Spotlight Series: When Emergency Medicine Meets Digital Health Leadership

A/Prof Dr Amith Shetty on Surge Complexity, System Failures, and the Digital Front Door

Part 1 of the Medora Advisors Spotlight Series

Most healthcare IT consultants have never managed an ED during surge. Most ED physicians have never led statewide digital health infrastructure.

A/Prof Dr Amith Shetty has done both.

As Clinical Director for System Sustainability and Performance at NSW Ministry of Health, Emergency Physician, and Adjunct Associate Professor of Biomedical Informatics at the University of Sydney, Dr. Shetty operates at the rare intersection of clinical operations and digital health strategy. He has held senior digital health leadership roles during critical system challenges that required both clinical and technical expertise.

We asked Dr. Shetty three questions about ED operations, crisis improvisation, implementation advice, and innovation. His answers reveal why service-line nuance is the difference between implementations that work and implementations that kill workflows.

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Q1: What's the one thing about ED operations that looks simple on a project plan but is actually incredibly complex during surge?

It's almost naïve to assume that anything in ED operations ever looks simple on a project plan, let alone during a surge. Having led multiple ED models of care and digital front-door initiatives, I've been reminded repeatedly that process maps dramatically under-represent reality. What looks like a neat sequence of boxes often hides layers of tacit operational knowledge, unwritten rules, and workarounds that clinical teams have built over years to keep patients safe.

During a surge, these hidden complexities amplify. The informal rules that keep the system functioning become fragile, unpredictable, and sometimes unsafe.

To manage surge effectively, organisations need deep insight into the day-to-day realities of ED operations—not theoretical flowcharts but lived workflows. Only then can we design STEP plans and surge responses that reflect actual practice.

Q2 : If you could give one piece of advice to a health system about to implement new ED technology or workflows, what would it be?

Don't treat digital as a vertical silo. In modern health systems where every function is now digitised, digital transformation cannot be designed or executed in isolation.

No technology or workflow change should begin without genuinely involving every stakeholder group, especially frontline clinicians and patients. They hold the operational wisdom, lived experience, and insight into where risk, workarounds, and failure points actually sit. When they aren't embedded from the start, systems inevitably create friction, duplication, or new safety risks.

And critically, digital transformation in health is not synonymous with EMR/EHR implementation. It's about redesigning the end-to-end experience of care—clinical workflows, decision support, communications, handover, escalation, and the human factors that determine whether technology helps or hinders.

Q3: What's one innovation in emergency medicine that you're most excited about—and what operational realities need to be addressed for it to succeed?

One innovation I'm most excited about is the evolution of a true digital front door—a single, intelligent access point that helps patients navigate to the right care at the right time while giving clinicians real-time visibility of demand across the system.

What excites me most is the potential to shift avoidable low-acuity demand out of EDs by using evidence-based navigation, virtual urgent care, and community-based alternatives. When done well, this creates a seamless, patient-centred experience while allowing ED teams to focus on high-acuity, high-complexity care.

But for this innovation to succeed, we must confront several operational realities.

First, a digital front door cannot compensate for fragmented governance, competing incentives, or low trust across jurisdictions. Without aligned purpose and shared ownership, even the best-designed pathways end up fractured when patients need them to be simple.

Second, the technology must reflect real workflows of ED and virtual care clinicians, not theoretical ones. Flowcharts dramatically underrepresent the tacit knowledge, workarounds, and unwritten rules clinicians use to keep patients safe. If we don't embed that lived reality upfront, the system will fail when it's supposed to reduce risk.

Third, the single front door will only reach its potential if we integrate real-time operational intelligence—capacity signals from EDs, virtual care services, primary care, and ambulance. A navigation system that doesn't know what's actually available is just a digital brochure.

Finally, sustainability depends on embedding the digital front door into the daily operational rhythm of EDs, VUC teams, Healthdirect, and system control centres. Surge plans, escalation triggers, and safety nets need to be rehearsed, not discovered during a crisis.

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Why This Matters

Dr. Shetty's insights reveal a truth most System Integrators and healthcare IT vendors miss:

Service-line nuance is the difference between implementations that work and implementations that kill workflows.

You can't design ED technology without understanding surge. You can't schedule system upgrades without knowing clinical shift patterns. You can't build a digital front door without embedding real-time operational intelligence.

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About A/Prof Dr Amith Shetty

A/Prof Dr Amith Shetty is Clinical Director for System Sustainability and Performance at NSW Ministry of Health. As an Emergency Physician and Senior Staff Specialist (FACEM, PhD), he has held senior digital health leadership roles and led multiple ED models of care and digital front-door initiatives, including the NSW Single Front Door and Virtual Care Program.

Dr. Shetty holds an Adjunct Associate Professorship in Biomedical Informatics and Digital Health at the University of Sydney and has completed executive education a Harvard T.H. Chan School of Public Health

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The Medora Advisors Spotlight Series features healthcare executives who've actually led operations—not just consulted on them. Connect with us at medoraadvisors.com.