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today on Newsday.

Laura O'Toole: We all want the same thing. The ultimate goal is to drive an alignment of how efficiency and access can make us all more efficient, and be able to make a difference for the communities that we serve.

I'm Sarah Richardson, a former CIO and president of this Week Health's 2 2 9 community [00:01:00] development where we are dedicated to transforming healthcare one connection at a time.

Newsday discusses the breaking news in healthcare with industry experts. Now let's jump right in.

(Main)

Sarah Richardson: Welcome to Newsday, where I am joined by Laura O'Toole, who's the founder and CEO of SureTest a company revolutionizing healthcare IT automation with over 30 years of healthcare industry experience. Laura is an operational and strategic leader specializing in client services, global consulting and acquisition strategies.

SureTest provides intelligent test automation solutions that empower health systems to transform their EHR and third party application testing processes. Their short managed automation solution eliminates thousands of analyst testing hours and improves patient outcomes by automating healthcare testing processes.

Laura, welcome back to the show.

Laura O'Toole: Well, thank you, Sarah. My goodness, you do a much better introduction for me than I do for myself. I appreciate that. It's great to see you.

Sarah Richardson: It's great to see you, and it's always easy to say nice things about people that you respect and enjoy being partners with and friends.

So thank you for doing [00:02:00] this. We've got three of them to cover and I love all of them 'cause the articles we found have a corollary to a lot of the work that you're doing and what's most important. In fact, I wrote an article that published this morning specific to cost management strategies that CIOs need to be thinking about.

This comes out of our city tour dinners. Comes out of our summits and obviously comes out of conversations that we have with you. But this one is about health systems chasing ROI, which is a target efficiency. In 2025, I would say it's always a target efficiency, but according to a Deloitte Global Survey, mm-hmm. healthcare executives are prioritizing operational efficiency. This year, over 70% of them are viewing efficiency and productivity gains as essential areas of focus. This is being led by AI powered automation, which can free up 13 to 20% of time adding. Up to 240 or 400 hours for nurses as well. And so I wanna jump into this because if you're a healthcare executive, operational efficiency [00:03:00] being a top priority, it's always been important.

But financial constraints are tightening and the ability to do more with less is crucial for some of these healthcare organizations. So what are been some of your thoughts about workforce impact? How we're accelerating transformation, just the investment that it takes to really be thoughtful about going down this path.

Laura O'Toole: Well, I think that's the key. It's about being thoughtful and if you think of what our health systems are dealing with today, never in my career have I seen, and I say this all the time, the CIO and their cabinet's job is harder than I certainly have ever seen it be in my career. And the pressure that's coming from every single cornerstone of those buildings.

Where they're living and working is just phenomenal to get ROI and to drive efficiency, it's not always an easy thing to do, and a lot of health systems have a hard time proving it. So as we've gone down this journey and as we see our clients go down this journey, it's becoming really important to understand when [00:04:00] we think about transformation and we think about digital transformation, what are the things that we can really do to impact.

The access and the efficiency and certainly automation. Machine learning, which is a space that I live in, is definitely one path. I think there's many paths. I think what's most important, and we're starting to see this now, is really some governance around this. Uh, I think in order to really get the ROI, everything's about change management and you can't just snap your fingers and move to automation without the conversation and the trust.

That needs to be built where people aren't worried about their jobs. What they are able to take the step toward is, how can I work at the top of my license? How can I spend time with a patient, spend that extra minute with a patient to make their day a little better? And I believe the tools and technologies that are really hitting the market by storm and SureTest is just one of them.

Really give those [00:05:00] clinicians the opportunity to operate at the top of their license, and that's what I'm, I'm most excited about.

Sarah Richardson: Well, and it also directly addresses the staffing shortages. By reducing that administrative burden on clinical staff, but then SureTest automation solutions also align with some of these priorities and put a lot of those tools equally into the hands of some of the IT teams.

Laura O'Toole: Yeah, I think certainly, we start with the CIO and those surround teams and those analysts.

That's where the biggest bang for the buck is, and that's where we can see the immediate ROI, if you can, through automation, give a health system back anywhere between twenty-thousand and thirty-five-thousand hours that these IT analysts and managers are spending. Think about what they can do with that time, how they can go and work at the top of their license, work on optimization, be out with their constituents and be out in the business figuring out how do we make workflow more efficient?[00:06:00]

And for us, what we believe is most important is in giving that time back. A lot of times when you come in with any automation solution, I think fear is a natural. Just emotion that people have. I'm a big believer that whether in your personal life or in your professional life, we operate on the spectrum of love and fear, right?

