IT Execs Seek to Tame Application Sprawl Without Stifling Innovation Through Shared Governance

Why It Matters

Effective governance of technology requests is critical for health systems to control costs, ensure seamless integration, and maintain the agility needed for rapid innovation in patient care. By aligning requests with strategic goals and fostering collaborative decision‑making, organizations can avoid fragmented solutions and drive meaningful improvements that directly impact clinicians, patients, and overall operational efficiency.

IT Execs Seek to Tame Application Sprawl Without Stifling Innovation Through Shared Governance

Navigating New Solution Requests: Balancing Cost, Integration, and Innovation · HealthsystemCIO webinar

The relentless demand for new technology solutions in health systems requires governance frameworks that balance fiscal discipline with the imperative to innovate, according to a panel of senior IT leaders who described how their organizations are reshaping request intake processes, evaluation criteria, and innovation cultures. Speaking during a healthsystemCIO webinar entitled “Navigating New Solution Requests: Balancing Cost, Integration, and Innovation,” the executives shared strategies for managing the flood of application requests while preserving space for transformation.

Structuring the Intake Process

At large health systems, the volume of incoming technology requests can quickly overwhelm IT teams that lack standardized channels for receiving and tracking them. Establishing a single point of entry has proved essential for organizations seeking visibility and accountability.

• Karen “K” Marhefka, DHA, Deputy CIO, RWJBarnabas Health said her organization treats every application request as a formal project that flows through a defined governance structure. Operational colleagues submit requests through ServiceNow, while IT‑originated projects enter through Workfront. “Both entry points have created for us a single point of entry, which we found was absolutely imperative for us to get control of these asks, and that has worked really well for us,” Marhefka said. The approach builds institutional discipline among operational partners, who develop consistent habits around where and how to initiate requests.

• Anika Gardenhire, Chief Digital & Transformation Officer, Ardent Health Services, described how her team rebranded what had been a technology review committee as an “impact and transformation committee” focused on problem identification. Her message to potential requestors is, “Please marry your problem. Know your problem really well. Be very close to your problem, but please do not marry a solution.” The shift encourages clinical and business leaders to bring challenges to the committee early, giving the technology team time to assess whether existing platforms already address the need or whether a market survey is warranted.

• Warren D’Souza, SVP, Chief Innovation Officer, University of Maryland Medical System & Co‑Director, University of Maryland Institute for Health Computing, emphasized the importance of proactive engagement. His team works to identify where technology can address strategic problem areas before individual requests begin accumulating. As a nearly $6 billion enterprise with a faculty practice, employed physicians, and independent physician groups, the University of Maryland Medical System relies on cross‑functional stakeholder leadership that includes clinical and operational leaders in addition to technologists. “The AI strategy has to be aligned with the business and clinical strategy, because we are, after all, healthcare organizations, not tech organizations, first,” D’Souza said.

Evaluating the Value Equation

Once requests enter the pipeline, the evaluation process raises a fundamental question: when is an existing platform capability sufficient, and when does a point solution deliver enough differential value to justify the added complexity?

• D’Souza cautioned against rigid thresholds. An assumption that 80 percent functionality is acceptable may overlook the remaining 20 percent that matters most for a specific use case. For transactional functions, core platforms like EMRs and ERPs should be the first place to look, given the scale of investment health systems have already made. For assistive or autonomous solutions, however, expanding the aperture may be warranted—provided integration, cost of ownership, and organizational disruption are carefully weighed.

• Marhefka described a similar philosophy at RWJBarnabas Health, where the organization completed a system‑wide Epic implementation roughly 18 months ago with a deliberately standard, non‑customized approach. The team continues to discover capabilities within the platform that were not initially activated. Her organization has also restructured its IT department along clinical service lines, so that a cardiologist requesting a new tool speaks with analysts who understand cardiology deeply. “We have created that level of comfort that we are working with them, not against them, and certainly not putting ourselves in a position where the only thing we care about is to stay standard, simple, and cheap,” Marhefka said.

• Gardenhire stressed the importance of tying every request to the organization’s strategic plan. At Ardent Health, enterprise‑wide targets are visible across the organization, and requests that cannot articulate alignment with a strategic priority are moved below what she calls “the water line” — remaining on the list but unlikely to receive resource allocation in the near term.

Defining Innovation on Your Own Terms

The panelists acknowledged that “innovation” has become an overused term in healthcare, one that organizations feel pressure to embrace without always understanding what it means in their specific context.

• Gardenhire drew a distinction between incremental improvement, transformational change, and everyday problem solving at the point of care. All three qualify as innovation, she said, and organizations benefit from being explicit about which type they are pursuing in any given initiative. She pointed out that operations teams that absorb significant new work year after year without requesting additional budget are, by definition, being innovative. “If tomorrow people do not do something different than they did today because our thing exists, our thing does not matter,” Gardenhire said. The ultimate measure of any technology investment, she added, is whether it produces a meaningful change in how clinicians, patients, or staff experience care delivery.

• Marhefka noted that RWJBarnabas Health does not employ a large team of software developers and is candid about that identity. The organization buys technology to support strategic initiatives and focuses its innovation efforts on identifying the right recipient — whether patients, providers, or the revenue cycle — before pursuing solutions.

• D’Souza offered a different vantage point from an academic health system where research, discovery, and innovation are embedded in the institutional mission. The University of Maryland Medical System’s adjacency to schools of medicine, nursing, and pharmacy gives it access to individuals who focus on disrupting and transforming healthcare delivery. “By the very essence of who we are as a health system and our identity, innovation for us takes on a certain meaning because it is a mission‑driven and mission‑aligned value proposition,” D’Souza said.

Take it Away

• Establish a single, standardized point of entry for all technology and application requests to create visibility and accountability across the organization.

• Encourage stakeholders to bring problems, not predetermined solutions, to governance committees so IT teams can evaluate existing platforms before surveying the market.

• Engage cross‑functional leadership — including clinical, operational, and financial stakeholders — in governance to prevent technology decisions from being perceived as IT‑only mandates.

• Avoid applying rigid “good enough” thresholds uniformly; evaluate each request based on the specific use case and the differential value a solution provides.

• Tie every technology request to a strategic organizational priority, and be transparent about where requests fall in the prioritization queue.

• Be explicit about what type of innovation the organization is pursuing — incremental improvement, transformation, or everyday problem solving — and recognize that all three have value.

• Invest in relationships across business units as a foundation for effective governance, particularly when processes have broken down.

All agreed that governance structures must remain flexible enough to accommodate a rapidly changing healthcare landscape. As D’Souza noted, his CEO frequently reminds the organization, “What has gotten us to this point is not going to sustain us in the future.”