As hospitals create dedicated AI executive roles, tech leaders warn that isolating AI strategy from IT leadership misreads structural constraints as capability gaps.
Major health systems including Cleveland Clinic, Cedars-Sinai, and VCU Health have begun appointing specialized chief AI officers in recent months, a trend that industry observers expect to accelerate. But the movement is triggering pushback from experienced information technology leaders who argue the healthcare sector is misinterpreting the complexity of their role.
According to Becker's Hospital Review, Maria Sexton, CIO at University Health System in Knoxville, Tennessee, contends that hospitals are drawing incorrect conclusions about why technology leadership sometimes appears disconnected from forward-thinking innovation work. "The role is almost being relegated to a backseat position," Sexton explained in a recent industry conversation. "It's like, you just run IT. We really need strategic leaders thinking about where technology can advance the industry."
Sexton brings three decades of experience across gaming, federal government, and healthcare infrastructure management. Her concern centers on a fundamental misreading of the CIO position in complex environments like hospitals.
The Infrastructure Burden Behind the Perception
Health systems operate under a dual mandate that creates an optical illusion about leadership capability. Every hospital carries aging infrastructure and legacy systems that demand constant maintenance, security patches, and operational oversight, even as clinical teams demand cutting-edge tools like artificial intelligence applications.
"CIOs have to ensure all the moving parts and spinning plates don't fall while still running," Sexton said. "Meanwhile, you're being asked to evaluate innovative technology."
This structural reality creates what appears to be a strategic gap but actually reflects cognitive overload. The mental and organizational resources consumed by maintaining mission-critical infrastructure leave limited capacity for the exploratory thinking that AI implementation requires. When leadership interprets this constraint as a capability deficit rather than a resource problem, the institutional response tends toward creating separate executive positions.
The Cost of Fragmented Leadership
Sexton deliberately frames her stakeholders as "customers" rather than "users," a choice reflecting the dual demands they place on technology leadership. Those customers simultaneously demand:
- Implementation of emerging AI tools to address provider burnout and access challenges
- Continued maintenance and eventual replacement of legacy systems that form the operational backbone
- Strategic guidance on technology adoption decisions
When organizations split AI governance into separate leadership tracks, they risk fragmenting institutional knowledge about how new technologies integrate with existing infrastructure. Sexton notes that some health systems have discovered artificial intelligence actually expands the CIO's strategic scope rather than constraining it, with technology leaders moving into enterprise AI governance, clinical partnerships, and cross-functional strategy roles.
"You almost don't have cognitive space to focus on strategy," Sexton acknowledged. "Sometimes it appears our CIO can't engage with AI or advance our strategic program. It's not because we can't. It's because we can't look away from everything else that still requires management and maintenance."
The question facing the healthcare industry is whether it will adjust its assumptions about IT leadership capacity or continue creating specialized AI roles that leave technology chiefs managing infrastructure in isolation. The answer may determine whether hospitals realize the full strategic value of artificial intelligence in the years ahead.
This article was originally published on AI Glimpse.
