Hospitals are rethinking how much innovation should happen within their walls — and how much should come from outside partners. As health systems face increasing digital complexity, many chief medical information officers say the balance between in-house development and vendor dependence lies in collaboration.
“In a connected world where systems rarely stand alone, it will become harder to support in-house development,” Neal Chawla, MD, CMIO at Raleigh, N.C.-based WakeMed Health, told Becker’s. “We will all likely depend more on our partners to deliver solid-state technology.”
That shift isn’t about abandoning innovation but redefining it. For some leaders, building technology internally allows faster iteration and closer alignment with clinical needs. But others note that maintaining in-house tools requires specialized staff, long-term support and substantial funding — resources many organizations can’t spare.
Jason La Marca, MD, CMIO of Los Angeles-based Mission Community Hospital, described two broad models: one in which large, well-funded systems maintain strong internal IT teams capable of developing new tools, and another where smaller hospitals lean on third-party contractors or managed service providers. “Outsourcing becomes the practical path,” he said, “allowing clinical leaders to define needs and workflows while specialized partners handle the build.” Still, Dr. La Marca noted, the “spark of innovation” often comes from within — from clinicians closest to patient care.
At Virginia Hospital Center in Arlington, CMIO Usman Akhtar, MD, is aiming for balance. His team retains control of data and workflows while leasing key technologies. “We’re developing what truly distinguishes care — local rules, governance, measurement and safety layers — while acquiring or co-developing utilities like ambient documentation and prior authorization automation,” Dr. Akhtar said. Contracts, he added, will increasingly tie vendor performance to outcomes and safeguard data rights and rollback procedures.
That philosophy echoes across systems. At Roseville, Calif.-based Adventist Health, CMIO Amer Saati, MD, calls it “disciplined innovation.” “The most successful systems create defined innovation spaces within their core platforms,” Dr. Saati said. “It’s about balancing creativity with governance, safety and scalability.”
Scalability is what’s informing the approach to in-house innovation for CMIO Nadeem Ahmed, MD, of Paramus, N.J.-based The Valley Health System.
“Technology is becoming ever more complex,” Dr. Ahmed said. “For many smaller organizations, in-house innovation is extremely difficult. We should partner and innovate with vendors — it allows us to focus on our primary product: excellent healthcare.”
Others are taking a hybrid route. At Norfolk, Va.-based Sentara Health, CMIO Joseph Evans, MD, said the system is pursuing a “buy, build or shape” strategy — purchasing foundational AI capabilities from large vendor platforms, building specialized models trained on Sentara’s own patient data, and helping vendors shape future tools through early collaboration. “The real advantage,” Dr. Evans said, “is when we can influence the direction of the technology itself.”
Though their policies differ, leaders agree the future won’t be purely in-house or outsourced. As AI, interoperability and data governance further intertwine, the challenge will be staying in the driver’s seat while scaling operations. As Dr. Akhtar put it, hospitals must learn to “leverage their infrastructure while maintaining control.”
