How does Cleveland Clinic London invest in AI and healthcare IT?

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc. 54 people in IT, 6% of the hospital budget for IT, EPIC and additional 100 healthcare IT systems.

[00:00:26] This is the infrastructure of the Cleveland Clinic London. In Berlin at the Digital Health Excellence Forum, organized by Smart Bridges, I spoke with the CIO of Cleveland Clinic London, Rehan Mugal, about how does the healthcare IT infrastructure work, how does the hospital invest in AI and what are the guiding principles when it comes to healthcare digitalization.

[00:00:56] As Rehan emphasized, CEOs are concerned about three things, revenue, costs and risks. So CIOs need to keep thinking about how can they increase revenue, reduce costs and mitigate risks. Enjoy the show and if you haven't yet, do check out our newsletter. You can find it at fodh.substack.com. That's fodh.substack.com.

[00:01:25] And if you haven't yet, leave a rating or a review wherever you listen to your podcast, subscribe to the podcast and stay tuned till the next episode. Now let's dive in. Rehan, a little bit of improvisation here at the Digital Health Excellence Forum.

[00:01:54] I'm very glad that you took the time for a few questions. You just had a presentation about the Cleveland Clinic in London. The project started in 2016. The hospital was built from the ground up. It opened in 2021. And your role is the chief's basically transformation innovation officer. After four years, in 2025, where is Cleveland Clinic?

[00:02:22] From a technology perspective, innovation is one of our core values. And so we continue to look at opportunities in the innovation space. How can we use technology to improve the patient experience? That's really our guiding principle. Patients first in every decision that we make. We've been highly successful today. We just achieved in stage seven. And we're the first European Epic customer to achieve honor roll.

[00:02:47] And we continue to look at ways that technology can be used to transform the organization. You mentioned in your presentation that you use over 100 systems, despite the fact that you use Epic, which is a large system that covers many other aspects. What types of systems are the 99 of the others? Yeah, absolutely. So I wish that Epic could do everything. Unfortunately, it can't at the moment. And I know they're looking to develop their roadmap in that space.

[00:03:16] But we have a number of systems on the HR side, on the finance side, ERP systems. We also have a lot of third-party systems in imaging and heart vascular, et cetera. So unfortunately, that's the golden place that we want to get to is to consolidate down our application stack. So reduce our costs, reduce our infrastructure and go Epic first. But there are a few areas that Epic can't currently do. Yeah, yeah. Where do you use AI?

[00:03:41] And can you talk a little bit about how you choose the AI products that you use? You mentioned that basically in the U.S. there's a pilot with five different ambient solutions currently taking place for a year. Yes. And that's when you're going to decide which one is going to stick. Yes. Yeah, so actually our UN site has just decided on who their ambient provider will be. In London, unfortunately, we can't use that tool currently because it's not GDPR compliant.

[00:04:10] In terms of our governance around AI, it's quite simple. We're looking at tools that help with the patient experience on the clinical side, make our hospital more efficient. And so we're looking at all examples in that space at the moment. Ambient certainly has a great opportunity to reduce the amount of time that physicians spend in a patient note. Unfortunately, EMRs, having big EMRs are great. They're very sophisticated, but it takes a lot of administration to document correctly.

[00:04:39] So Ambient is one of the examples that we're looking at. We're also looking at tools in decision making. When you think about any hospital, any healthcare system, it's very complex. And I could look at some data from disparate systems and make a decision on nurse staffing, for example, to say this is how many nurses that I need on any given day based on patient census, based on how many patients are in outpatient beds, et cetera.

[00:05:04] You could look at that data and actually come up with a different determination around how many staff you need on that given day. So we are looking at the use of advanced analytics within the AI space to help us with some of that decision making. ORs is another great example. We have eight OR theatres in our hospital. And the key is to make sure that those ORs are always full. It's one of the highest cost resources in any hospital organisation.