Love has clean motives. Fear one way or another somehow has a dirty motive. And if we can get the conversation going, and to get back to the change management aspect of this, where. The employees and the clinicians that are working at these health systems feel like these are tools that are going to make me better for the communities that I serve, and allow me to do more meaningful work.

Allow me to spend that extra minute with a patient, or from an IT perspective, allow them to optimize that particular application or bring in a new application or spend the time to realize how all these other third [00:07:00] party applications that Are so fantastic, can work together and we can integrate them and test them from a regression perspective in an automated fashion so that we're comfortable, that we're doing everything we need to do to make sure that workflow is efficient, that there's not any breaks in the downstream workflow, because that's where problems happen.

That's where patient care. Gets affected and that's what I get most excited about. I had a client this week and I, I we're working on a white paper together, so I don't wanna mention the client yet, but they're working on doing an expansion. So we, automated all the EPIC testing and some of the surround applications.

And of course they have a huge digital transformation effort and they wanna really take a look at the access for their patients and how, you know they're going to engage in patient engagement. The last thing you wanna do is put in all this patient engagement, and you haven't tested it with your clinical workflow and in the downstream regression integration testing.

So they're [00:08:00] working on getting an expansion. In order to justify that, they went out and figured out that if they were running the tests that we're running for them in an automated fashion, if they wanted to do the volume of testing that we're able to do for them, it would cost them. Close to $6 million over the life of our contract.

So, when you can begin to really drive metrics to prove an ROI that allows people to say, let's start with this. Let's see that it works. Build trust, build community, work with them on the change management aspects so that people aren't scared. So it's not about I'm going to eliminate your job necessarily.

It's, Hey, next year when I need 20 more people, now maybe I only need 10. I've been able to be more efficient with the operational staff that I have today. So I think there's all kinds of ways to get these programs implemented and to demonstrate an ROI. But to your point, [00:09:00] I think what's most important is you have to show the ROI, and I believe that's our obligation to do that, and we need to help our clients be able to demonstrate it.

Sarah Richardson: That's exactly what we're hearing in conversations with health systems where even St. Luke's and Boise with the Reids team they're doing AI literacy training and as part of the implementation of new products, they show them how to use 'em with prompts, with new ideas, and in these labs, they're able to start to figure out, this is not about taking your job away, this is about making you better at your job so you can do things you like better and things that are actually a little bit harder, that need more time assigned to it.

So it's taking away exactly to your point, the fear factor that can be associated with some of these solutions. And it takes us into our second conversation about. Healthcare IT leaders prioritizing ROI and workforce support. So from HIT Consultant Media, a recent survey revealed that healthcare leaders are focusing on maximizing returns on their investments while addressing the resource strain.

This goes into [00:10:00] retaining and budgeting for qualified IT resources as the most pressing operational challenge by 39% of the CIOs who gave feedback. And when I think about this contextually, Laura, it's back to how do you make sure that you're getting the most out of your existing system? So all that optimization, right?

How you're handling your end users. Because if you have clinical end user education and knowledge transfer, that's really well baked into your environment. Then the physicians as an example, or clinicians using some of these tools such as ambient listening. Yeah. They also start to trust it in other areas, whether it's automation of testing, so use of copilot for creation of different aspects of their job.

Then you get to see where the training gaps are. You get to expand that growth and learning, and then you can use some of those additional either dollars or savings. For the things that still need to be addressed from a cyber perspective, because that's absolutely the other area that is the most sort of [00:11:00] expensive and concerning for these leaders.

So I'd love to hear from you that, how does testing automation really improve the reliability and adoption of existing technologies and some of the impact in terms of. Where those resources can be allocated most effectively in the organization. You touched on it, but I know there's more to the story.

Laura O'Toole: Yeah, absolutely. And I completely agree with you. Cyber is here to stay and the threat is here to stay and it's going to get worse, not better. I. So I think, whoever would've thought right pre Covid that we would be sitting here and saying, we can do so much of healthcare in a virtual environment.

