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Executive Interview: ROI or Bust - Why Emotions No Longer Cut It in Healthcare

Speaker 4: [00:00:00] This episode is brought to you by CDW Healthcare. CDW understands how to connect the latest technology solutions and services to advance your healthcare mission while keeping patient and staff at the forefront. Whether you're looking to upgrade your EHR, redesign your infrastructure, improve care delivery at the bedside, or elevate the home health patient experience, Our dedicated team of industry tested experts leverage software, hardware, and comprehensive services to orchestrate cost effective solutions that leads to positive patient experiences, higher quality care, and more efficient clinical workflows.

For more information, check them out at ThisWeekHealth. com slash CDW.

I'm Drex Deford, president of Cyber and Risk here at this week, health and the 2 29 Project. Our mission is Healthcare Transformation powered by community. Welcome to this executive interview on the UnHack Channel. Real conversations about managing risk [00:01:00] at the highest levels.

Let's dive in.

Drex DeFord: Hey everyone. Uh, welcome to HIMSS 2026. It's been a great week. A ton of stuff going on with my buddy Eli Harlow from CDW. Dude, I haven't seen you for a while. How's everything going as the kids say, it's been a hot minute. Trex, good to see you. Uh, tell me a little bit about you and your background. Part of the reason I love what you guys are doing and the strategist group in general at CDW, all real world been.

In the hospital, run the show, know what's really going on. That street cred is huge. But tell me a little bit about your background and that street cred and then some of the things you're doing at CDW.

Eli Tarlow: Sure. Thanks Drex. So as a good friend of mine said, I'm a recovering CIO yourself.

Drex DeFord: Yeah.

Eli Tarlow: I've been with CDW now for six years. I thought I'd dine CIO in my boots, kind of. I loved every bit of it and it's just such an incredible place to be today, I would say I love what I'm doing, but I. To be part of that group today. And through so many advanced technology things are way, [00:02:00] way different from the days when we were like, you know, making sure the data center was up and, and you know, EHR limitations were just still happening.

Drex DeFord: Yeah.

Eli Tarlow: But there's so much more that the CIOs bring today. So I do miss a lot of that. But I do love what I do at CDW before I joined CBW. As you know, I was a CIO for different health systems in New York City, and both in public health and in and, uh, private health. Yeah,

Drex DeFord: What are you focused on here?

What have you seen here? Um, what, what's going on with CBW?

Eli Tarlow: Yeah, so, you know, at this point, a lot of it sounds cliche, but it's, I'm gonna underscore some of the really important things. So, one of the things that I saw here, um, and I continue to see here at the previous conferences, there's kind of a, a pivot in the whole world of ai.

So if you think back about, you know, handful of years ago, AI has been around, right? It's just been called different things. Sure. It's, you know, it's just kind of reformatting it. But, um, it's gone from, okay, what is AI number one? Number two is, there's no place for that in healthcare. Right. Obviously there is, but it's just we're risk averse, which we need to be.

Number three is, okay, so now everybody's talking about it's, I gotta do something. Mm-hmm. [00:03:00] Right. So now chasing the shiny toy,

Drex DeFord: yeah.

Eli Tarlow: Number four is, okay, so whoa, whoa, hold on a second. Governance. So governance, a way to get it done correctly, or is governance a kind of a way to slow everything? Just throttle Because we don't know what to do, right?

Yeah. So you gotta, you know, we, we talk hard. We have hard conversations about that, like. Are we using governance because we're not ready? Are we using governance? 'cause we are ready, we gotta do it correctly. And then it was the shiny toy syndrome and Right. And what I see now is that the entire, um, the entire world about AI is not only here.

And I think, you know, bill mentioned that, and I think you've mentioned that and I talked about that. Um, another shameless plug. I did write an article and, and I see you commented on this.

Drex DeFord: Yeah, yeah.

Eli Tarlow: There's no AI in insanity or no insanity in ai, But now it's two things I've seen happening in this year, and it's just continuing to evolve.

The first is that there's measurable objective, ROI. So this is not anymore about should we do it? Should we not do it? This is, how can we not do it? Here's an example, whether it's in back office business functions, in clinical [00:04:00] improvements, regulatory requirements. Where it's the competitor, it's become the new competitors.

So That's one. And I'll, take a deep

breath.

Drex DeFord: it's the finding. So as we go through this, I feel like I see more and more any project that comes through in a health system we have continued to evolve toward. There has to be, you gotta have a business plan for it. You can't make the argument on purely emotions anymore that we should do this, it's good for X.

Right? But there has to be an ROI. And it can be hard or soft. It's actually preferred if it's hard given the environment that we have right now. Those are the same kind of evolution that you've seen in any AI project. Instead of just like, we should be doing ai, everybody's doing ai now it's come down to business plan.

Plus the ROI.

Eli Tarlow: Yeah. Fun to mention. I actually, um, was talking to a, to a partner yesterday and they're, so far along in their belief in their product that they're willing to do it on a, profit share. So they really believe in ai. They're saying. Let's just [00:05:00] implement, I had had two meetings already this week about that exact, uh, model where they lease so much in ai.