[00:05:32] And again, trying to get all of that scheduled with the right staff at the right time can be difficult. And that's the right decision making. Your role as the chief innovation officer is also to be mindful of the increased efficiency and increasing cost in the last five years. What have you managed to change to achieve those roles? Yeah. So I always say CEOs are concerned about three things, and that's increasing revenue, reducing cost and mitigating risk.

[00:06:01] And we've been very thoughtful around how we measure the success of IT implementations and transformation. And that's always going to be on return on investment and also a fairly new concept about return on employee. And that's very important. Going back to Ambien, we talk about the efficiency gains that you can have in reducing the amount of time in a note. Actually, there's a real phenomenon around physicians leaving the organisation. They're getting burnt out. There's just too much for them to do.

[00:06:31] So we actually measure both of those components when we make selections around tools that we're going to be using or efficient that can happen for our organisations. Going back to AI, how much time do you take from finding a solution, testing the solution and actually implementing and buying that solution? I mentioned the one year pilot earlier. Yeah. But with new and new things coming up, how does that process look like? Sure.

[00:07:01] I would say we're very conservative. Absolutely. Take your time to make a decision. Run pilots. Be sceptical about what vendors are promising, because many vendors are promising the world. So, yeah, we are very conservative in our approach. We like to pilot over an extended period of time, as you mentioned, with Ambien before we make a decision. And it has to be the right fit for the organisation, not just in terms of the value it brings to our patients, to our caregivers, but also from a cost perspective.

[00:07:30] If we're removing one of the 100 systems that I mentioned and replacing it with an AI alternative, that's great, but there has to be a return on investment. How do you measure return on employee? So, many different ways we survey our employees, whether it's physicians or clinicians, has this tool made your life easier? We also look at retention rates.

[00:07:53] So, not just, again, on the clinical side, from an IT perspective, is the use of innovation and being involved in these projects, does that keep employees with the organisation? And then, lastly, we actually pull the market and see our doctors, clinical teams joining us because we're known for innovation. And therefore, they know working for an organisation that is highly innovative, that will make their job easier, and it actually becomes a USP for them to join us.

[00:08:21] When you mentioned that it's good to be rigorous about what you implement, I can totally get that from the hospital perspective. You have to be careful about what you invest in. I get that from the patient perspective, because obviously you don't want to get hurt by AI. However, from the Western perspective, it's a bit more difficult to survive if you just have to run these long pilots.

[00:08:47] So, how do you, what kind of financial structures do you have around paying for the pilots? And then also, how long are the contracts that you sign with the vendors? Yeah, sure. So, actually, today we've had good participation from a lot of these startup companies who are offering tools to us. And actually, they're either willing to work at risk during the pilot phase or at a very reduced cost, almost at cost, if you like, just to prove the concept of the product.

[00:09:17] And actually, as a CIO for Cleveland Clinic London, that's what I'm looking for in our partnerships, in our vendors, is not to come to us and say, yes, we're going to charge you X amount for a pilot that may not actually go anywhere, but say, look, we'll put this tool in, obviously, through our governance process and make sure that it adds value to you, and then we can talk about commercials. The ambient listening vendor that we are piloting, we're due to start piloting next month,

[00:09:42] has come to us with a at-cost proposal for the pilot, and that will be a one-month pilot. And at the end of that phase, if we feel it's added value, then we'll enter into probably a one-to-two-year agreement with them going forward. How come you're going to only pilot for a month? We're a fairly small organization, and our goal is to run a pilot with 20 different providers across four different specialties, let's say, for example.

[00:10:09] I think because our Cleveland mothership has gone through this process over the course of a year, we understand what to look out for, we understand what to measure, and that's really why we're able to shorten that pilot phase. In your presentation, you mentioned that you have a quite large budget for innovation, so 6% of the hospital budget goes to IT, which is a lot more than many hospitals, especially in Europe, can afford.