And when I sit back and I think about that devastating time as we all went through Covid, look at the 2, 2 9 project, the fact that. The company brand, right, is called the 2 2 9 Project because we will never forget that Covid was a leap year and February 29th and what we learned about Covid during that time, it [00:12:00] had we not gone through that.

I do like to be a glass, generally half full kind of gal. We would never have been on the trajectory that we are now in terms of being able to leverage automation and the tools that we have today in a virtual way. And make no mistake, it is a war for talent. Out there because of that virtuality, I think our health systems are in a war for talent and I think it's gonna get much worse.

So when we think about the solution that we bring to market in terms of automation and really automating that full integrated workflow and the workflow that flows into the downstream systems where you're continually regression testing that, think about the risk that you're eliminating, there's nowhere near enough time to test everything that you need to test.

With an automation solution, like what we do at SureTest, you can do full regression testing on that integrated workflow, which affects so many other things outside of [00:13:00] maybe what the singular scope of one analyst might be, and that's where the beauty of it all comes together and freeze up these resources to not only work at the top of their license.

Have better job satisfaction. So we have a couple of clients that use this as a recruiting tool. You come and work here, we have automated testing. You don't have to test, you don't have to do that. You can be out solving, optimizing, enhancing the build, being out, solving problems with your clinician counterparts, and that's an attractor.

So I think for us to be able to drive that ROI and make a difference for our IT teams that are drowning, that are exhausted, that are working harder than I have ever seen them work. 30 years in my career. And if we can be a small part of giving them relief through automation with this solution I'm thrilled about it.

The other piece, I think that's so important. You talk about training, you talk about optimization. [00:14:00] Now that SureTest has evolved as a company. We have over 4,000 workflows, clinical revenue cycle workflows, and 30 now surround. Third party applications in our library. To me, the beauty of where we're headed next, as I start to think about AI and what we can do with AI and that intelligence to be able to look at our library and not only jumpstart the automation based on what a client's particular workflow is, if it's customized or whatnot, not only jumpstart that, but.

Far more importantly, share some intelligence among our client group. That's been my ultimate dream for the company because if you think about all our libraries de-identified, but if I have a client like UNC that does a particular surgical workflow and 40 steps, and I have a client like UVA that does it in 59 steps.

There's some learning there, [00:15:00] and ultimately to be able to use some of these tools to take us up the intelligence ladder, because at the end of the day, when we think about AI, we all want the same thing. The ultimate goal is to drive an alignment of how efficiency and access. Can make us all work smarter, more efficient, and be able to make a difference for the communities that we serve.

And we're just thrilled to be a part of that.

Sarah Richardson: You know, That people were nervous or afraid of it in some aspects. However, all of the clients that we know that utilize Sure, test, have said, what else can we automate?

What else can we automate? Once they see it, they want more and more of it. How do you decide? What to choose next. What is that governance process? Internally, we hear about how hard governance is for health systems choose, but you have ideas coming at you all of the time. What process do you use to make sure that you are using the right, not only selection criteria for what's next, but also that change management aspect of is this gonna be a good enough idea to take mainstream?[00:16:00]

Laura O'Toole: Absolutely. So I think when you start to look at the third parties that are now in our library, it's pretty clear. You can see a very consistent path of. The majority of our clients use, say these ten third party applications, so they would make sense. If you look at where healthcare is going from an ERP perspective and moving up the enterprise, we know that Workday is winning, right?

We see Workday, we see in four, we see some Oracle. So certainly some synergies around what makes the most sense as we go up the enterprise level for sure. Will make a difference. And the key for us is we're testing at the end user level and that's where we're really eliminating some risks.

'cause a lot of times when an analyst is manually testing. They're just going about their business, the way they might sign on to a system, which is very different than what an end user does. So I think continuing to maximize that capability and the learnings that we get from our clients, and that's what I've [00:17:00] loved about this journey for us, is what we've learned from our clients.

They have pushed us. They have pushed us to be better. You know how I feel about partnership, right? It is a partnership and it needs to be a partnership and how we can make each other better. And this is just gonna get worse. the drive to, get more ROI and documented tangible ROI.

So one of the things we did is just incorporate a whole new system. That, every single click, every mouse click. We scoured the market and we built our secret sauce, our frameworks, our speed to value on top of a tool called Eggplant Keysight. And they are a great strategic partner of ours.