One is on the rev-cycle side, one's in the clinical side, and they're saying, just don't take that word for it. You'll get, like you mentioned Rex, you're gonna get their hard dollars. What, you know when we talk about it, this is, you mentioned the strategist team and we had this conversations a lot. And by the way, governance is the bedrock.

You have to do that correctly. Yeah, yeah. There's no, um, emotion in ai and you have to be careful that you don't just turn off an infusion pump. 'cause the AI said. It wasn't tested correctly. Right, right. You had to make some of those, you know, it's, it's decision support. But, um, one of the things we do talk a lot about is aligning with the quadruple aim.

So start with number one. We asked three questions when we talk about AI as a, as a program.

Drex DeFord: Okay.

Eli Tarlow: Number one is what does it improve? Is it a clinical outcome, physician experience, patient engagement, regulatory requirement? And of course, does it increase, uh, revenue or decrease op operations? Exactly.

That's question number one. It's easy for everybody to say, oh, of course this brings. Clinical improvement because I don't think it was an IT project to hurt patients. Right? So that's, that's too easy. [00:06:00] So you asked the second question, which is, okay, by how much, so let's take patient experience as an example, right?

Think about the H CAP scores. So in the, you know, communication between nurse and patient. First of all, let's get a baseline. So let's pull up the score 3.8, whatever that is, and let's talk about how much this ai, well by, this is just good. Whatever good behavior for I coverage. By how much, but we don't stop there because anybody can get off the hook by say, okay, it's gonna improve, you know, the, you know, the falls or whatever.

It's gonna improve. Right? The third question we ask is, buy when, because it's a cashflow game, right? Nobody will say no to a project that has an A real ROI. Right? If you gimme, if I tell you Drex give me a hundred dollars, gonna be back a thousand, you're gonna find, you're gonna find that a hundred dollars, right?

Yeah. It's The problem is that we don't define the ROII went.

Drex DeFord: The other thing is the closing the loop on that conversation, because the project comes through, we answer those questions, the project gets started, but we never come back and close the loop. And for the operations leader who's [00:07:00] actually responsible for that project, not it, even though it's an information services project, absolutely.

The operations leader who's in charge of that project, who really owns that project, coming back to them and saying. By the way, did you reduce that by X or did you get this much more Y Uh, and if you didn't, now I have to hold you responsible. That's a broken part.

Eli Tarlow: Yeah.

Drex DeFord: So in a lot of places,

Eli Tarlow: number one, public accountability.

Right? So you have the chief nursing officer that says, I want your organization to invest this type of money in it to get these benefits. Yeah. It's not it saying yes, it's not it saying no. So immediately, you know, you're not the CI. No. Right, right. The second thing is that he or she earns credibility. So next time they wanna.

Pitch a project to the governance committee. It's like, did I not deliver? It causes people to stop and think before they do that. And here's the kind of the euphoria, which I love when I do some of these things, which is at the end of the year when the CEO says, you know, we've been accused of the insatiable appetite, the CIOs, right?

Oh no, you didn't. You didn't give us any money. The money you invested in it. This is what you got. You got a reduction in [00:08:00] CLABSI cow infection rates, right? We've got, um, better, uh, access for, you know, patients to come in the morning and at night. These are all the things, was it worth the money? So at again, you can actually go true up and say all that IT investment.

These are all the real real ROI that you got.

Drex DeFord: I love it. And you've gotta document it. And you and I have talked about this, uh, a hundred times the CIO's budget balloons, but not because for the most part they're doing things for. The department, they're doing things for everybody else. The expense accrues into the information services budget, but the benefit accrues in the operational departments.

And so making sure that you can do that math turns out to be really, really important when the, we need to reduce by, okay, cool. Here's a bunch of red pencils. Tell me what you don't want to do anymore. Pizza.

Eli Tarlow: Yeah, exactly. And I've had those conversations with the CFOs and others. In, in, in my former, uh, career and in currently, and it's like, like you said, you want to cut the budget by 4%.

Sure. You wanna turn off Epic? You [00:09:00] wanna turn off sermon? Do what do you wanna do? Yeah. Wanna, you wanna extend the SLA for meantime to respond?

Drex DeFord: Eli, I know you guys were recording, but I just have to say hi.

Eli Tarlow: Appreciate.

Drex DeFord: I'm sorry. Go ahead.

Eli Tarlow: Get the hell outta it. That's awesome.

Drex DeFord: That will be something for the, uh, blooper radio that

Eli Tarlow: stays in.

That stays in, that stays in.

Drex DeFord: Um. You've been walking around the floor, you've been talking to a ton of folks. What's stuff that you've seen this week, the last few days that you think you're gonna, it's gonna be impactful down the road?

Eli Tarlow: Yeah. So again, you know AI everywhere, right? And it's now becoming like people know the right questions to ask to prove that a water bottle is not ai, right?

So that's number one. Every single banner has got the letters, a dot i in there. But the people, the, the consumers are way more educated. Um, and the second thing, as I mentioned earlier, is the sharing. So not only, um, are we learning from. From our partners, from our manufacturers are learning from each other.

