Health systems have begun naming dedicated AI executives at a growing pace. Nine hospitals and health systems, among them Cleveland Clinic, Los Angeles-based Cedars-Sinai and Richmond, Va.-based VCU Health — have named chief AI officers to oversee the technology’s rollout. More appointments are expected to follow.
Maria Sexton, CIO of University Health System in Knoxville, Tenn., thinks some health systems are drawing the wrong conclusion about CIOs.
“The role is almost being relegated to a little bit of a backseat role,” Ms. Sexton said during an episode of the “Becker’s Healthcare Podcast.” “It’s like, you just run IT. We really need to bring in strategic leaders to think about where technology can move in an industry.”
She has spent three decades in IT and cybersecurity across industries from gaming to federal government, most recently as CIO at Las Vegas-based University Medical Center of Southern Nevada before arriving at University Health System 18 months ago. She’s seen the industry evolve and has seen organizations approach the CIO role differently.
“Some people might hear this and say, no, I am a strategic leader and that’s not the case,” she said. “But I do feel like in some conversations, and I’m seeing this pop up in other articles and conversations in other forums, where all of a sudden a leader has been bearing the slings and arrows of trying to run technology in a very complex industry like healthcare. But now that we have truly innovative things like AI and other innovations, it’s almost like CIOs are being seen as ‘old technology’ making sure computers are running and that we have the infrastructure in place. But for these truly innovative things, [the systems] need different leaders for that.”
The concern is that the bind CIOs face between managing legacy systems and driving innovation is being misread as a capability gap. Every health system carries a burden of aging infrastructure and systems that must be maintained, updated and kept operational even as clinical and operational teams push for newer tools. CIOs own that obligation entirely, simultaneously responsible for the systems keeping the hospital running today and for evaluating what replaces them.
“[CIOs] have to make sure all the moving parts and all the spinning plates are not falling and they’re still running,” said Ms. Sexton. “Meanwhile, you’re being asked to look at innovative technology.”
Ms. Sexton uses the word “customers” rather than “users” to describe her stakeholders — a deliberate framing at University Health. Those customers want both things at once.
“Our customers are demanding the implementation of new and exciting, innovative, shiny technology, which we can do so much to address access and provider and nurse burnout and all those things that improve the patient experience,” she said. “Meanwhile, we still have to manage and buy down all of that old and tarnished technology — the stuff that’s tried and true. It’s basically the horsepower of what we do here.”
Healthcare CIOs have increasingly flagged tech debt as a constraint on digital progress, describing the tension between maintaining legacy systems and advancing AI adoption as a difficult balance. The dual burden is precisely what makes CIOs appear less strategic than they are.
“You almost don’t have the cognitive space to be able to focus on strategy and focus on that,” she said. “And sometimes it’s a little bit of [the idea that] our CIO can’t really look at AI or bring us forward in terms of a strategic program. It’s not because we can’t. It’s almost because we can’t look away from all the other things that still have to be maintained and managed.”
When health systems interpret this as a leadership deficit rather than a structural one, the response tends to be the same. Other health systems have found that generative AI, when CIOs are given the structural conditions to lead it, is expanding the CIO’s scope rather than shrinking it — with IT chiefs stepping into governance, clinical partnership and enterprise AI strategy. Ms. Sexton hopes that trajectory holds and she is watching to see whether the industry adjusts its assumptions about the role.
“Organizations are bringing in other leaders to do the flashy, shiny, whiz bang stuff,” she said. “I’m most curious about how these roles are evolving and how industries and employers are looking at the CIO role, and how the CIOs themselves are positioning themselves to be the leaders that are driving the strategic capability of the organization and not being overshadowed, or even to some degree replaced.”
At University Health, Ms. Sexton has tried to create space for strategic thinking by tightening the project portfolio she inherited. When she arrived, the organization had more than 400 items on its project list. Working with leadership to implement a more disciplined intake process, vetting proposals against organizational objectives and resource capacity before committing, she has significantly reduced that number. The change required sustained change management and met early skepticism before gaining broader organizational support.
“A year and a half into these changes, there is tremendous support from the organization and understanding,” she said. “We’re getting better and better with the discipline around how we are spending those valuable and limited resources of time, money and people.”
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