And we continually look in the market to make sure that they still are the leader in dealing with automation as it relates to very complex clinical workflows, and as you think about the number of journeys that a patient can go through when they hit the door of a hospital, for us, what's becoming most important is to make sure that [00:18:00] we're becoming more prescriptive for our clients.

And creating a situation. Whereas if you think about it, we're doing it at the end user. Back to your training component, we've recorded every single keystroke. So now how easy is that to put into an electronic e-learning document that if somebody forgets what they need to do, they can just, click on the link and watch that in real time.

So I think there's a whole host of things to go up the value chain. But at the end of the day, it's about how can we best serve our clients to make a difference for them, save them money, help them keep high satisfaction amongst their employees. The cost of recruiting is exorbitant.

Exorbitant. The burnout factor is insane. And if we can give them a tool that says, Hey, you can let your people work at the top of your license, I feel we've brought something to the market.

Sarah Richardson: Well, everything that you've shared thus far is such a perfect corollary. We've got our third, conversation navigating healthcare workforce challenges this year.

So. [00:19:00] Healthcare organizations, Laura, are facing a critical workforce shortage that we know that's expected to worsen, and that by 2028, which what, three years from now, the shortage of healthcare workers could be over a 100,000 in the us, which is inclusive of another shortfall of over 73,000 nursing assistants.

So you touched on the burnout epidemic. So nearly half of all healthcare workers experience burnout, which is creating more absenteeism and reduced productivity. There's EHR inefficiency, whether the inability to integrate effectively creates challenges. The demographic to me is the one I'm watching most closely to a degree, and that's the retiring boomers um, person that's gonna create more, more staffing shortages.

The other thing too, this is where you talk about. Roles being poached or health systems being able, from the remote aspect of what we do, like who knew how much health can be virtual. So the regional disparities in pay are causing workers to either relocate, which creates shortages [00:20:00] or leave after a period of time.

And at one of our recent summits, we had a academic medical center say, at the 10 year mark for my Epic clinical analysts, I'm paying them X. They're getting poached and paid 50% more to be. Either remote or virtual, or a consultant for some of these other organizations, and I think about that whole connection between whether your system is integrated, whether it's reliable, whether you have satisfaction and growth from the teams by.

Automation can improve implementation of some of these customized workflows. When you consider what it takes for an organization to be stickier, to want to stay in a location, how can automation, you said it's, it is being used for recruitment and retention. But how else is it allowing us to really improve the experience of the [00:21:00] employee?

Because the intent is not that people are doing twice as much,

Laura O'Toole: right? The intent is to give back meaningful hours for meaningful work. And at the end of the day, everybody wants to do meaningful work. They don't wanna do mundane tasks. They wanna be able to operate at the top of their license. And as I think about automation and I think about how our health systems retain their people first and foremost.

Let's stop talking about automation for a minute. I think it's about leadership and I think it's about connection. You wrote something the other day where you said, none of us should be doing this on our own. people need to be in this together, and most people wanna feel like they're a part of something bigger than themselves.

And I think if you are on the leading edge of innovation and you're willing to do the hard work around application rationalization, because that's part of what needs to happen here. Really take the opportunity to [00:22:00] test. Well focus on optimizing your workflow and you can make your employees feel more satisfied that they feel heard, that they're not scared, their job's gonna go away, but that they can work more efficiently.

So at the end of the day, if we're all working more efficiently and a solution like SureTest is giving you back 30,000 hours a year when you go to budget time next year. You should be able to add some of those projects that are in the queue, that the squeaky wheel out there that the clinicians want done can start to get done and then not add more operational overhead.

So do more with less and allow people to use the tools that are available to them to make them feel innovative. I just think that's so, so important that we do that for people in their work lives and in their career. And I just think there's a tremendous opportunity here for us all

Sarah Richardson: when you go into a new account or to a new partner scenario, and this [00:23:00] is obviously addressing a need that they have.

What are some of the lessons learned or things that you believe are most important from a strategic perspective for healthcare organizations to successfully adopt and maintain these enhanced efficiency solutions?

Laura O'Toole: No, this is gonna sound so basic. But I actually have now put together and had our team put together.

We have a whole methodology, but at least now we're offering up. I think what's happening is our leaders in healthcare are so incredibly busy. It's like their heads are spinning off. Their body like in, uh, the Exorcist. That's what it feels like to me. And then everyone's grabbing at them.