So we got, you know, those panels that are talking about it and those networking connections are being made. Say, hold on a second. Did you really do that? I just read a, you know, I did a podcast with, right?

Drex DeFord: Yeah.

Eli Tarlow: Um, so there's a lot of sharing going [00:10:00] on. Obviously security, I mean, you can't get away from that.

Um, security on the DR side and making sure, you know, we talked about this a couple months ago where, um, the CIOs and just IT leaders have less control over things. Number one is. It's, it's really sad. Today there's just announced there's another cyber attack,

Drex DeFord: right?

Eli Tarlow: The hospital has been out for three weeks in the Mississippi area.

Right. It's been, it's been a struggle and it's only getting worse and worse.

Drex DeFord: Yeah.

Eli Tarlow: The second thing is, as you move to the cloud, we can't control disaster recovery when you're subscription as a service.

Drex DeFord: Yes.

Eli Tarlow: You don't get to have an IRE when you're just paying a subscription every month to have a service provider to you.

I

hope

Drex DeFord: you're having that conversation with your third party provider about what's their plan.

Eli Tarlow: We are.

Drex DeFord: Yeah.

Eli Tarlow: But they have to ask their provider as well. Right. Exactly. Think about some of the impacts

Drex DeFord: and fourth party,

Eli Tarlow: right. I mean, again, not to mention names, but you know, there's an outage that co that crossed so many industries.

Drex DeFord: Yeah.

Eli Tarlow: Because it wasn't, it was, they, they released a patch too il.

Drex DeFord: Yes.

Eli Tarlow: So that's the, the provider to, the provider to the. So, I mean, through the end of the day, it's about clinical resiliency, which we talked a lot about. When the things do [00:11:00] go down, how can you continue to fly the plane? Yeah. Your cockpit is dark,

Drex DeFord: so, yeah.

Yeah. And we talk about it. We usually talk about it in the context of cybersecurity, but it turns out as often as anything else, it's some operational mistake that we've made the pat, we released the patch too early. We Fat fingers, something in a router. Those are the kinds of things that you see and that, you know, partners are working on all the time too.

Talk a little bit about that.

Eli Tarlow: Yeah, and it was, uh, I think it was 12 hospitals that were down because like you said, somebody, um, fat fingered made a mistake on a database with fixed production. It was, um, as mirroring on their, on the sands or whoever it was.

Drex DeFord: Yeah.

Eli Tarlow: And they were down. Now they did have a good clinical care resiliency plan, so no patients were harmed in the making of that movie, as they say.

Drex DeFord: Yeah.

Eli Tarlow: But, um. But yeah, I mean, even, you know, 25 years ago we were dealing with, you know, change management and it's just as prevalent today. Um, on, on the networking side, on the infrastructure and all costs, the infrastructure on the desktop side, you release patch incorrectly. Um, that, that only becomes even more and more important because there's so much more dependency [00:12:00] on technology.

It's not just email anymore. It's not just Microsoft Office. It's, it's, it's so much more closer to patient's lives than it ever was.

Drex DeFord: And then back into the cybersecurity mix. The bad guys are looking for those tiny mistakes. You've made those those details. I just had a conversation with somebody who was hit by lock bit and the bottom line that he said to me was like, we were in a hurry and healthcare's in a hurry right now.

We were in a hurry and we made a tiny mistake in detail. And that's what the mad guy found. And once they were in, they were off to the races. And so that is another thing I think for folks to sort of take away from the conversation is. The devil's in the details, and you gotta spend time focused on the details or you've gotta be a victim.

Eli Tarlow: Yeah. I mean, think about, so now let's bring it together, the security of the ai, right? So think about a mistake on the, on the provider's side, where the bad guys have AI looking for it. It's not even a guy now who's awake at three o'clock in the morning, who's looking for that crack in the [00:13:00] scene. Yeah.

It's a robot that's ready. To snatch it the second it happens.

Drex DeFord: Yeah.

Eli Tarlow: You know, it used to be a fight of the CISO versus the ciso. Yeah. It's now a fight of AI security and AI security. It's true. I mean, the bad guys just are agent scripting, code vibing to break systems. Yeah. So it's, yeah. I, I, I do miss the CI role some days, and I think about these things and I'm like, okay.

It's a give and a take.

Drex DeFord: We, we sit down, you know, you and I have, uh, these great conversations. Uh, you and I also have a lot of conversations with CIOs and CISOs, so as a recovering CIOA, recovering CIO. There's many days where I have those conversations with CIOs and CSOs and CIOs and Chief Medical Information Officers and my PTSD kick in and I'm like, oh no, I'm really glad you're doing that.

And I was really kind of glad I'm not doing it. You do. You right. Exactly. I'm really, uh, glad you, uh, had a chance to stop by and have a chat. Of course. It's always good to see you, man.

Eli Tarlow: Always rest. Appreciate it.

Drex DeFord: Thank you.

Eli Tarlow: Thank you.

Speaker 7: Thanks for joining this executive interview on UnHack with me Drex Deford here this week. Health, we believe every healthcare leader needs a community to [00:14:00] lean on and learn from. Build your network at this week, health.com/subscribe and share this with a colleague because together we're stronger.