What happens when the technology is ready but the health system isn’t? And what happens when the health system is ready but the technology timeline says Q3?
Dr. Clifton Watt has lived both sides of that tension. A practicing cardiologist and Executive Medical Director at UCSF, he trained as a software engineer before medicine — a combination that gives him a rare ability to see the gap between what technology promises and what clinical reality demands.
In this episode, Dr. Watt joins Angela Adams and Kandice Garcia to talk about where healthcare innovation is actually heading, why access to care is cardiology’s most urgent disruption opportunity, and what it will take to redesign who cares for patients, where, and when.
The Chaos: Innovation That Stalls in the Gap
Healthcare has no shortage of innovation. What it has a shortage of is implementation. Too many stakeholders, too many layers, too much inertia — and technology built on timelines that don’t account for the fact that patients don’t wait. Dr. Watt puts it plainly: clinical time doesn’t wait for a company timeline. When you sit in biweekly meetings with your ambient listening tool vendor and they tell you a critical feature is coming in Q3, the clinical reality is that documentation problems are happening now, twenty-four hours a day, seven days a week.
The good news, he says, is that health systems have started to close the gap. Chief innovation officers, governance committees, real use-case and business-case processes — things that didn’t exist a decade ago — are beginning to move the needle.
The Leadership: Cardiology as a Testing Ground for Access Redesign
Like radiology, cardiology is a data-driven specialty. And like radiology, it is becoming a proving ground for the kind of care delivery transformation that the rest of healthcare will eventually need to adopt.
Dr. Watt sees two major disruption opportunities in cardiology. The first is access — the backlog of patients who need to see a specialist when they may not need the specialist’s full expertise. The second is acuity stratification: the recognition that a patient coming in for routine hypertension management is consuming the same appointment slot as a patient with complex cardiac disease who needs it far more. Technology — wearables, remote monitoring, pharmacist-led care teams, AI-assisted titration — can redistribute that load. UCSF is already doing some of this. The next five years, Dr. Watt argues, will determine whether the rest of healthcare follows.
He also raises a question the current administration is actively exploring: could pharmacists, armed with wearable data and AI-supported guidance, manage routine chronic disease without a physician visit at all? The answer, he suggests, is probably yes — for the right patients, in the right conditions, with the right safeguards.
The Success: The Engineer’s Advantage
What makes Dr. Watt’s perspective distinctive is not just that he understands both worlds — it is that he refuses to let either one off the hook. Technology is not an excuse for clinical inertia. Clinical complexity is not an excuse for tech companies to build without accountability to patient time. The best outcomes happen when providers with deep domain knowledge sit at the table with the people building the tools — and say, this cannot wait for Q3.
There is also a new complexity in the exam room: patients arriving with AI-generated diagnoses from ChatGPT, Claude, and Perplexity. Dr. Watt does not blame them — he has family members who do the same thing. But navigating AI-generated medical misinformation has become a real and daily part of clinical practice.
For any leader thinking about the next five years of healthcare delivery, this conversation is essential. The future of care — who delivers it, where, and with what technology — is already being built. The question is whether your system is building it intentionally or inheriting it by default.
Listen to the full conversation.
Episode Chapter Guide
00:40 The Intersection of Healthcare and Technology
09:35 Innovation vs. Quality in Healthcare
12:58 Disruption in Cardiology
19:20 Transforming Patient Care with Technology
25:45 The Role of Pharmacists in Patient Management
29:20 Navigating Patient Expectations in the Age of AI
35:03 Inspirations for Healthcare Reform
Full Transcript
AI-generated transcript. Accuracy may vary; please excuse any transcription errors.
Angela Adams, RN: I’m Angela Adams, the CEO at Inflo Health.
Kandice Garcia, RN: I’m Kandice Garcia, CEO of Tungsten QI Partners and the QI Director for the ACR Learning Network.
Angela: Our guest today is Dr. Clifton Watt, a practicing cardiologist and Executive Medical Director at UCSF. Before medicine, Clifton trained as a software engineer and has a unique perspective that shapes how he sees healthcare challenges today. Today we’re talking about what happens when innovation outpaces implementation and what it really takes to redesign access to care in a complex health system. Clifton, welcome to Success and Chaos.
Clifton Watt, MD: Thank you so much for having me. Appreciate it.
Angela: Absolutely. So tell us — you’re a practicing cardiologist, you have a software engineering background. How does having one foot in clinical care and one foot in technology shape how you see healthcare and maybe the chaos that comes with it?
