Health system CIOs are rethinking their tech stacks

Health systems spent years building up layers of technology as digital transformation accelerated and vendor choices expanded. Now many chief information officers say they are paying for that accumulation and are trying to reverse course. Across organizations of different sizes, IT leaders are describing the same mix of pressures: shadow IT, aggressive vendor repricing, AI licensing costs that are rising faster than visible returns, and technical debt that continues to consume operating budget. Together, those pressures have made platform consolidation a leading response to cost pressure and are prompting earlier-than-expected conversations with vendors.

Deb Muro, CIO for El Camino Health in Mountain View, Calif., said the hidden costs of decentralized purchasing have become a major burden on IT budgets. She said shadow IT built through years of decentralized purchasing has produced duplicate tools, software and renewal increases that outpace inflation. Muro also said it is common for technology to be repriced around AI features, often at higher tiers, and that consolidation and license rationalization are becoming recurring ways to save money. She added that technical debt and legacy systems can take up a disproportionate share of operating budgets just to remain functional, which affects modernization efforts.

A recent survey from the College of Healthcare Information Management Executives found that health systems are already saving millions of dollars by eliminating IT applications. Leaders in the field said the discipline required to keep those savings in place is also changing how portfolios are governed. Instead of adding tools in a piecemeal way, organizations are paying closer attention to what stays in the stack and what can be removed.

Vendor repricing is also showing up in contract terms. Muhammad Siddiqui, CIO for Reid Health in Richmond, Ind., said several major platforms moved this year to consumption-based pricing or AI add-on pricing models. He said that has made total cost of ownership harder to predict and has forced prioritization conversations that were not expected mid-cycle. In that environment, technology leaders are being pushed to review assumptions earlier and to reexamine what each platform is really delivering.

The consolidation trend is visible across security, infrastructure and clinical applications. Dennis Leber, PhD, CISO for Erlanger Health System in Chattanooga, Tenn., said his team has moved aggressively toward platform-based solutions to reduce duplication. He said rising labor costs, vendor spending and regulatory burden are reshaping the technology roadmap. Leber said Erlanger is consolidating its security and infrastructure stack and is prioritizing platform-based solutions, particularly within Microsoft, to cut duplication, licensing and operational overhead.

At Stanford Health Care and Stanford School of Medicine in Palo Alto, Calif., two senior technology leaders described similar efforts. Ann-Marie Yap, executive director of technology and digital solutions, said rising costs for cloud storage, hardware and cybersecurity have required a more disciplined approach to the portfolio. She said the organization is consolidating and standardizing platforms to reduce redundancy and total cost of ownership. Yap said the focus is shifting from simply deploying technology to demonstrating clear value, scalability and sustainability across the enterprise.

Puneet Waraich, senior director of IT clinical applications at Stanford, said the consolidation push has made application rationalization and contract management central priorities rather than side tasks. He said organizations are under increasing pressure to reduce operating costs amid ongoing financial headwinds across healthcare. Waraich said that has increased attention on application rationalization and more disciplined, strategic contract management. He also said the traditional goal of doing more with less has gained new urgency, leading to more deliberate prioritization across the technology portfolio.

For rural and community health systems, the same pressure often means relying more heavily on existing enterprise investments instead of adding new layers. Bob Berbeco, CIO for Mahaska Health in Oskaloosa, Iowa, said cost pressure is making every technology decision more disciplined, especially in a rural setting where supportability and long-term value matter as much as innovation. He said Mahaska’s roadmap is increasingly focused on workflow-native capabilities that reduce waste, including ambient documentation and denial forecasting, while continuing to strengthen core investments in data governance, analytics, identity and cybersecurity. Berbeco said the organization is also being more selective about bolt-on tools unless they provide clear incremental value beyond what can be achieved through its core Epic and Community Connect strategy.

Lisa Stump, executive vice president and chief digital information officer at New York City-based Mount Sinai Health System, described the same logic as it applies to AI. She said point solutions had once proliferated across vendor pipelines, but integrated platforms with proven value are now the standard. Stump said that means making sharper choices on platforms over point solutions and working with strong partners. She said Mount Sinai is prioritizing use cases that create real value through financial returns, better outcomes, higher throughput or reduced administrative burden. For her organization, she said, delivering and documenting that value is critical to enterprise success.

Across the examples cited by health system leaders, the direction is consistent: fewer redundant tools, more emphasis on platform standardization and tighter scrutiny of contract and license costs. The pressure comes from several places at once, including shadow IT, cloud and security expenses, changing pricing models and the cost of maintaining legacy systems. In response, CIOs are not only trimming applications but also rethinking how technology decisions are made, with a stronger focus on total cost of ownership, measurable value and long-term sustainability.