And I think what's happened is this downstream of communication. So you get the key stakeholders involved. They get their initial team director level managers involved, and everyone's like, oh my gosh, hallelujah. This is awesome. And then we go to a kickoff. Some of these poor people are like, oh my [00:24:00] God, what's happening?

What's gonna happen to my job? Wait, this is what I need to do. So I think we've learned we can be far more prescriptive and help those leaders. This is basic change management 1 0 1, and really pushing down communications in the right way so that people feel comfortable. And now what we're starting to do is bring our implementation teams into the sales process.

So that they get to know the people that they're gonna be working with because this has to be about connection and about trust. And at the end of the day, and I, you and I have talked about this. I hate being called the vendor if I'm not your partner. It's really uninteresting to me. I live my life believing that everybody can win and that it's every leader's responsibility to do their part, to help everybody win.

And that doesn't happen without communication. It doesn't happen without connection. So the more that we can do to connect those dots, early in the process, we've seen people [00:25:00] have. Incredible success. I'll give Cook Children's as an example 'cause I cannot say enough about Theresa and Charity and the team there.

They are a group of leaders that had it together. And they listened. They took our methodology. They said, you see how this has done? Well, we're gonna adopt what you're suggesting here. And we had their entire library developed and ready for deployment. I wanna say it was two to three months.

, and this is a children's hospital, right? So these are very important, complex workflows. So, some hospitals take a little longer, but I think the biggest lesson learned I've had is don't be afraid to step up and say can we call a time out here? Because I know everybody has their own process, but I.

I need you to trust us. these are the health systems we've seen. Get the ROI so quick and soon if you do these few things. That's probably been my [00:26:00] biggest lesson this learned this year is I've watched some health systems. ECU is another one. Yale Health is another one. Outstanding job at managing their methodologies and really aligning with the project team and not have this be a one off.

Project, but really integrate into what their teams are doing. And those are the ones I think that where we've seen the most success. And, the ones that, bucked the system a little bit. It just took us a little longer, but they saw the value and now we're expanding and it's all, it's all good.

But I think I would speak up a little bit sooner. Obviously when you're doing consulting and, we provide this fixed fee as a managed service. We wanna be respectful of our clients, but If you're my partner and you think I should be doing something better and I can do it better, I sure hope you would tell me.

Right? Yeah. So, and that goes both ways. And this is all about leadership. It's about self-awareness, it's about leaving your ego at the door. And everything [00:27:00] we've talked about, at the end of the day, it boils down to leadership. And I think the clients that are having the most success with moving the needle.

Reducing an ROI and innovating and really transforming where we need to go with automation, machine learning, whatever those innovations might be that are gonna move the needle on patient care and getting access sooner. I think those are the ones that lead and that lead from the front, and those are the clients that I'm most attracted

[Mic bleed]

Sarah Richardson: For the right reason. Clearly, and with all these headlines we see about chasing ROI, looking for workforce solutions, thinking about the challenges we have, recruitment, retention burden and burnout, et cetera. If you could pick a headline, Laura, for the end of the year based on the things we've talked about, things that we continue to see, what would be the headline that you would like to see us literally discuss in first week of January, 2026?

Laura O'Toole: Oh man. Be [00:28:00] thoughtful and move the needle on innovation the right way and empower your teams. Empower your teams because I think the answers are there and the solutions are there. If you think about, we talked about the rural areas. We've talked a lot about nursing, I sit on a board for Shell Health that does think about mobile.

Ultrasound for Uber, Uber for ultrasound, just one of the things that they do. What about all the ancillary shortages? Think about x-ray checks, ultrasound checks, echo checks. How are we going to move people in general? With Innovation and using some of these tools to help people get smarter. Think about what we can do from a remote hands perspective, right?

If you have somebody that could operate potentially at a lower license with somebody shadowing them above, talking into their ear I think I told her I went to a board meeting and I didn't realize this. I had no [00:29:00] idea. Ultrasound techs all get certified, right? They all go to school. And this is just another example of how we need to think about staffing shortages, how we need to think about innovation.

Because at the end of the day, especially in the poor rural areas where people just don't have the access to care that they need, and I'm not gonna get on a political soapbox here, but how do we make that better for people that are the underserved? And make sure that they have access to good care. So here's an example.

