Noel Toal is the CIO for DPV Health. With over twenty years ICT leadership experience including ten years as a healthcare ICT Executive. He has experience leading a range of ICT and Non-ICT teams in healthcare. He was judged by CIO Magazine as one of the top fifty Australian CIOs in their CIO50 list for 2022 and 2023. He was also awarded a spot in the CSO30 list for 2023 as one of the top thirty cyber security leaders in Australia and in 2024 the CRM project he led for DPV Health was a finalist in the ITnews Benchmark awards for Best Health project. He is a regular speaker at Healthcare and ICT Executive events discussing Data, AI, Cyber Security and Digital Transformation. His extensive experience as an Executive, Board Director/Chair and Business Owner who sold a business to an ASX listed company provides a business perspective that shapes his view of ICT as a value creator for organisations.
Recently, in an exclusive interview with CIO Magazine, Noel shared his professional trajectory, insights on the most significant changes he has witnessed in the healthcare IT landscape, the secret mantra behind his success, future plans, pearls of wisdom, and much more. The following excerpts are taken from the interview.
Hi Noel. Tell us a little about your educational and professional history.
Education: Completed a Bachelor of Business (Computing) at RMIT with the intent of been a developer.
In 2017 completed a Master of Business Administration (Executive) at Australian Graduate School of Management with the MBA jointly awarded by The University of Sydney and The University of New South Wales. I undertook this to improve my understanding of the broader business, to speak their language and be better able to bridge the divide between business teams and ICT.
Throughout my career I undertook a number of certifications ranging from vendor certifications including Novell, Microsoft and HP through to industry certifications such as ITIL and Prince2.
Professional history: I began my career in the middle of a recession in 1991 when I cheekily applied for a senior COBOL programmer role with a start up financial software company called Hiportfolio. The owner rang me up and said that role is beyond your experience but your cover letter showed the enthusiasm I want and invited me to have a chat with him. He then created a new role where I was the assistant programmer to his most senior programmer and I also took on all the ICT network and desktop support.
As the organization grew rapidly with international offices I found myself setting up data links to these sites in the days before internet was around. I was totally out of my depth and learning on the fly but it was an exciting time that taught me a lot. As the organization grew I was told I had to pick between been a developer or been an ICT network and desktop support person. I had realized that been stuck behind a desk coding predominantly bug fixes to someone else’s code was not as exciting as engaging with people and solving the network, application and desktop issues.
My next role was as the inaugural ICT network and support engineer for Victorian Breastscreen supporting the first seven sites. I only lasted nine months in the role because while I was busy I didn’t find it technically challenging enough after my time at Hiportfolio.
The next role was a Senior Systems Engineer for a systems integration company called Business Computers of Australia. This was far more technically challenging getting called in to deal with major issues. I provided project and problem resolution to a range of organisations including JP Morgan, BHP, Shell, Coles, Norwich Union and the Australian Grand Prix Corporation. This is where I got my first taste of management when I was made a team leader for five staff who were delivering a six month project to convert BHP Petroleum from Novell to Microsoft. I loved it and I learnt early lessons about how trusting and supporting staff was a powerful way to get good outcomes and the hard lesson that organisations need to recognize the career aspirations of talented staff or lose them.
Hiportfolio had continued to grow when I had left and had been bought out by a subsidiary of the multi-billion dollar multinational DST Systems and was now called DST International. They head hunted me back into the organization as a Senior Systems Engineer to help them deal with some issues they were experiencing. When my manager left I put up my hand for the role and was Acting Regional Head of ICT for six months before taking on the role permanently and stayed in that role for eleven years. The international clients included National Australia Bank, JP Morgan and Swiss Re-insurance. With Australia the main development centre for the organisations most important product we were providing 24 x 7 support for the servers and network.
After competing my MBA while working for DST International I purchased a Cardboard Box manufacturing business which I went to work for. It was a totally new experience and taught me a lot about all elements of business as I transformed it and then sold it three years later to a company listed on the Australian Stock Exchange (ASX).
