Jefferson Health bought almost all of its software for decades. Its top technology executive now wants to reverse that model.
“We grew up buying applications; we bought 99% of them,” Luis Taveras, PhD, executive vice president and chief digital and information officer of Philadelphia-based Jefferson, said during a Nov. 4 panel at Becker’s CEO + CFO Roundtable in Chicago. “So what I’m trying to do is go from buy, partner and once in a while build something, and flip that around: I want to build, I want to partner, and once in a while buy something new.”
Part of the case is financial. Jefferson pays “millions of dollars” every year in vendor support fees, he said. “Why can’t we use that to build our own applications and really use the experts we have to build them?”
Another part of the equation is sprawl. Jefferson has 1,000 different applications that accumulated over years of departmental purchases, Mr. Taveras said, leaving the system with plenty of data but no enterprise-level view. “Is that really what we need?”
Jefferson has about 45 potential projects on the docket and plans to build 15 to 20 of them this calendar year, prioritized with a criticality index. Clinical tools will mostly wait.
“I don’t want to cut our teeth on clinical applications,” he said, adding that most will come after January.
To staff the work, Mr. Taveras plans to convert a large part of the team that supports applications into one that develops them, and said the system is willing to look for nearshore talent in Mexico or elsewhere.
Ideas come from AI champions embedded in departments who build full applications, “not just agents,” he said. Training also supports the effort: An oncologist now leads AI education for its 65,000 employees.
Mr. Taveras also argued against a common first step.
“Many organizations got caught up at the beginning on, ‘We have to create a governance model for AI.’ You don’t need to do that,” he said. Jefferson fits AI into its existing governance instead. His other rule: “Don’t let vendors tell you what you need.”
Adam Landman, MD, senior vice president and chief digital information officer of Providence, R.I.-based Brown University Health, said he is on the same page with Mr. Taveras.
“Many of us were fortunate to have programmers and developers in our organizations, and over the last 10 years we’ve reduced that,” Dr. Landman said. “AI is changing the game. I completely agree it’s changing the build-versus-buy debate. … You can build really sophisticated applications very, very quickly.”
Brown gets there from the bottom up. Staff can build assistants and simple agents on a secure AI platform IT monitors; a few hundred of its roughly 20,000 employees are building, Dr. Landman said. His teams look for “hot spots of real value,” then harden and scale those tools.
Dr. Landman said Brown University Health differs on governance, however, adding that AI tools deserve “special attention” and “additional rigorous review.” Because of that, Brown scales its review to the risk: Autonomous clinical care requires executive approval, while a billing or coding tool needs less.
Mohan Giridharadas, founder and CEO of LeanTaaS, which uses AI and software to unlock capacity in health systems, endorsed building where possible but warned about its limits.
“In many cases the last mile of healthcare is very hard, and Claude simply can’t vibe code your way to heaven on that,” Mr. Giridharadas said, pointing to how surgeons operate and how flip rooms work. His advice: “Pilots are cheap and quick, but they don’t create value. Focus on things that create tangible, sustained value with a positive ROI.”
Size matters as well. Alan Kumar, MD, COO of Powers Health, a four-hospital system in Northwest Indiana, said his system aims for “the back end of cutting edge or the front end of mainstream” because, at $1.5 billion to $2 billion, “failure is difficult to absorb.”
Even so, Powers’ finance teams have built their own agents, letting the system forgo full-time equivalent hires it had planned and redirect that capital toward growth, Dr. Kumar said. He cautioned that any tool — built or bought — needs sound operations underneath it. Otherwise, “new tools aren’t going to make you better; they’re just going to cover up some of those issues.”
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