[00:10:37] So how do you see the question of technology in other systems, like in the NHS? You said that IT should become a commodity with digitalization, that's an understandable statement, but I do wonder, how do you see the challenge of budgets that many other hospitals are facing that are in the public systems? Yeah, absolutely. It's a great question. I talked about removing variability, removing or ensuring consistency.

[00:11:05] And I think if you look at the NHS or you look at any other large healthcare system, you'll go from one hospital to another, and things are done slightly differently. And with variability, that increases costs. So really what we've been successful in doing with Cleveland, with London being the hub, is having shared support resources, shared systems, and some of our business systems. And that brings down the cost of running your IT shop.

[00:11:31] So my advice to any big healthcare system is to look at the hub and spoke model, if you like, where you have shared capability and expertise from your mothership. And then you have local expertise where it's needed in your local hubs. One thing that also stood out for me was, you mentioned that because you're in IT, it's important for you to walk around the hospital, ask people how they're doing,

[00:11:59] where are the inefficiencies, observe the work, ask questions, to just be closer to the patient. And I wonder, in the last five years, where do you see that you managed to improve things most because of these observations? Yeah, that's a great question. And we certainly need to do more asking our patients. So I spend, as you said, a significant portion of my working week or month floor walking,

[00:12:25] asking clinicians, asking nurses, what do they think of the systems, show me how you work, an hour in your shoes kind of thing, looking at whether the systems that we provide actually provides benefit and value and looking for those opportunities for waste and frustration and can technology be used to solve some of those problems. I think I've got numerous examples of where we've identified those pain points and then we've put systems or solutions in place. You know, let's take communication tools.

[00:12:54] For example, we use VoiceAera, which is our communication tool across the hospital, and that's used to make sure that patients can get, sorry, caregivers can get rid, can get hold of each caregiver in real time. From a patient perspective, we obviously have our patient portal, and that's utilised by 73% of our patients. So they are able to get their imaging, all of their patient letters, appointment confirmations. They're able to speak directly with our physicians as well,

[00:13:20] which is something that is unheard of in the UK currently. So we continually look at how technology can be used to facilitate more seeing this process between caregiver and patient. Cleveland Clinic wants to have a global reach. You are present in the Middle East, in the UK, in the US. How do you see the challenges that the public healthcare systems are facing?

[00:13:48] The waiting times in the UK are very high. At the end of 2024, I think 8 million people were waiting for hospital treatment. How does that impact you? Does it impact you because you're still a private hospital? So that's associated with private insurance and private costs. But do you see, in essence, a positive impact on you and the patients that you get because the NHS is under strain? Yeah. Yeah. And unfortunately, and I think you're right,

[00:14:16] most public healthcare systems around the world are struggling at the moment. And our philosophy has always been to be a partner. Whilst we are a private hospital in London, we do see NHS patients and we have partnerships with many NHS trusts to see those patients at cost. We make no commercial benefit from seeing those patients. And really, that's always going to be our guiding principle. We're strong on community.

[00:14:41] We don't want to be seen as an American hospital coming in to take patients away. In fact, on the contrary, we want to help our NHS partners and see many of these patients that have been waiting months, if not years, to get effective treatment. If I would be a devil's advocate, I would say taking patients away is not a problem because there's too many of them anyway. But that's not the case for the workforce, which you are taking away from the NHS, right?

[00:15:10] I would say I would maybe challenge that slightly. Many of our physicians, if we take that caregiver population, work in the NHS and we actually encourage them to continue their practice in the NHS. They work for us part-time, for example, so they may work with us one day a week, two days a week. And actually, we make no commitment for them to join us full-time. We don't want to pull these critical resources away from the NHS. Of course, you're always going to have, and I see it within IT,

[00:15:38] some of my team have left the organisation to join the NHS. And likewise, we take some of the resources from the NHS who are skilled within EPIC, for example, to join us. But I think that promotes a healthy dialogue and sharing. And again, part of my presentation today is an open ask for everyone to collaborate. That's something we don't do necessarily well in healthcare. We're very insular. Of course, there's going to be unique things and intellectual property on certain initiatives that we do.