I then joined Access Health and Community as their inaugural General Manager Information Systems. It was my first big role in Healthcare and I was with them for six years through three mergers. This was the first role that I was given some Acting CEO experience in when the CEO took leave. I moved from an outsourced ICT support model to internal and built a high performing team. I was also given responsibility during my time there for Facilities Management.
I left that role for my current role as Inaugural CIO for DPV Health. It was formed from two newly merged organisations and the new CEO was assembling a new executive team and I took it as a great opportunity to get in at the ground floor and really make an impact. In august this year I will have been with the organization for five years. I heard my role described as CIO plus because I also manage three non-ICT teams under Client Access. These are Reception/admin across all sites, intake who are the call centre and referral processing team, Language services who provide the interpreters. I was asked to take this on during my tenure to utilize my expertise with data and processes to improve the client waiting lists and wait times for services. It has been a good learning experience to build broader management and leadership skills.
Brief us about your role and responsibilities as Chief Information Officer at DPV Health.
I joined DPV Health as their inaugural CIO six months after it was formed from the merger of two healthcare organisations, with the task of developing and implementing a digital transformation strategy.
DPV Health provides services to the community of Northern Melbourne that experience significant levels of disadvantage and is a negative outlier on most health metrics. The organization needed ICT systems that would support the growth in clients, new services and sites while also supporting the provision of excellent care for every person, every time.
Technical debt was restricting the organisations ability to grow. The network and systems were slow and unreliable leading to frustrations for staff and clients. Something as simple as entering consultation notes into a medical record was interrupted regularly with issues.
The network was very rigid and didn’t provide the scalability of easily adding new sites while also not supporting the mobility that clinicians needed to deliver new services in clients homes and at non DPV Health sites.
The COVID-19 pandemic threw up its own challenges and the organization rose to the occasion running large vaccination hubs and popups, site based and mobile testing, and a range of community support programs. These saw revenue increase by 65% in two years as staffing numbers increased. At the same time core services were moved where possible to telehealth with Doctors adopting a fully documented and supported telehealth service they had been trained on within two weeks. The implementation of a collaboration platform with video conferencing capabilities was accelerated to support work from home and service delivery in the community.
Thin client pc’s and the Citrix farm were replaced with laptops and tablets with Azure Virtual Desktop. This was accelerated to provide secure and controlled work from home environment during the pandemic but also provided the mobility capabilities needed to support provision of services in peoples homes and at sites in the community. This enabled the organisation to grow services beyond its sites.
The new ICT strategy to deliver the much needed Digital Transformation included a focus on simplifying and streamlining the ICT environment by building out the Microsoft Technology stack, merging applications and reducing the number of systems used. Simplifying the ICT environment reduced the management overhead and allowed a focus on improving what was retained while also creating capacity to bring in core functionality that was needed by the business but not provided by the legacy systems.
Simplifications included replacing eight Human Resource systems from the previous two organisations with a Human Resource Information System (HRIS) that included recruitment, onboarding, performance management, learning management, credentialing and payroll.
Another example was merging two client management systems used by Allied Health clinicians so they no longer had to switch between systems when seeing different clients. This was also a foundational piece in making the move to a single client view in the CRM possible.
An example of bringing in new functionality was the implementation of a system to support the efficient provision of NDIS and Home Care Packages (HCP). This allowed the organisation to turn loss making NDIS services into profitable ones to support other essential services. It also allowed the organisation to start providing HCP services. As both NDIS and HCP services are uncapped it allowed the organisation to grow its provision of services to clients without the constraints of block funded services.
The organization migrated to the cloud providing the scalability needed for growth while also allowing the full range of the Microsoft Technology Stack to be utilized. The network was rebuilt on a Clinical Grade Network (CGN) co-designed for the Victorian Community Health sector with Optus and the Victorian Department of Health. The CGN provided link redundancy, auto-failover of ICT infrastructure, improved speeds, express route to Azure, improved connectivity to the Acute Health organisations.
