Digitalization in public healthcare requires robust architectures, safe cloud frameworks, and user-centric adoption strategies. In this interview, Confare Swiss CIOAWARD Nominee Marc Besson, CIO/CDIO at IMAD, discusses deploying production-ready AI tools, maintaining data sovereignty across 18,000 locations, and using predictive models to support ambulatory care teams.
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Michael Ghezzo:
Marc, great to see you again. You have known the Swiss CIOAWARD and the Confare CIOSUMMIT for several years, and this year we are celebrating our 15th anniversary. Before we talk about your work as CIO, could you briefly introduce IMAD and its purpose?
Marc Besson:
Of course. IMAD is one of Switzerland’s largest home-care organisations, similar to what is known as Spitex in the German-speaking part of Switzerland. We provide home care across Geneva and support more than 18,000 people. Our purpose is to help people, particularly older adults, remain safely at home and avoid premature institutionalisation.
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Michael Ghezzo:
What is your role as CIO/CDIO in this organisation, and how important are IT and digital technologies in home healthcare?
Marc Besson:
I joined IMAD five years ago as CIO/CDIO at a pivotal moment, because it was really the beginning of our digital transformation. Before that, I had worked on digital transformation in the private sector, particularly in e-commerce and retail. I was entering a new sector where digitalisation was still at an early stage.
For home care and healthcare, digital technology is essential to the future of care. We are under a lot of pressure, there is a shortage of care workers, and we need digitalisation to transform the way we work. I joined the executive committee to launch this transformation, and over these five years we have made IMAD a recognised digital player in healthcare.
Michael Ghezzo:
I always find it interesting when we see CIOs from the public and healthcare sectors at the CIOAWARD. It shows that digital transformation is just as relevant in these areas of our daily lives as it is in large private enterprises.
Marc Besson:
Absolutely. Digital is key in healthcare. We need to have the right information at the right time and in the right place. In home care, I don’t have one site or one location like a hospital. I effectively support care delivery in more than 18,000 homes where I need to make sure that our information systems and the necessary information are available in a timely manner, 24/7. That is essential if we want to provide the right care to the right person.
Michael Ghezzo:
Privacy and data security must be particularly important in such an environment.
Marc Besson:
Of course. We need to make sure that we have the right solutions. When I joined IMAD five years ago, we had no cloud-based services. Since then, we have rebuilt our technology and control foundations so that we can use cloud solutions securely. We need to protect the information and its sovereignty while at the same time using state-of-the-art solutions.
For example, if we want to use AI tools, we are not going to reinvent solutions that already exist on the market. We are developing solutions based on Microsoft Copilot, for example, while embedding security into them. We use a secure tenant, bring-your-own-key and encryption mechanisms to ensure that we protect the information our patients have entrusted to us.
Michael Ghezzo:
Healthcare is increasingly moving from hospitals towards patients’ homes. What does this ambulatory model mean for you?
Marc Besson:
That is definitely the direction healthcare is taking. We cannot simply build more and more hospitals. Costs and the limited availability of caregivers are major challenges. Ambulatory and home care solutions are therefore an important part of the future of healthcare.
Digitalisation is essential for this because we need to make information that was traditionally available inside a hospital available in a patient’s home. It needs to be mobile, and information has to move between the different professionals involved – from the GP and the hospital to physicians and nurses in the field. We need a continuum of information to be able to take care of the patient. That is what digitalisation enables.
Michael Ghezzo:
IMAD has implemented one of the first production-grade AI use cases in Swiss home healthcare. What have you learned from that experience?
Marc Besson:
That was a real journey. We had been looking at AI for a few months and wanted to identify a proper use case – something that was more than a toy or a demonstration. We wanted something that could actually be implemented and make sense for our caregivers.
We did a lot of analysis and ran a lot of pilots. Last year, we created Ariane, our AI assistant. Healthcare is based on procedures, and we have more than 2,000 pages of them. Ariane makes this knowledge accessible to our caregivers. Instead of searching through large amounts of documentation to find the right information, they can ask questions about our procedures and immediately access the information they need.
Ariane gives each nurse immediate access to the procedural knowledge they need, directly in their pocket.
Michael Ghezzo:
How did the nurses react when you introduced Ariane? Was there concern about AI replacing parts of their work?
Marc Besson:
At the beginning, there were concerns. People were asking: What are you going to do with AI? Is AI going to replace us? That is why we decided very early to involve our nurses in the development. We did not develop the solution within IT and then simply give it to them. We worked together with the people who would actually use it.
This completely changed the perception. They could see what AI could do for them and where it could support their daily work. Today, Ariane is really their tool. We have seen strong adoption, and people are asking us to add more information and more capabilities. That is probably one of the most important lessons we learned: if you want people to trust AI, you need to involve them in building the solution.
Michael Ghezzo:
Ariane is one concrete example. Where else are you already using AI?
Marc Besson:
Another example is our voicebot. During heatwaves, we may need to place more than 3,000 calls a day. We call to check on people’s wellbeing and provide guidance. It is not feasible to add dozens of staff just to handle these peaks, so we developed a voicebot that can make the calls, analyze their answers and help us manage this surge in demand.
Again, the objective is not to replace people. We want our caregivers and employees to spend their time where their expertise and human interaction are really needed. If technology can take care of some repetitive tasks, our people have more time for the patients.
Michael Ghezzo:
You are also working with predictive models. What are you trying to achieve there?
Marc Besson:
We have developed a predictive model around the risk of falling. Falls are a major issue, particularly for elderly people. A fall can have serious consequences and can sometimes be the beginning of a loss of autonomy.
We have a lot of information from our daily work with patients. Based on this data, we are working on a model that can identify whether someone is at increased risk of experiencing a fall. The idea is to identify the risk early enough so that we can take preventive action.
Michael Ghezzo:
That sounds very promising, but it also raises an interesting question. Once the system tells you that a person has a high probability of falling within six months, what do you actually do with that information?
Marc Besson:
Exactly. That is where it becomes very interesting, because the technology is only one part of the question. If an algorithm tells us that someone has a high probability of falling, we need to decide what we do with this prediction.
Do we tell the patient? What impact does that information have on the person? What preventive measures can we take? And how certain does the prediction need to be before we act?
These are ethical questions that we need to discuss together with healthcare professionals. It is not a decision IT should take alone.
The model can give us information. But then we need to understand how to use that information responsibly in the care process.
Michael Ghezzo:
So AI can help you anticipate a development, but the decision about what to do with that information remains a human responsibility.
Marc Besson:
Absolutely. And this is particularly important in healthcare. We need to understand what technology can do, but we also need to understand its limits and the consequences of using it.
For me, that is one of the most interesting aspects of digitalisation in healthcare. It is not only about implementing new technology. It is about finding the right way to use technology to improve care while maintaining trust and responsibility.
Editor’s note: The discussion continues in Part 2, where Marc Besson details the transition of IT from a support unit to Digital Services, building reliable offline-first architectures, and introducing remote care concepts like the Health Operating Center. Stay tuned!
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