As health systems evaluate clinical technology investments, alignment between CFOs and chief medical information officers often hinges on how value is defined, measured and timed.
Across multiple organizations, CMIOs describe a recurring tension: CFOs prioritize near-term, quantifiable return, while CMIOs often advocate for tools with harder-to-measure downstream benefits.
“The core tension is time horizon and proof standard — and that’s the CFO’s job, not a character flaw,” said Becket Mahnke, MD, CMIO at Wenatchee, Wash.-based Confluence Health. “CFOs are accountable for hard dollars, a clear causal chain from spend to intervention to measurable outcome, and results inside the current budget cycle.”
Dr. Mahnke said value often shows up as avoided cost and second-order effects — lower burnout, fewer errors and reduced clinician turnover — outcomes that are meaningful but not always easy to tie to a single investment. “Turnover is the classic example,” he said.
CMIOs noted that alignment improves when clinical technology has a direct operational or financial impact.
“CMIOs think in systems; CFOs think in constraints,” said Jason La Marca, MD, CMIO of Los Angeles-based Mission Community Hospital. “We align when clinical technology clearly protects revenue, frees capacity, or reduces labor pressure.”
Amer Saati, MD, CMIO at Roseville, Calif.-based Adventist Health, said ROI clarity, especially around workforce and efficiency gains, is often the common ground.
“CFOs and CMIOs align most around clinical technologies with clear ROI, especially digital health tools that improve efficiency, stabilize the workforce, and reduce avoidable costs,” he said.
Frustration tends to arise when the financial upside is real but indirect, particularly with tools aimed at workflow or experience improvements.
John (Clay) Callison, MD, CMIO at Knoxville Bass University of Tennessee Medical Center, said those cases often involve a disconnect between financial models and broader care team impact.
“Differences in opinions tend to occur when the hard financial numbers or financial [return on investment] do not line up with some of the softer outcomes that can be important to patients, providers and the care team,” he said.
He cited AI as a common flashpoint: The promise is strong, but cost savings aren’t always immediate or guaranteed. “AI comes with a cost, and although it may streamline workflow and improve efficiencies and quality, it does not always translate to cost savings,” he said.
Similarly, Dr. Saati noted that high-value investments like documentation reduction can be a hard sell without fast, measurable returns. “The friction comes when high-value clinical investments like reducing documentation burden or improving usability lack immediate or easily quantifiable financial returns,” he said.
Several CMIOs emphasized that improving alignment starts with better translation — and, in some cases, process redesign.
“The work isn’t buying more tools — it’s translating clinical impact into economic reality,” Dr. La Marca said. “And just as often, the right answer is redesigning the process before reaching for new technology.”
Dr. Saati added that leading organizations are connecting clinical experience more directly to financial performance. “Leading organizations close this gap by treating clinician experience as a core financial strategy, directly tied to retention, productivity and long-term sustainability,” he said.