I didn't realize this Medicare, it's the radiologist's license that's reading the test. That is what you need to put the claim together to bill. It's not the ultrasound tech. Now they all get their certifications and whatnot, but I kid you not I am no clinician I had an earphone in my ear, a Doppler, and I did an echo.

With someone talking to me in my ear, remote hands in a call center where the echo certified person was and the radiologist was, [00:30:00] and they're telling me, go, right. It would vibrate in my hand, like it would like gimme a little shock. Like, you gotta go this way, and I was able to produce an echo that.

It was in a test environment, obviously. And this is another example of where automation, test automation can go. Think about all this virtual devices we can test. It's limitless what we can do. And think about how you can take smart people and have them school up. How can we use medical assistants?

How can we use CNAs? How can the hospitals use the staff that they have at their disposals that aren't, RNs to do some work with the support of a model that's scalable. That's where we need to go, and all of that needs to be tested because we cannot risk harming that downstream integrated workflow.

So those are things that I get excited about. So the headline, thoughtful Innovation. [00:31:00] Surrounded by governance because you know what worries me more than anything I can get on a tangent now is we're talking about application rationalization all the time. If we're not careful and put some governance in place for every AI tool that's coming out there today, you are gonna have the, OR trying to contract for their own tools.

You're gonna have radiology con, can you imagine a nightmare that's gonna be for our CIO colleagues? The governance has to get in place, so I think we need to be thoughtful. The technology's there. The technology's gonna get there. Let's get there the right way in a thoughtful way so that we don't end up spending tons of money going through a whole nother application rationalization exercise with no governance and no leadership,

Sarah Richardson: and there's a level of responsibility that says.

Look at the roadmap from what's coming within your EMR partner, from what's coming from point solution partners and otherwise, because I keep hearing more and more Laura, that people are like, I'm gonna go all in with what comes from [00:32:00] my EHR vendor, and that roadmap is good enough and I've gotta believe there's also that bifurcation of the governance process that says, When is good enough.

Okay. And when is good enough? Not gonna be advanced enough for things that we need to do. And to your point, that rationalization activity is maybe we do need some resources for this solution here and this other space is good enough. But I'm always very cognizant of the impact of all your eggs in one basket, because to me that's stymies in innovation.

And when you are in a scarcity space, you can be the most innovative, but you can't be innovative if you're just. Relying on what's going to be delivered to you, you've got to create and push that envelope forward

Laura O'Toole: at a minimum. You not only have to push the envelope, but you need to ask the questions and not say.

What can't we do, but what can we do and really begin to solution this. And I'm a firm believer in, the 80 20 rule and for the here and now, if there's ways to make [00:33:00] incremental progress within the EHR, absolutely do it. I have a client right now that made the decision, they're a Cerner client.

We've automated a whole Cerner and surround application library for them and they made the decision, they're moving to Epic, they just went to Madison. They're in the throes of their implementation. And so we're talking to them about, okay, how do we, at the right point, when you get to that integrated time in that build with testing, 'cause you want everybody to test, it's a great way to learn and I'm all for that.

But think about the number of integrated test runs that we can do. Building the automation alongside of the implementation. Yes. And then better than that, you get to the end of the implementation. You're not two or three upgrades behind because the automation has kept up with it. To me, that is innovation.

That's the way to really maximize what's available and make a difference for your employees and come out as an innovator. On

Sarah Richardson: the other side, we're gonna have some great headlines to cover. In 2026, especially if you and I continue to [00:34:00] push the conversations that we believe are important inside health systems with our CIOs and, partner brethren.

So thank you for joining me. As always, I love the things we talk about. I love how we don't really hide some of the bigger ideas that we believe need to be discussed and tying it into what's happening today so people can bring all those pieces and parts together for a clear picture of some ideas of what they could pursue next to find these successes within their own healthcare organizations.

Laura, thank you for joining me. Thank you for your partnership with SureTest, and I look forward to our next conversation.

Laura O'Toole: Always great to be with you and the team. Thanks so much, Sarah. Great to see you.

Thanks for listening to Newsday. A lot's happening in our industry. And while Newsday covers interesting stuff, another way to stay informed is by subscribing to our Daily Insights email, which delivers expertly curated health IT news straight to your inbox.

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