Donna Roach, CIO at University of Utah Health, brings a valuable blend of healthcare operations expertise and systems analyst skills to her role. Donna leads with a systems mindset and a strong focus on people. In this “C-suite conversation” with Judy Kirby, she shares her perspective on leadership, digital health strategy, hybrid work, and the real-world impact of AI in the industry.

University of Utah Health is the Mountain West’s only academic health care system and provides patient care for the people of Utah, Idaho, Wyoming, Montana, and much of Nevada. The system is staffed by more than 24,000 employees, including 1,600 board-certified physicians at five University hospitals, 12 community clinics, and several specialty centers.

Q & A with Donna Roach

Judy Kirby: Your career has spanned very different organizations, including consulting and academia. What were the skills you possessed or learned that helped you with transitions to different organizations?

In healthcare IT, I started as an application analyst, so I understand how the applications work and how to implement them. I also did a lot of project management work, which came to me naturally.

Another important skill is something I call zooming in and zooming out. When something just doesn’t feel right, it is the ability to zoom in and ask the right questions, listen to the answers, gather information, and then zoom out to offer guidance or advice. Some people might call that micromanagement, but actually, it’s micromanaging when something doesn’t feel right and stepping back again and letting the team do their work when things are back on the right path.

I love leadership development–finding great leaders, understanding the skills they bring to the table, and meshing that into a team. I tend to bring together team players who have very different make-ups, behaviors, and personalities. It’s more work to lead that team compared to one where the people are all on the same bandwagon, but that’s dangerous because you can get into some really bad groupthink and nobody is challenging you.

Lastly, I would say, is relationship building. My top priority is my C-suite executives. They’re the ones that I have the closest relationship with, and to understand what’s important to them and what they need from me. I’ve learned how to be more thoughtful about the questions I ask so that it doesn’t sound like I am challenging them in a negative way, just trying to get better information.

Judy: What do you look for when hiring leaders?

Donna: I want them to know and appreciate that healthcare is unique. Sometimes I’m hiring IT people who have no healthcare experience. They need to understand that they’re going to have to develop and learn, that healthcare is about serving the community, the patients, and our clinicians, and they have to be willing to embrace a servant leadership model. Do they know up front that this is very different from a Fortune 500 or a manufacturing job because there are people at the end of our systems, and they could harm them?

I also look for people with great communication skills, not just written but verbal. Not everyone in IT has high EQ, but as a leader, I need them to bring that to the table because they’re going to be dealing with executives, physicians, and clinicians who aren’t always going to understand the IT speak.

I also like people who have innovation in how they think, aren’t stuck in their ways, and are willing to challenge themselves.

Judy: What has been the biggest challenge during your career?

Donna: The thing that is the hardest to wrap my head around is when people see me and my role and think, “You’re just the computers, right?” Or “You’re just the network.” They look at the CIO role as a director of IT. No, I’m your chief executive when it comes to all things IT and the big C of change management. So it’s a challenge sometimes working with another executive who only wants to bring you in when something’s gone wrong on a system that was implemented five years ago. Why didn’t you bring me in earlier when we could have had a better discussion? It’s like the musical Hamilton. I want to be in the room when it happens. I want to be in the room when we talk about strategy because IT is going to connect to everything.

Judy: You and I have talked about giving back. Can you speak a bit about how you’ve accomplished that and how it has influenced your career?

Donna: Early on, I was very involved with HIMSS, especially at the local chapter level, and I truly appreciate what HIMSS did for me by connecting me with other healthcare professionals. So now I serve on the advisory board, which is my way of giving back to HIMSS because that organization was there for me throughout my career. I’ve also been on the CHIME board, and I’m really active right now on the Federal Policy Committee, lending my voice to comment periods of federal policy. I think that’s giving back, too.

We’ve done some great things here in Utah, and I want the rest of the industry to benefit from the experience, so I try to present at national forums.

Judy: So, one of the questions we’re hearing now is, what’s the difference between a CDIO and a CIO? Is there really any difference?

Donna: I don’t see a difference. I don’t feel the need to have “digital” in my title because I’m doing it anyway. I think it is duplicative. I will say that I’ve had this discussion with my CEO in the context of succession planning. One day, when you are backfilling my job, you may need to add “digital” because otherwise some candidates may not think you’re digital.

When I came to Utah, I worked closely with our chief marketing officer, who has digital over her space. And I think that the collaboration that we created was amazing because she didn’t feel like I was competing with her. The message is “I’m here to collaborate with you, not to take it over.” What’s more important is acceptance among my peers and their confidence that I’m doing the job that will support them and the strategy and vision of the organization.

Judy: One of the big concerns I hear over and over is about the lack of up-and-coming IT leaders to fill future healthcare CIO positions. We’ve seen a lot of retirements recently. What are your thoughts around this void?

Donna: I think it’s real. I think the pandemic did not do our industry any good, especially for female leaders. I think some really strong female leaders look at this job and think, “Why would I take on this level of stress when I could be doing something just as beneficial in another job, in another industry?” It’s similar to the thought process we saw physicians go through, realizing how stressful it was and leaving their medical practices.

It is a high-stress position. Cybersecurity will always keep me up at night. And you have to wear a lot of hats, and I think that can take a toll on your well-being.

Judy: Looking back over your own journey, what career advice do you have for rising technology professionals interested in becoming a CIO one day?

Donna: Create your relationships and contacts with the various groups, like HIMSS, CHIME, and other professional organizations that can put you in contact with other people at your level. If your goal is to be a CIO someday, you will get it through the network you’ve created.

