Hospital and health system CIOs are facing a fast-growing list of challenges — from the rapid rise of agentic AI to unrelenting cyberthreats and soaring technology costs — that are reshaping how they think about the future of healthcare IT.
Becker’s asked four health system CIOs: What’s keeping them up at night?
Preparing for the agentic AI era
For Chris Akeroyd, CIO at Fort Myers, Fla.-based Lee Health, the pace of AI evolution is both exciting and daunting.
“What keeps me up at night is preparing for the agentic AI era that’s already upon us,” Mr. Akeroyd said. “This isn’t about incremental change; it’s about redefining the operating model of the enterprise for a future where autonomous AI agents fundamentally reshape how work gets done.”
To make that vision a reality, he said health systems must simplify their technology portfolios and strengthen their data foundations.
“Complexity is the enemy of agility,” he said. “We should focus on consolidating fragmented systems and moving toward platform-based architectures to reduce technical debt.”
He added that high-quality, real-time data is critical for AI to deliver on its promise — and that success ultimately depends on people, not just technology.
“Engaging and preparing the workforce through AI literacy, upskilling and change management is essential to building trust and unlocking the full value of AI,” Mr. Akeroyd said.
Balancing cybersecurity, AI and finances
Zafar Chaudry, MD, chief digital, AI and information officer at Seattle Children’s, said CIOs are facing a “confluence of critical issues,” led by the escalating threat of cyberattacks and the challenge of turning AI potential into measurable value.
“This existential security crisis runs parallel to the massive challenge of realizing tangible value from artificial intelligence,” Dr. Chaudry said. “CIOs must pivot from pilot projects to scaled deployment, which requires an immense, often difficult, effort to clean up unreliable and fragmented data foundations while establishing clear AI governance and ethical oversight.”
On top of those priorities, financial constraints are intensifying the pressure.
“All of these advanced technical demands must be achieved under severe financial pressure,” he said, “forcing CIOs to relentlessly pursue IT cost optimization, demonstrate clear ROI for every technology investment and strategically implement digital tools to address persistent clinical workforce shortages.”
Rising costs
Mark Weisman, MD, CIO and CMIO of Salisbury, Md.-based TidalHealth, said the escalating costs of healthcare IT — particularly in cybersecurity and revenue cycle management — are keeping him awake.
“The rising cost of good healthcare IT is what keeps me up at night,” Dr. Weisman said. “We can spend an unlimited amount of money on cybersecurity, and it still won’t be enough — and none of what we spend is reimbursed or revenue-generating.”
He added that the same is true for revenue cycle technology, which has become an arms race between providers and payers.
“We see rising costs in revenue cycle software, which is used to combat the AI systems used by the payers to deny claims,” he said. “Every dollar spent on these things is less money we have to spend on patient care or supporting our frontline clinicians.”
Planning for a complex cancer-care future
Omer Awan, vice president and CIO of Seattle-based Fred Hutchinson Cancer Center, is focused on how well health systems are preparing for the care and research demands of tomorrow.
“Are we organized, resourced and architected not just for today’s care-and-research environment, but for the cancer-care/precision-medicine complexity of 3–5 years from now — and do we have a roadmap to get there safely?” Mr. Awan said.
The common thread
While their specific concerns vary, all four CIOs share a common anxiety: how to balance innovation, protection and cost in a healthcare landscape that is changing faster than ever. Whether preparing for agentic AI, strengthening cyberdefenses or managing soaring IT budgets, these leaders agree the stakes have never been higher.