Clifton: That’s a great question, Angela. I definitely see the chaos. I think that is inherent in healthcare, in clinical medicine. It’s just part of what we do every day. And so I think that’s something that we as clinicians have to accept and adapt as we see patients and take care of patients.
I think the unique perspective with regards to technology is that, in my opinion, technology tends to be a much more organized, less chaotic environment — it sort of makes sense. We’re writing software and it does what it’s told, or we’re creating a platform and designing it to do a certain thing. And I think this concept of merging technology with clinical care is a really fascinating exercise, because on one side you have the craziness of practicing healthcare, and on the other side you’re trying to make technology make our healthcare lives much easier. It’s this clash between chaos and the more organizational methodology that technology has.
And it’s a challenge because there’s so much of healthcare that we cannot predict, cannot control, but we are trying to control it with technology. We’re trying to utilize ambient listening technologies and make our workflow simpler and easier. We’re using technology to operationalize our billing and our referrals. So the concept is to try to make our healthcare lives more organized and easier. It’s not always possible, but I think we certainly still try.
Kandice: Yeah, there’s such a difference between the lives we live outside of the hospital and coming to work as a healthcare provider. It’s almost like you get stripped of all of the technology that you use in your normal life. And I think there is an expectation that this should be easier — that there should be tech here for me.
What I’m hearing you say is that UCSF is fairly ahead on AI — you have enterprise ChatGPT, you have AI scribes, fairly early adoption of system-wide technologies. And yet there are still things like scrubbing PDF referrals and answering emails from staff manually. How does that gap of innovation actually meet the front line? How do you make enterprise decisions and also address the things staff are facing day to day?
Clifton: That’s also a great question. I think that’s the question of the year or our technology lifetimes. I think we definitely in healthcare want to innovate. Innovation is a buzzword we use because in many ways we understand that we tend to be stuck in inertia a little bit in clinical medicine. And so innovation is one way for us to deliver more efficient healthcare — but also deliver it better and more effectively.
There’s definitely an interest. It’s just that there are so many layers in healthcare and so many stakeholders. Patients, providers — physicians, nurses, nurse practitioners, technicians — hospital administrators, middle management, payers, insurance companies, the government. There are so many layers that each have their own stake in the whole flow, and I feel like that’s part of the inertia that makes it difficult for innovation to move from the tech company and the product to being incorporated.
I think healthcare systems are opening up in many different ways to better incorporate those innovations. Groups like chief innovation officers, governance groups that really look at the technology out there and say, yes, these are the technologies we want to adopt, we have to create guardrails, and we have to have a use case and a business case for these technologies. I feel like that’s something that has really evolved — these sorts of innovation groups or a push for innovation just wasn’t there maybe ten years ago.
I think with how powerfully technology has already impacted what we do clinically, that has caused the movement to narrow that gap. Healthcare systems are now saying, yes, this is what we are going to have our doctors do, and it helps you too — it’s gonna make your life easier, make you more productive. I think all of these concepts are narrowing the gap, slowly but surely.
Angela: Yeah. I would love to dig into a couple of things you said. Kandice and I have had a lot of leaders here on Success and Chaos say similar things about where innovation comes from. I think ten years ago, quality was the big push — it was being driven out of the Affordable Care Act and a lot of the legislation pushing hospitals toward value-based care. And then COVID changed everything. A lot of the quality metrics tied to the ACA and those penalty-and-incentive programs were paused for almost three years.
Coming out of that, hospitals were trying to recover — and right in the middle of that recovery, the AI age was in full swing. I think it’s interesting that quality drove innovation a decade ago, and now innovation for the sake of efficiency is what’s driving demand in hospitals. Ambient listening. Making sure physicians aren’t spending six hours a night on documentation — what people call pajama time. There’s a lot driving that innovation spirit today.
Something Kandice and I hear a lot is that the ability for a health system to make decisions quickly — with a governance structure that supports a multidisciplinary committee that can quickly identify a problem, understand what solutions exist, build the right team, and move to a rollout plan — is really what’s going to separate health systems that succeed in the next decade from those that fall behind.
UCSF has always been on the front end of that. And cardiology, I would say, has always been very much innovation, data, and technology driven. So if we talk about cardiology specifically — where do you feel like it’s ready for disruption? Referral triage, chart summarization, patient-facing intake? What feels ripe to you?