[00:16:07] But ultimately, our success is through collaboration. And that's what we try and promote. You reminded me of one thing, and that is that when we talk about the workforce and the shortages in the workforce, we usually primarily focus on clinicians and nurses. But in healthcare IT, we have the same, if not even a larger problem of the fight for talent and the challenge of attracting people in hospitals

[00:16:35] where the vendors can pay them much more. So can you talk a little bit about how big is your IT team? Is that structure changing over time because of all the innovation that you're introducing? How do you see that side of the development of digital health? Yeah. So the team that I lead is about 50 FTEs that we have locally in London. We have support from our US teams and we have some partner support out of India as well.

[00:17:04] It's a good question. Our philosophy has always been to hire for attitude and to train for skill. So we are somewhat protected in that. Yes, talent shortages within IT and digital transformation is a real thing, but we have a longer term view to this type of problem. And that is we bring in people with the right attitude. We train them over the course of a number of months or years and we treat them well. Engagement and culture is a key tenant of what we try and promote within the team.

[00:17:33] And actually we have very low attrition rate, less than 10%, which in central London in healthcare IT is quite amazing really. So we play the longer term view to make sure that we can bring talent in, we can train them, we treat them well and hopefully they'll stay with us for some period of time. So you've got a great team, you've got a great budget compared to others. What's your biggest talent? The biggest challenge I think with obviously AI

[00:18:02] being discussed at every conference that you would go to and every CIO thinking about it is the need to do more with technology. A generative, predictive, agentic AI, there's some great examples where you can really use them to improve the patient experience. But most CEOs around the world now, their focus is on increasing revenue, reducing cost and mitigating risk. So my challenge is focusing the team on those three factors

[00:18:30] and trying to make them more efficient in how they get work done. Teams across the world are always inundated with too much work. Every CIO you will speak to will say that they don't have a team big enough and they need to hire many more resources. My view is you need to focus the team to focus on where the value value is. So that would probably be the biggest challenge is we're a growing organisation. We continue to add new service lines to Cleveland Clinic London.

[00:19:00] We're keeping the lights on. We have, as you said, 100 different systems fully integrated. So you've got the kind of BAU piece of the work, which is keeping the lights on. But then you've got the transformative growth opportunities. And it's making sure that I can set clear priorities to the team to focus on where the real value is. Ryan, thank you so much for this short discussion. Maybe I can just wrap up with what do you look forward to?

[00:19:27] Or what's the one advice that you would give to your peers, the other chief innovation or chief information officers? I would say to remember why we're in this role. Why are we all doing what we do? I talked a little bit about it earlier and it's difficult sometimes within IT because we're not at the patient bedside. So we don't have direct contact, but we need to remember as IT leaders, the decisions that we make, the solutions that we provide,

[00:19:57] and whether that's external or internally, they will have a key, noticeable difference to the impact to the patient. They will have a key, noticeable impact to making our organisations more efficient. And so that's really my why. That's why I get up every day and I'm excited, even though there's lots of work going on. I'm excited about where technology can take organisations. Ultimately, we're all going to be a patient at some point in our lives. And I'm sure many of us have had experience as a patient.

[00:20:27] And if we can make that just a little bit more seamless, a little bit more efficient, then our role within IT is obviously adding that value. Thank you. Rehan, thank you again. And good luck with reducing costs and increasing efficiency. Absolutely. Thank you very much. You've been listening to Faces of Digital Health, a proud member of the Health Podcast Network. If you enjoyed the show, do leave a rating or a review wherever you get your podcast, subscribe to the show

[00:20:55] or follow us on LinkedIn. Additionally, check out our newsletter. You can find it at fodh.substack.com. That's fodh.substack.com. Stay tuned.