Some people think a CIO role will just eventually happen, but no, you have to have a plan. You have to be purposeful. Think about your background and where there may be some holes, and try to gain some experience in those areas.

Judy: Can you talk a little bit about remote and hybrid working models and what you’ve done there?

Donna: I was hired here in the middle of COVID, so everybody was remote. Then, as the pandemic wound down, there was talk about bringing everybody back into the office. But my IT folks were like, “No, no, we like it.” So I decided that, even though it may make my job a little bit harder, I would support the hybrid model.

I think I get more out of my staff by giving them this flexibility. There are people who want to come into the office every day, and we have that capability. And we do things where we bring everybody in. I have about 450 people in my IT department, and we just had a meeting at one of the big theaters, and we had 300 people in attendance. You have to incorporate those opportunities so you can get people together and have camaraderie and a sense of community.

I’ve heard other CIOs say, “How do you know that they’re working if you can’t see them?” I think, “How did you know they were working when they were all in the office? You’re not watching them all of the time.” It is more about how you are driving your value metrics, whether it be projects completed or project timelines. Those tell me more about how well we’re doing versus me watching people to see if they come in at 8:00 and leave at 5:00.

At the same time, I don’t want someone working 20 hours a day. We even put some rules in place so that if somebody’s in a different time zone, you can’t call a meeting at 5:00 pm for you when for somebody else it’s 7:00 pm. You have got to be thoughtful about that.

Judy: Can you talk a little bit about the status of your succession plan and the approach you’ve taken?

Donna: We’re just kicking off a project to plan for that so that, if I get hit by the proverbial bus, there is someone to step in. I do feel confident that any of my leaders could step in and run the ship for me. I’m very confident in all of their skills because it’s been a team effort. Succession planning must be done across the whole C-suite, and that’s what our CEO is doing right now.

Judy: How is generative AI impacting your organization and your strategy? What type of AI work are you leading, and most importantly, what sort of ROI are you looking for?

Donna: This is probably one of the most exciting things I have seen during my career, but it is early days for us. The university CIO and I issued a guidelines statement, a one-pager. We have a chief AI officer and a Responsible AI initiative on the university side. In healthcare, I hired someone to capture AI use cases and look at the value metrics to make sure we’re working on the right use cases as opposed to the shiniest objects, and to understand what will bring the most benefit back to the organization.

We’ve incorporated different large-language models. We haven’t settled on just one. Part of the secret sauce is that these models are all different, and they have different benefits. Where one may work great for one specific use case, another one is probably more beneficial and has higher viability for others.

One of the most exciting use cases–and I am sure you are hearing this from others you talk to–is ambient listening. I have never been in a situation where physicians come to me and say, “I absolutely love this. If you take it away, I will leave. I will retire.” I love the fact that they have embraced it, and they’ve also helped us refine it and make it better. We started out in the ambulatory space and implemented it in our inpatient space. I want our nurses to be able to tap into it, too.

Even in the Clinical Document Improvement space, there are AI triggers giving the physician feedback as they are documenting. I mean, we’re on the cusp of really changing and improving our clinician workflow. Now, sometimes the workflow is broken, so you have to remap the clinical workflow so that AI can be utilized effectively. It’s an iterative, agile process that’s reducing the administrative burden of documentation, and that’s been fun.

We’re on Epic, and we probably have six or seven applications with the Epic AI tools, but we’re also looking at others. I have a group that is called “Reimagined EHR,” and one of our physicians is improving the clinical workflow within just the EHR and bringing that actionable data back to the clinician.

I have an AI model for the ED that, as people come in, if the model detects a stroke, it immediately calls out the stroke team. And as you know, with a stroke, the faster you can treat that patient, the better. That’s one truly clinical workflow that’s been improved dramatically by AI.

Judy: Have you looked at the cost versus the benefit of ambient listening? Are you able to point to real ROI?

Donna: The way we track the value metrics is by looking at the soft and the hard benefits. Right now, I would say the financial ROI isn’t there. But if we add in the soft metrics, you see real value. For example, we’ve improved things for physicians who can now be more efficient, close out their charts at the end of the day, and not have to work nights and weekends to get that administrative work done. We have essentially removed the administrative burden of documentation.

I think responsible AI will be a factor too–what models we are using and the GPU usage. We don’t have an electrical grid system that can handle all the power required, so it’s also important to understand which is the right model to use and put some guardrails around it.

Judy: If you hadn’t become an IT leader, Donna, what other career do you think you were cut out for?

Donna: Well, two areas. One is a pathologist. I’ve always loved looking under a microscope and the science of pathology. But if I didn’t do something in healthcare, I would have been a farmer, like a fruit orchard or blueberries or something like that. My grandparents were farmers, and in the summertime, I always did 4-H. I’m a farmer at heart.

Judy: What do you like to do in your free time?

Donna: I golf and I play tennis, and I love both. I’ve golfed ever since I was a little kid, but I wish I were better. I am outside with people that I enjoy, and there’s camaraderie. I love tennis because it keeps me really active. I enjoy the competition, and I am getting better at the game. I am very aggressive at the net, which intimidates my opponent.

Judy: How do you have time for all this?

Donna: I make time. If I don’t carve that time out, I don’t do well at work. I like to wake up in the morning and think about what I am excited about today. That excitement, even if it’s just one small thing, like I’m going to play in my golf league that night, that excitement carries me through the day. It gives me a better outlook on my day and affects how I interact with people. When I don’t do that, I carry the weight of the world, and that’s not good. There’s a lot of stress in what we do, so if you focus on something you’re really excited about, it spills over into everything else that you do.