CIO is something of a loaded acronym in healthcare these days. Whether your “I” stands for information or innovation can be perceived as a marker of the progressiveness of your organization. But is that fair? At the Health 2.0 pre-conference provider summit in Santa Clara yesterday, two chief innovation officers and a chief information officer went back and forth on the terminology, and how innovation looks in their organizations.

Though Rasu Shrestha holds the title of chief innovation officer at the University of Pittsburgh Medical Center, he’s skeptical about the accuracy of the title. 

“Calling someone a chief innovation officer versus a chief information officer I think in many ways is redundant in today’s day and age,” Shrestha said. “The evolving definition of the ‘I’ in CIO is emblematic of where we are as an industry. Innovation doesn’t belong in anyone’s silo. Innovation happens everywhere, and to have one person tasked with innovation is basically telling a lie across the institution.”

Darren Dworkin, who is chief information officer at Cedars-Sinai Medical Center in Los Angeles, agreed. 

“I am the chief information officer, not the chief innovation officer, and in fact Cedars doesn’t have a chief innovation officer,” he said. “I would say that innovation is part of what a lot of people do. There’s a type of innovation that many of my teams get involved with on the digital side, but that doesn’t encompass our [whole] definition of innovation.”

Dworkin advanced the position that Silicon Valley promises of disruptive innovation ignore the need for stability and robustness that drives large health systems to so-called legacy EMRs. 

“We’re a big, complicated company, and big, complicated companies are going to need large, sophisticated, nuanced, complex, and, yes, expensive core systems. Healthcare isn’t really that different from other industries that are being reimagined by lots of new opportunities and lots of great apps and great digital ideas that can kind of sit around the edges and in some cases really redefine pieces of the core. … The analogy I’d offer is I flew here today on a plane that was built in the 80s, although it was a comfortable ride and it was refurbished on the inside. And the technology that was there, or at least the layer I saw as the customer, was completely different from what it was originally — the no-smoking sign had been replaced with a wifi on-off sign — but it really was the same core that was always there.”

Peter Fleischut, the chief innovation officer at New York-Presbyterian Hospital, agreed that innovation needed to fit in with existing systems.

“The IT infrastructure that’s put in place is important because I think as we heard earlier, what a lot of companies struggle with are issues around scale and sustainability,” he said. “With our digital health initiatives, there’s certain things we decided to leverage our existing infrastructure for because it allows us to go at a different pace. The other thing is that the acquisition rate that hospitals have right now introduces a lot of complexity, so you still have to strip some of that and get down to some core systems or you’re just building and building and building and it’s going make it unmanageable moving forward.”

All three hospitals lean on startups to help foster innovation in their organization. Shrestha discussed UPMC’s leadership of a $17 million investment round in mental health startup Lantern Health as well as their recently launched telehealth spin-out startup Curavi Health, while Dworkin talked about Cedars-Sinai’s accelerator program. New York Presbyterian recently launched programs that tap Grand Rounds, Avizia, and American Well for telehealth, Fleischut said.

Dworkin said that Cedars-Sinai fell into the accelerator game after a bad experience trying to build their own EHR in the 90s. 

“So faced with the legacy on the left that we didn’t want to build anything and, believe it or not, the challenge on the right that there was nothing out there to buy, we had to figure out what early stage companies could we work with,” he said. “What we learned along the way that partnering with early stage companies forced us to more or less behave as a venture capitalist. So we thought, if we’re going to have to behave like a venture capitalist, why not actually become a venture capitalist?”

But guiding early stage companies to the point where their products can be used in the hospital has its own challenges. 

“While I’m sure many companies sit on the outside and look at CIOs, chief information officers, as the people who say no, I look out and see smart, great teams and companies that are 1 to 2 percent off,” he said. “And the problem is — it’s the going to Mars problem. If you’re 1 percent off at the beginning of a launch, by the time you get there it’s significant enough that maybe we can’t really use the product. So we really wanted to solve for the problem of how could we work with companies at scale and help get them launched at exactly the right trajectory.”