As the organization moved to the cloud, built out the CGN and implemented new systems it was taken as an opportunity to embed Cybersecurity improvements at all levels. This led to very significant and measurable improvements to better protect the privacy of client data. The success of this has been recognized in Department of Health reviews and audit results.
A CRM was developed that pulled together the client data from siloed client management systems. This has provided a single client view allowing us to personalize the client experience when they call and capture inclusion information and enquiries. Changes to demographic details in one system are now reflected in all of them providing a consistent record.
The CRM was linked to a new cloud based omnichannel contact centre providing the client with the ability to contact via phone, sms and chat while also automatically identifying them to the call taker. This can then use the skills based routing to route calls based on their preferred language when we have someone who can speak that language. This all improves the client experience.
To provide the organization with the ICT support levels it needed and support the major projects the organization moved from external ICT to internal teams. This has led to a significant uplift in staff satisfaction levels with the helpdesk with them regularly achieving 99% plus satisfaction.
One of the new teams implemented was a data and clinical application support team. They have introduced a data lake pulling together the data from the different client management systems and integrating it with the CRM. They also created a range of interactive PowerBI Dashboards that provide real-time interactive information for clinicians and leaders, replacing the clunky excel spreadsheets. This has changed the management of productivity from end of month when reports were available to say if targets were hit to real time information on whether the end of month target will be met. This allows leaders time for corrective actions.
Additionally during my time with DPV Health I was asked to take on executive responsibility for three non-ICT teams under the Client Access structure. These teams are Intake who run the primary call centre and process referrals, language services who provide interpreters for clinical consultations and the Client Services team who undertake the reception and administration duties including phone answering across the twenty sites.
This has been an opportunity to improve my business leadership skills and use my data and process experience to improve the management of service waitlists and reduce client waiting times for appointments.
What is the most significant change you’ve witnessed in the healthcare IT landscape since you began your tenure at DPV Health?
Cloud: The use of the cloud by healthcare organisations has continued to increase and while some services are lagging in its adoption there is a clear understanding that Cloud is an important component of a modern ICT infrastructure.
Hackers target healthcare: There used to be a time pre-pandemic when Healthcare was not heavily targeted by hackers with many hacking groups respecting the important services they provide. Since the pandemic this has dramatically shifted and hacking groups now see healthcare as an easier target than many corporates and they have realized the high value of the client data that healthcare organizations store. As a result the number of large scale and sophisticated attacks on healthcare has significantly increased.
AI: While AI has been around since the 1950’s it was the advent of generative AI easily accessible by everyone via systems like ChatGPT that has caused the biggest hype. Healthcare is now looking at the tremendous opportunities of AI to improve both clinical and back-office use cases. IT represents the greatest risks and opportunities for healthcare in a long time.
Recognition for Digital Health: ICT teams used to be seen as keeping the lights on and reactive problem solvers. This has now shifted and healthcare boards and executives now see ICT as an important proactive driver of efficiencies and innovation that can positively support the cost effective and high quality delivery of service to clients. The gradual shift from government block funding for delivery of healthcare services to competitive and leaner fee for service funding has heightened the need for efficiencies. This has led healthcare organisations to see ICT as key drivers of their sustainability and success.
How and why is technological innovation so central to the development of the healthcare landscape?
We saw during the pandemic how strained our healthcare systems are with low numbers of qualified staff who have to deal with lots of complex and diverse client health issues. The health care needs are far greater than the scarce clinical workforce and it causes increases in waiting times for a range of services.
To maximise clinician ability to help more clients and reduce their burnout we need to free clinicians from the administrative burden that constrains them, and rectify the delays that inefficient ICT systems imposes on them.
Networks and systems that are slow or unreliable cause clinical consultations to be longer or cancelled. This has an impact not just on the clients ability to get a needed clinical appointment but also on the clinical deterioration they may experience while waiting for service.
Automation of manual workflows and the use of AI are areas of technological innovation that can greatly assist clinicians, giving them back time for more consultations.