Clifton: I think there are two major areas. One is not unique to cardiology, and that’s access. We are dealing with so many patients needing to see us, and we are struggling because of that backlog. That’s a bottleneck that I think technology is really well-equipped to help us disrupt — whether it’s optimizing referrals, better triaging referrals, making sure the patients who really need to see a cardiologist are seeing one. Chart summarization makes our lives easier. And that goes naturally with our ambient listening tools and our patient encounter-based documentation tools.
Back to access — I think it’s really ripe for disruption when it comes to technology helping us with the whole process of referral to records transfer to records review. That’s going to help free up the bottleneck.
The other thing, which I think is more unique to cardiology, is the way we see low-touch, low-acuity patients in clinic. Let me explain. In cardiology we can have patients with high blood pressure, stable patients who feel fine, but who may need some minor medication adjustments for blood pressure or lipids. This is a situation where we as cardiologists can take care of these patients — but we can also defer them to our primary care colleagues. And that can free us up for patients who have complex cardiac disease.
If we as cardiologists are seeing lower-acuity patients, it limits our ability to see higher-complexity patients — referring them for procedures, that type of thing. And I think what’s unique in cardiology is that we have a wide spectrum: very simple patients, very complicated patients, and patients who have problems that primary care can handle — but perhaps patients have less trust in their primary care doctor and want to see a specialist, even though they don’t necessarily need a specialist for hypertension or dyslipidemia.
So I think this is something in cardiology where we can use technology to help manage those low-acuity patients and take a little off our plate. Intelligent wearables can monitor blood pressure and heart rate and deliver more regular advice, perhaps even recommendations, without us being intensely involved in the care. We stay in the loop as the provider, but we move more routine cardiology care into the ambulatory, non-clinic space — remote monitoring, telehealth, wearable data. That frees up our time as cardiologists for patients who have more acute or higher-complexity problems. The future may be that a lot of what we see now — patients coming into the office to have their blood pressure checked and their hypertension managed — moves out of the clinic and into the prevention and remote monitoring space.
Kandice: I love this framing because it really lives at the intersection of technology and quality and change within a system. What I’m hearing you say is that innovation actually lives in our ability to evaluate what we’re doing and redefine roles and responsibilities. It’s not just the tech that supports the new processes — it may be a preventative care unit, it may be redefining primary care, it may be utilizing remote technology in place of an appointment. It’s a real shift of who cares for the patient, where, and when.
What I love about where we are right now is that the question is no longer just what technology is available — it’s how does it get integrated into our system, and how do we transform the way we provide care in order to make space for it?
Clifton: Totally. I think the next five years are going to be transformative, because I don’t think we can stay how we are now. The concept of seeing your doctor once a year for an annual checkup — how useful is that, really? We have much better ways to maintain contact with your provider. Blood pressure monitoring, transmitting that data, getting more frequent recommendations and evaluations rather than just once a year. Whether we like it or not, that’s how our world is going to change.
Our consumer devices are already generating all of that data. Patients come to me asking about their smartwatch — their VO2 max is dropping, what does that mean? Is it significant? As Kandice said, it’s going to be key how we deal with this and how we transform ourselves as a healthcare society. We can’t stay put. We have too much change, too much data, too many patients demanding answers from this new information. We’ve already gone the way of all this wearable data — and now we have it and we have to be able to deal with it.
Angela: Mountains of data that no one knows what to do with. It’s interesting — if you travel a lot, I know the current administration has pitched this concept, and I actually saw it in practice. I was in France last year and we had to go to a doctor for my husband. Instead of writing a prescription, the doctor gave a recommendation for the pharmacist to then prescribe. When we showed up to the pharmacist, we didn’t have a prescription from the doctor. We had basically a guidance sheet that the pharmacist looked at and said, okay, this is what you should be on, this is what you should take.
We saw the same thing in Belize. The pharmacist actually asked what was going on, what symptoms, and said — okay, this is what you should be taking, let me grab that for you.
That’s what’s being pitched by the current administration. Primary care has an access problem — some health systems are seeing twelve to sixteen week waits just to get a patient an appointment. Even for cardiology it’s much longer. So who does this go to next? Could somebody with a simplistic case of high blood pressure or hyperlipidemia just go to the pharmacist? The pharmacist reads their wearable data, understands their running totals, knows what’s been tried, does a med reconciliation, and prescribes an adjustment. You wouldn’t need to wait for a backlogged primary care or cardiology appointment. It would help alleviate the backlog and bring higher-acuity patients to the top of the list for both.
