When John Gaede arrived at Farmington, N.M.-based San Juan Regional Medical Center as CIO about two-and-a-half years ago, the hospital’s IT operations were outsourced to a third-party vendor, and it wasn’t working; the company was making decisions that didn’t align with the hospital’s unique community needs. Mr. Gaede realized something had to change.
He pulled IT back in-house in what he called a “strategic insourcing” move and restructured the department around clinical problem-solving rather than vendor-driven priorities. He then sought a clinical partner to realize his vision for IT at the 198-bed hospital.
Carlo Hallak, MD, joined as the hospital’s physician informatics executive about six months later, the first person to hold that role in the organization’s 116-year history. He brought 15 years of informatics experience and previous roles at Cerner and Franklin, Tenn.-based Community Health Systems to San Juan Regional Medical Center. Then the duo identified Oracle Health as the right partner to modernize their technology and operations.
“We will become the leading 200-bed and below hospital in the country running on the Oracle Health platform,” Mr. Gaede said. “That’s where we’re going.”
Last December, the hospital took an important step by deploying Oracle Health AI Agents, ambient AI documentation tools, across ambulatory and specialty clinics. Where a typical IT implementation of that scope runs six to nine months and requires coordinating infrastructure, security and clinical informatics teams across concurrent workstreams, this solution was operational in under a week. Physician training easily condensed to the five minutes it took to download the app and show them how to use it.
“All the traditional things that we do to have this kind of impact on an individual clinician’s experience — it breaks all those paradigms,” Mr. Gaede said.
The effect on clinical workflow was immediate. Physicians who had previously spent significant time after appointments completing documentation found draft notes generated and ready for review by the time an encounter ended.
“It’s becoming very common now that we say physicians are editors of notes, not writers,” Dr. Hallak said. “They have the ability to focus on what is important for the physicians and providers. The Clinical AI Agent allows for face-to-face contact, not to have a device in between you and the patient.”
The clearest stress test came during a separate implementation, when the hospital migrated an orthopedic clinic from a niche EHR to a fully integrated Oracle Health platform in four months. By the second day after go-live, physicians were asking to return to full patient schedules, which is unthinkable under most complex EHR transitions.
“Oracle Health AI Agents alone brought so much joy to a lot of the physicians,” Dr. Hallak said. “We integrated it with our orthopedics clinics and we did it in four months. It was an amazing success story. We managed to convert from a niche EHR to Oracle fully integrated in four months, and the agents were the saving grace because physicians could continue caring for their patients.”
San Juan Regional Medical Center is now working through the consent and communication processes needed to extend the Oracle Health AI Agents to the acute setting — emergency department, intensive care and inpatient medical-surgical units — with strong interest from the hospitalist group.
The capacity management deployment with Oracle Health, completed during the same period, produced comparable results. The implementation unified patient flow, transfer center and command center tools together under a single platform. In a 60-day post-go-live review, the organization’s consultants only heard positive feedback and key performance indicators improved.
Dr. Hallak sees the capacity management foundation as the precondition for the AI-driven work that follows.
“You cannot do any of this without bed flow,” Dr. Hallak said. “Now there’s visibility across the building.”
With that operational infrastructure in place, data governance has become the immediate priority. Mr. Gaede traces data governance back to its foundation. “Data classification, being able to just know what data we have and the processes we put around that are all going to be tied back to governance,” he said.
The pace of deployment over the past year produced a harder lesson. After rolling out ambient documentation, capacity management, and other initiatives in rapid succession, Mr. Gaede and Dr. Hallak realized they had exceeded the rate of change their clinical staff could absorb.
“At some point, for the nurse on the floor, this becomes one more project, one more thing for them to do when they’re just trying to take care of patients,” Mr. Gaede said. “We’re actually getting ahead of our clinicians.”
The response was a deliberate slowdown achieved by inserting pause periods between implementations, tighter project sequencing and a shift in how the team frames its work with clinical staff.
“Our clinicians don’t feel like we’re doing technology to them, but with them,” Mr. Gaede said. The plan for the next phase includes nursing-focused ambient tools and enterprise-grade AI access designed to give staff a clinically validated alternative to the public generative AI platforms many are already using.
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