Historically the data about a clients various medical conditions is locked into siloes created by different specialized Electronic Health Record (EHR) systems and spread across multiple health organisations. This causes a clients medical record to be fragmented with no complete medical record available to any clinician. This lack of a single client view is impacting on the level of care that can sometimes be provided. My Health Record is meant to address this but is not currently delivering the consistent level of information needed.
Innovation in the integration of clinical records both within an organization and between them can address this problem and also provide the data needed for a clients health journey to be tracked and the impact of each health service provided to be measured. This ability to share client data will be central to realizing the full value of AI to augment client care and provide reliable clinical predictions.
So innovations that address this core problem of a lack of client health record integrations are highly sought after and can greatly improve the quality of clinical care and also provide more opportunities to better inform clients and involvement them in the management of their own health.
How about AI in healthcare…what are your thoughts of what’s working and where we’ll see better use of AI in healthcare?
Healthcare is one of the sectors that can most benefit from the adoption of AI but it is also an area that is by its very nature cautious. So the descriptors we have had of early generative AI such as “sometimes usefully wrong” and “can have surprises” are not something we can afford to have when dealing with decisions that can impact a persons life span and quality of life.
For this reason there will be parts of healthcare that are slower to adopt AI for clinical use and will wait for Large Language Models that are certified for medical use just like we certify drugs and medical devices.
It will be important for patients to understand that AI will augment clinicians not replace them, ultimately AI will be there to reduce cognitive load and allow clinicians to focus on the client. A good example of this is Ambient Intelligence in a consulting room where the AI listens to the conversation between a doctor and patient. The Doctor doesn’t need to do any data entry so they can focus on the patient. At the end of the consultation the AI will summarise the information from the consultation into a medical format suitable for upload to a medical record system. The Doctor will review the notes and made amendments if necessary before approving for upload. A patient friendly patient will be automatically generated that provides information the patient needs such as medication dosage, tests required etc. This too will be reviewed by the doctor before it is sent to the patient.
The back office supporting functions for healthcare are safe areas for AI to be initially used and learnings to be gained. An example is the pilot DPV Health did with an appointment predictive model that allows a call taker to know the appointment times that are most likely to be attended versus those with a high risk to a patient not attending. This model was 91% accurate and can be used to improve appointment attendance thereby increasing the number of patients seen by a clinician in a week which reduces overall wait times for appointments. We know that some health conditions deteriorate over time so improving the attendance rate to appointments allows clients to be seen earlier before their condition worsens.
Other examples of Ai use that can be adopted early are sentiment analysis of omni-channel communications with clients to identify opportunities to improve our engagement with clients. The creation of chatbots available 24 x 7 to answer patient questions and the translation of brochures etc into other languages to make services more accessible.
The opportunities for AI to be used in non-clinical healthcare use cases is substantial and is a safer way for it to start delivering early value.
In the coming years, how do you see the role of the CIO evolving in the healthcare industry?
The role of the CIO is changing as it very much becomes accepted as a transformation driver for healthcare organisations to maximise the delivery of healthcare services to more patients within constrained clinical staffing.
So a CIO is a business leadership role with an ICT specialty that strategically utilizes Technology to solve problems and take advantage of opportunities. The old days of a CIO only keeping the ICT functioning so clinicians can use it to deliver services is already on its way out. The modern Healthcare CIO needs to deliver increased value from the technology investment.
The growth of AI puts more focus on a Healthcare CIO to have strong governance skills so that its use is governed to reduce risks. As AI is so new to many and not readily understood beyond the use of ChatGPT, it will be the CIO who needs to educate the Board, Executive and broader leadership team on how AI can be utilized and the risks that need to be considered. So a Healthcare CIO in the age of AI needs to be a thought leader, an innovator, someone who can think outside the box and imagine the possibilities while pragmatic enough to understand what is deliverable today and what needs to wait for regulatory and technology change.
You have been recognized as one of the top fifty Australian CIOs for 2022 and 2023. You were also recognized as one of the top thirty Cybersecurity leaders on the CSO30 list for 2023. Our readers would love to know the secret mantra behind your success.