Clifton: I see it. I think that’s a great point. UCSF has been a little ahead of the curve in this area. Using the same example of high blood pressure — we have multidisciplinary teams. We have pharmacists, we have advanced nurse practitioners who can make decisions and give recommendations about blood pressure and chronic disease management. Their availability is typically better than ours as physicians, so they can do these quick visits.
I could start seeing a patient for high blood pressure and then transition that patient to follow up with the pharmacist for blood pressure medication management. If it’s as simple as titrating a medication, our pharmacists are amazing — they can titrate meds, talk about medication side effects, evaluate for adverse effects. So this concept of having a team — not just “go see the doctor,” but a team with different members who can help with chronic disease management — I think that’s the future, and we’re already doing it in some institutions like mine.
I still think we need to keep humans in the loop. But eventually our devices will be able to give us advice. I know that’s a little risque to say, but if we’re talking about blood pressure medication titration, looking at simple trends — our wearables, with AI stored in them, could make decisions on their own. We’re not just listening to our devices blindly, but for low-risk situations — adjusting medications, not making new diagnoses — having safeguards and algorithms on our devices to do this? I think why not? Titrating an amlodipine from five milligrams to ten milligrams with minimal side effects is something that can be monitored quite easily remotely without a doctor’s visit.
Angela: Have you seen patients change over the last few years? Used to be they’d come in with something they found on Google. Now it’s LLMs — Claude, ChatGPT, Perplexity. How has that changed the conversation in clinic? Are they bringing relevant information that you have to weed through? How much more complex does it make the visit?
Clifton: It’s definitely a reality now — whether we like it or not. Patients sometimes preface it by saying, I’m not that person who goes on Google and looks up my medical conditions. And then they say, but I did look it up. It happened to me today with a patient. And more than just Google — doing an AI chat and trying to figure out their problem.
Do I blame them? I have family members who do the same thing. So it does make it more difficult. I still don’t think technology can supplant or replace a human’s ability to make diagnoses at this point, and certainly not advanced decisions. And AI can be wrong — we see it all the time. So it does make our jobs a little more complex in the clinical realm. We have to reorient, correct, reassure, and say: what any of these AI tools told you does not need to keep you up at night.
Kandice: You know, it feels like the transformation is not just about implementing technology — but even if you don’t implement it, you’re still learning how to change your practice to integrate the access of information that you have, that your patients have, and the new expectations that come with that. The complexity is so multidimensional.
And your experience as an engineer, a cardiologist, and now a leader in your healthcare system — it requires this level of perspective. Being trained in other fields really does bring a different lens to where we’re at and lets you meet the moment in an innovative way. It lets you question: what am I supposed to be doing as a physician, what can technology do, and how do we bring these two worlds together?
Clifton: I think so. I agree. The perspective helps. Some of my faculty colleagues and I meet with our ambient listening tool team every two weeks, and we have to push back — if your tech timeline is that this feature is coming in Q3, we have to say, patients are not going to wait for Q3. This has to be implemented now. Medical documentation and clinical workflows are twenty-four hours a day, seven days a week. Clinical time doesn’t wait for a company timeline.
That’s just one example. But providers who understand the tech landscape have that perspective, and it will probably be more and more important as time goes on.
Angela: Well, we have loved having you today. We wish we could talk all day, honestly. If you could leave us with two or three resources — books, articles, thought leaders that inspire you right now — we always like to close with this and it gives our audience something to look forward to.
Clifton: I think one person that inspires me — and this might surprise some people — is Mark Cuban. He’s been really passionate about healthcare reform. We all know him as this super wealthy, charismatic person who’s on TV, but his low-cost drug program and his ideas about healthcare being too complex to actually help patients and providers — I think his ideas about how the healthcare system has evolved into this unwieldy beast resonate with me. He has a finger on the pulse of both providers and patients.
From what I’ve heard in his interviews, he’s against insurance companies that harm the well-being of patients and providers through prior authorizations that delay care or prevent tests from being covered. He’s been vocal against the idea of profit being at the center of medicine. So I think Mark Cuban has been an inspiration. I’d recommend listening in on some of the discussions and chats he has with national thought leaders. And his low-cost drug program — I’ve had patients who’ve used it, and it’s been genuinely helpful.
Kandice: I love that. Innovation — meet the market, meet the patients where they’re at, and do what’s right for everyone involved. Well, thank you so much for your time today, Clifton. It was so great to speak with you. And thank you to our audience for joining us on Success in Chaos. Be sure to like, follow, and share today’s episode on Spotify, Apple Podcasts, YouTube, or wherever you get your podcasts. And a special thank you to the Inflo Health team for their production support.
