vendor, or custom-developed in house or with a vendor

• Artificial intelligence, such as machine learning, generative AI and agentic AI

• Internet of things, essentially biometric devices connected to patients in their homes or while on the go

• Mobile devices, for example, handheld devices; wearable devices on body, in visual field or over ears; vendor apps; or custom-built apps

• Automation, such as robotic process automation and more modern AI platforms and tools that go beyond traditional RPA capabilities

• Digital twins, essentially digital simulations of patients moving through facilities to model and improve flow or twin of a human body and genome to be more precise in diagnosis and personalizing treatment

Leadership for each technology, project and/or program will depend on the organization. Smaller hospitals and healthcare organizations might have a single tech executive in charge of planning and delivering the system, for example, a CIO, CDIO, chief digital transformation officer or CDO.

Larger enterprises will likely have one or more additional positions as part of the broader transformational leadership team. For example, CTO, chief applications officer, CAIO, CISO and chief analytics officer. In all cases, it is crucial to have senior business leaders who are co-leading and/or sponsoring or co-sponsoring, at the executive level, any transformational initiative.

Unless the transformation is extremely narrow and impacts only the technology team, business leaders will be critical to partnering with the technology chief(s) in leading change. The chief human resources officer, COO and CFO are some of the executive officers who you would expect to see participating in key leadership roles.

In healthcare, other senior leaders essential to collaborating with technology and business leaders to imagine and make change happen include titles such as CMO, CNO, CHIO, CMIO, CNIO and chief practice information officer.

Q. How do you organize such a comprehensive and wide-ranging effort as digital transformation?

A. Critical success factors, in my view, include leadership from the top; establishing cross-functional teams with a clear vision and mission; linkage between these teams and the rest of the organization; and a transformation management office to keep everyone organized and synchronized.

I would make the teams as small as possible to be efficient and nimble, but they should be representative of the groups that have a stake in the change. Some leaders abide by the two-pizza rule made famous by Jeff Bezos; I would advise not to follow this rule strictly in a hospital or healthcare setting.

Engaging people is critical; if you artificially constrain the size of a team to, let's say, seven people when the size and complexity of the population being affected is not well represented by this small group, you run the risk of some if not many groups feeling disengaged in the process and this issue will come back and bite you later.

For example, if your academic health sciences center has 40 clinical subspecialties across a dozen medical and surgical departments, and you populate your provider advisory council with only seven physicians, nurse practitioners and physician assistants to guide a massive clinical transformation – good luck to you! I think that's too small a number for this kind of organization in this context.

To tailor these key ingredients into a form that works for a specific organization, there are numerous ways that companies can organize the details of their digital transformation initiatives, depending upon the objectives, scope, structure and culture of the organization, among other factors.

Many hospitals and healthcare organizations have recent experience, are currently implementing or planning to install a modern EHR system as an enabler for transforming the experiences of patients, providers and health professionals with an aim to improve the safety, efficiency, quality and experience of patient care while establishing a foundation for ongoing improvement and innovation.

These kinds of programs are examples of a type of digital transformation from which healthcare organizations can learn to determine what works well, what does not work well and what they should consider adjusting to improve how they organize for future efforts.

Some hospitals and healthcare organizations desire to set a higher bar and truly reimagine the experience of patients, families, providers and other stakeholders in a broader digital transformation that will be core to the business strategy – and not be just a one-time project or ongoing program.

These care providers should be open to questioning and changing everything, thinking differently and aiming to create entirely new, better models of care delivery, more efficient, engaging end-to-end processes and journeys, and shifting focus from sick care to preventive health and wellness. They should think differently about how they organize their efforts going forward and not do things the way they always have.

I would recommend looking outside of your own walls and outside healthcare for inspiring examples of successful companies across industries and across the world to learn from and inform the design of your transformation initiative. Getting outside perspectives from management consultants, advisors, peers, customers, patients and other stakeholders can inform your planning.

Q. Currently you are working on one of Canada's largest healthcare providers' digital transformation strategy, which includes telehealth triage, virtual care, transitions of care, hospital-at-home, home care, remote patient monitoring, seniors' living and other initiatives. Please talk a bit about this project and some of the advice you've given.

A. After serving as board advisor for a digital transformation initiative at SE Health, I became their CDO and senior vice president earlier this year. SE Health is among Canada's largest not-for-profit social enterprises, providing healthcare services across home and community care, long-term care, acute care and primary care. Its customers include governments, regional health authorities, hospitals, the seniors' living sector, community organizations and consumers.

Project Acorn, as the digital transformation project is named, aims to revitalize SE through people-focused transformation of technology, processes and how we work together. Its scope is expansive – including health records, patient relationship management, finance, payroll, human resources, enterprise service management, and cybersecurity, privacy and risk management.

It's early days for Project Acorn, which had been in the initiation phase during 2023-24 and is formally kicking off this month, following the conclusion of vendor selections and contracting with several partners for software and professional services to assist with systems integration.

Of course, at this stage of inception, there are no outcomes to report yet. But I am happy to say there is extremely strong commitment and active, visible leadership from the board of directors, CEO, senior leadership team and people across the company.

SE has a clear, compelling vision for the future, has a transformation plan and roadmap, is up-staffing and up-skilling, has formed a governance structure and project teams, has established a transformation management office and has partnered with systems integrators.

SE is well organized and beginning to move forward with reimagining care at home, people and finance modernization, enhancing our privacy, security and risk management, and improving the experience of clients and team members across the organization.

The technology SE has chosen is new and incredibly exciting – but the real magic is the way that people across SE are coming together to redesign so many aspects of the way we do things to create a better future for SE and, most important, to improve the health and lives of those we serve across Canada and the U.S., and beyond through our research institute and social impact work.

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