I always tell my teams that “I want us to be known as the best team in the country at ….” So I want each of my teams to be the best at what they do. I often use the analogy of the forwards, mids and defenders in a football team. They are each a mini team with a specific desired outcome, if one excels and the other doesn’t they can still be a good team but if they all excel they will be a premiership winning team.
So I am always striving for excellence and whether it is an existing team that I want to uplift to excellence or building a new team the target is always excellence. “why be average when you can be excellent”.
The secret to my success is that I have always hired or promoted the people who are the best at what they do or can be if given the opportunity.
So I hire potential a lot, I have a knack for identifying it and then enjoy nurturing it.
My teams are always full of very different sorts of people who all bring a unique set of skills and views that allows great outcomes to be delivered. They are all the same in that they want to be the best.
I don’t worry about one of them been able to replace me, in fact I always seek to develop a successor so that when I leave the organization, what has been achieved can be maintained and built on. My chosen successor also needs a strong 2IC who can step up and replace them.
What this does is create great depth of leadership in the teams and this drives great results.
I received the accolade of a CIO50 and CSO30 award, but it is really recognition of the amazing people who work for me delivering on the ICT strategy and innovation.
What drives your passion for health-information technology?
Healthcare has been a backwater in its use of information technology and yet it is a sector that can really benefit from innovative use of it. We have all at some point in our lives engaged with the health sector and had family and friends who have. So healthcare touches us all and has a dramatic impact on our lifespan and life quality so I am driven to contribute to it.
With healthcare been behind in its adoption of technology there is huge opportunity to innovate and deliver great value. So I see it as a great sector to drive improvements and there is a growing movement to utilize technology better.
Its always a great feeling to go to work knowing that what you do is helping the community by improving their access to and the quality of healthcare services. So while I am not a clinician I can contribute my ICT skills and experience to assist on a broad scale which is very satisfying.
What is your biggest goal? Where do you see yourself in 5 years from now?
My ultimate goal is to be seen as one of the best Healthcare CIO’s in the world through delivering innovations in digital health. The two areas that I see as critical to this are enhancing data integrations between health record systems within healthcare organisations and the interoperability of systems to allow controlled client data flows across the different organisations they visit in their healthcare journey.
In five years time, I would like to be in a larger healthcare CIO role with the ability to positively impact even more patients through digital health innovations.
Many companies are currently undergoing digital transformation processes – what are your tips on a successful digital transformation?
- Even big ambitious projects should start with smaller pilots to test out assumptions, make improvements and get learnings.
- Successful small pilots create proof and excitement about the change that you are providing and if done well you won’t have to push other teams to accept the change, they will actually line up to have it. The easiest way to affect change with ICT is to have people asking for it and lined up waiting for it. Successful pilots will do this for you.
- Know that change fatigue really is a thing, non-ICT people don’t find technology as interesting as you do and can get tired of it. So wherever possible effect change so it is not noticeable for things like cybersecurity and infrastructure changes. Because if they notice it then it contributes to their change fatigue.
- The best way to get end users to adopt to your digital transformation is for them to see the value of the change and trust in your vision. This will only happen if you have successfully delivered on some earlier changes that make a positive impact for them. Then when you say the next change will also be positive they are more open to it.
- Always have the final goal in mind and visualize and plan for the steps to achieve it. The worst thing you can do is make short term decisions and implement things that you need to replace later or majorly change to get to the end goal. This will increase the change fatigue, drive up costs and increase the time required. So strategically think through where you want to get to and how to make it happen.
- Ensure that you have the board and executive support for the digital transformation elements because technological issues, resourcing constraints and push back from some teams will occur and you need support to continue.
- Don’t be afraid to change your mind. Sometimes you may be committed to a technology direction and you have communicated that. As things progress you learn more, technology options change and your knowledge can improve to the stage where you now see a different path as the best one. If you doggedly continue on the original path even though you no longer think it is the best one you are setting yourself up for failure. Be brave, say you changed your mind and follow the best path because you will ultimately be judged on the outcome of the digital transformation not whether you followed the path you initially intended.
One word that best describes how you work.
Strategically.