For the seventh consecutive year, healthcare executives who are members of CHIME (College of Healthcare Information Management Executives) participated in our online survey* examining IT priorities and pressures facing their health system. The results reflect the perspective of technology leaders navigating daily complex decisions.
Executive Snapshot: What’s Moving the Market in 2026
Every year, the CHIME CIO survey reveals something about the mindset of healthcare technology leaders, not just what they’re doing, but what they’re preparing themselves for. And this year, in 2026, the story that emerges is a blend of pragmatism, urgency, and the slow but steady reshaping of how organizations fund and prioritize the digital backbone of care delivery. If we zoom out to the highest level, several themes dominate the CIO agenda:
- Application rationalization has vaulted into a top priority position, with 61% declaring it a “high‑urgency” need; a signal that unmanaged growth, technical debt, and vendor sprawl have caught up to many organizations.
- Cybersecurity remains a constant at the top of the list of priorities. What is notable is how it competes head‑to‑head with rationalization and EHR initiatives for the #1 budget slot.
- EHR implementation and optimization is back in force, tying for the top priority position and marking a return after its 2024 dip.
- Budgets continue to lean heavily into OpEx, with most organizations allocating roughly 75% of IT spend to operational expenses in both 2024 and 2025.
These themes hint at a broader story: CIOs are trying to regain simplicity and control.
The Priority Puzzle: Three Initiatives Share the #1 Spot
CIOs continue to hold the most influence over IT spending decisions, with 50% of organizations naming the CIO as the primary executive determining IT budgets and priorities. The CEO follows at 22%, and notably, CEO influence has risen significantly from just 7% in 2025. That level of ownership matters, because when CIOs set the direction, the organization’s technology investments tend to align with long‑term strategy rather than short‑term operational pressure.
And that influence becomes especially clear when we look at how CIOs ranked their top priorities for 2026. The answer wasn’t a single front‑runner; it was a three‑way tie. Application and portfolio rationalization, cybersecurity, and EHR/EPR implementation and optimization each captured 22% of first‑priority votes. In many ways, these top three reveal the story of where healthcare IT is headed: leaders are cleaning up the foundation, securing the organization, and modernizing the clinical core.
They also reflect a broader shift. Fewer organizations are naming infrastructure refresh as a primary priority, a sign that CIOs are increasingly channeling resources into strategic transformation rather than tactical upkeep. The focus is no longer just about keeping systems running; it’s about building an environment that can scale, adapt, and prepare for emerging technologies like automation and AI.
This is where our work intersects with the priorities expressed in this year’s survey. Health systems engage us when they’re ready to tackle these kinds of initiatives:
- Application portfolio rationalization that reduces licensing waste, simplifies vendor landscapes, and creates a cleaner runway for modernization.
- Cybersecurity readiness and response programs that help organizations strengthen posture, run tabletop exercises, and address talent gaps in high‑demand security roles.
- EHR implementation and optimization that helps clinical and operational teams get more value out of the systems at the heart of patient care.
The Re‑Emergence of EHR Implementation & Optimization
Last year’s survey revealed a surprising decline in EHR work as a top priority. This year, the pendulum has swung back. EHR implementation and optimization is once again a top‑tier focus.
Leaders are circling back to long‑delayed upgrades, optimization efforts, and in some cases, the groundwork for major transitions.
Where CIOs See the Biggest Opportunities for Cost Savings
Before diving into how budgets are structured, it’s worth looking at where CIOs believe real cost savings and efficiency gains will come from in the year ahead. Across the survey's responses, three categories emerged as the top priority, and each represents a different dimension of the IT ecosystem: technology, IT operations, and cybersecurity.
- Artificial Intelligence (AI) / Robotic Process Automation (RPA)
- Process / Workflow optimization
- Cybersecurity best practice development
Taken together, these priorities show a leadership mindset centered on sustainable efficiency, not just one‑time savings. They set the stage for the budget realities that follow and for how organizations are rethinking their operating models in 2026.
Budget Realities: The OpEx Era Continues
If priorities reflect the “what,” budgets reveal the “how.” And the “how” of 2026 is that most health systems fund IT as a slice of net patient revenue and then allocate the majority of that slice to OpEx.
Across our respondents, 33% are now allocating 5% of net patient revenue (NPR) to IT, an increase from 2025, when most organizations reported spending at or below 3%. At the same time, that allocation is predominantly operational: in both 2024 and 2025, the prevailing split (70% of respondents agree) was 75% OpEx / 25% CapEx, and that ratio barely moved year over year.
This OpEx‑dominant model reflects an industry settling into cloud subscriptions, managed services, and modern licensing models as standard operating practice. It also creates pressure:
When more spend is fixed, less remains for capital‑heavy modernization or large transformations.
Where CereCore Fits In
As priorities shift and budgets tighten, we’re seeing healthcare organizations require partners who can reduce complexity and accelerate execution. At CereCore, this often looks like:
- Helping CIOs operationalize application rationalization into a sustainable discipline
- Supporting EHR optimization or implementation with a blend of advisory, project execution, and managed services
- Strengthening cyber resilience through security assessments and response planning
- Stabilizing IT operations via fractional leadership, managed services, and support
About the CHIME Survey
The respondent demographic was primarily made up of Chief Information Officers (56%). More than half of participants (53%) represented mid-to-large healthcare organizations with 250 beds or more. This audience profile affords us insight into the rationale of those responsible for maintaining and implementing healthcare technology within seasoned organizations.
Are you a CHIME member who didn't get a chance to respond to the survey, but would like to be a voice next year? Get started today.
*The 2026 online survey and the data reported is based on responses from 24 healthcare executives, all CHIME members, sponsored by CereCore.
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