Some 57% of healthcare professionals are using AI tools their employer never sanctioned, according to a recent survey published by Wolters Kluwer. For most health system leaders, that number reads as a compliance failure.
During a panel titled “Tech Transformation and Trust: What the Top CMIOs Do Best (and Lessons Learned)” at Becker’s 11th Annual Health IT, Digital Health and RCM Conference, three chief medical information officers discussed their experience regulating these tools, also known as “shadow AI.”
All three panelists: Joseph Izzo, MD, chief medical information officer at San Joaquin General Hospital in French Camp, Calif.; Clara Lin, MD, vice president and CMIO at Seattle Children’s; and Philip Bernard, MD, senior vice president and CMIO at Children’s Health in Dallas described a similar pattern of physicians seeking out unauthorized tools to find solutions that may not exist within the organization’s toolbox.
“There’s also the list of shadow AI that people are already using because your network isn’t blocking it,” Dr. Lin said. “That list is what keeps me up at night quite a bit. But, to [Dr. Bernard’s] point, that is also the list of where you see the needs are in the organization. “If you’re not giving them a text assistant or a Grammarly-like tool, they’re going to go out there and find the ones that they like on their own. If you’re not giving them a ChatGPT, they’re going to go out there and find ChatGPT.”
Rather than treat that as purely a control problem, she said she uses the list to help decide where to expand licenses — a tool approved for one department, such as finance, sometimes turns out to be exactly what another department, like supply chain, was quietly looking for on its own.
Dr. Bernard described the alternative approach — and why it failed. When ChatGPT launched, his institution’s initial response was an outright ban.
“Thou shall not use it,” he said. “That lasted about two weeks. That’s not a strategy.”
Dr. Izzo said the underlying dynamic is one CMIOs can’t engineer their way around. “Physicians are resourceful, and network filtering only goes so far,” he said. “We can’t really stop it. Clinicians will do what they feel they need to do to advance their workflows, especially if we’re not providing them with an acceptable alternative.”
That reframe echoes what other health system leaders have told Becker’s: rather than only restricting unsanctioned tools, systems nationally are increasingly treating shadow AI as feedback about where governance and tooling haven’t kept pace with what clinicians actually need while improving visibility into what’s already in use, investing in AI literacy and building sanctioned alternatives rather than relying on restriction alone.
For Dr. Lin, that meant building a resource clinicians could check before going around her team altogether. Early on, she said, staff had no option but to email her directly and wait to hear whether a given tool was safe to use.
“We built a website that can answer 80% of the questions people are asking me,” she said. “I think people felt like they could rely on that as a source of truth.”
The page is dated by month, a deliberate choice given how quickly the landscape shifts. “A month in AI is like an eternity these days,” Dr. Lin said. “So we always make sure — this is the May update, this is the June update.”
For Dr. Izzo, closing the gap is about who gets a seat at the table before a policy is written. He said governance frameworks that amount to box-checking rarely hold up. “You can have a framework, a committee, a process where it just is performative,” he said. “Or you can have folks who come to that table energized across the organization, who want to actually consider safety, who want to consider how this works throughout their departments.”
Any framework a system borrows from elsewhere, he added, has to be localized. “It’s not going to be one size fits all. It comes back down to culture.”
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