Spring Forum Season Final Report Out: What We Heard Across Our Final Spring Forums
THMA’s Spring Forum season wrapped up in June! In this final installment of our Spring Forum Insider series, we recap what we heard from health system leaders across informatics, nursing executive leadership, and pharmacy. The specifics differed by forum, but some pressures consistently surfaced: AI investment that keeps growing regardless of measured return, workforce strategy that has to be built years before a hire is made, and governance structures built for approval decisions rather than for what happens after a tool goes live.
We've distilled key forums into Forum Insider pieces. Here's a quick look at what each covers:
CMIOs: Precision Medicine's Operating Gap, AI's ROI Blind Spot, and a Role Outrunning Its Structure
Precision medicine pilots that don't scale, AI portfolios that keep growing despite negative ROI, and a CMIO role expanding faster than its authority or staffing.
CNIOs: From Influence to Infrastructure
Seats at the governance table as the real lever of influence, institutional knowledge as the prerequisite for automation, and a case for leading AI strategy as process transformation.
CNEs: Building a Workforce That Doesn't Fit One Playbook
Five generations with five different recruiting pitches, workforce pipelines built years in advance, and unionization emerging as a defining threat with no shared response.
Pharmacy Leaders: Business Acumen as the New Core Skill
Regulatory change arriving all at once, a structural workforce shortage, and pharmacy leaders learning to speak the CFO's language to compete for capital.
CMIOs Confront Precision Medicine's Operating Gap, AI's ROI Blind Spot, and a Role Outrunning Its Structure
Chief Medical Information Officers convened at THMA's Spring 2026 CMIO Forum in Carlsbad, CA with three key problems sitting on top of each other: precision medicine pilots that aren't converting to scale, AI portfolios that keep growing even where the numbers don't justify it, and a role gaining accountability faster than it's gaining resources. The conversations were candid about where governance and financial discipline haven't caught up to the technology.
Key Takeaways:
1. Precision medicine adoption is still earlier than its operational ambition.
A live poll of CMIOs found 82% of health systems are in early awareness or pilots across one or two clinical areas; no respondents reported systematic integration into standard care.
Speakers described genomics activity arriving through oncology, cardiology, reference labs, and patient demand, but disconnected use cases can create interface sprawl, EHR ambiguity, and ungoverned testing spend.
Financial cases for precision medicine are built around downstream revenue, risk identification, cost avoidance, and patient retention — the right mix depends on payment model and market.
2. AI investment is outpacing ROI accountability.
Of 23 AI deployments with confirmed negative ROI in THMA's survey, 74% are slated for increased investment; the absence of formal decommissioning criteria means AI portfolios keep growing regardless of performance.
Where ROI is tracked, roughly two-thirds of deployments are positive. Call center and supply chain tools show the strongest returns (67% and 43% positive ROI), yet remain underdeployed compared to clinical AI.
CMIOs said operations, not informatics, needs to own the financial outcomes of AI deployments; when informatics carries ROI accountability it wasn't resourced for, implementation quality suffers.
3. AI governance needs to extend well beyond the approval decision.
Several systems said their governance work starts with cataloguing deployed tools; one inventory found more than 90 AI-enabled applications, some deployed outside informatics' visibility.
AI features are reaching clinicians before organizational approval, creating uncertainty around contracts, data use, and business associate agreements. Leaders described governing the channel as more workable than attempting to block it outright.
One system discovered a back-end model change only after clinician thumbs-down ratings spiked — leaders said post-deployment monitoring needs named owners and regular attention to catch this kind of drift.
4. The CMIO role is expanding faster than its operating model.
83% of CMIOs reported expanded accountability in a 2026 THMA survey. At the same time, 43% described their teams as under-resourced or strained.
CMIOs reporting through clinical leadership were more likely to describe resource strain than those reporting through IT leadership, though the right model is context-dependent.
Clinical informatics can often lack standardized occupational recognition, billing mechanisms, or industry standards, which can cause variation in compensation and benchmarking.
5. EHR governance debt is compounding, and the post-go-live playbook needs a rewrite.
Attendee survey data showed 75% of health systems have been live on their current EHR for six years or more; years of ungoverned customization have produced excess order sets, missing naming conventions, and ineffective alerts that are more expensive to fix than to have prevented.
One system's EHR quality declined predictably during months three through six after go-live, following strong initial performance under a clear mandate — a pattern leaders said is rarely modeled in advance.
Structured optimization efforts can produce measurable clinical and operational improvement, including alert reduction and shorter length of stay, though available resources vary by system size.
CNIOs Move From Influence to Infrastructure
Chief Nursing Informatics Officers convened at THMA's Spring 2026 CNIO Forum in Carlsbad, CA to talk about where their influence actually comes from. Leaders were consistent on several points: governance seats and executive partnerships matter more than title, and the institutional knowledge CNIOs carry has to shape a workflow before it's automated, not after.
Key Takeaways:
1. Governance involvement and executive partnership are the most reliable levers of influence.
Chairing or co-chairing governance committees was cited as the single most effective driver of influence, independent of title; one CNIO at a large multi-hospital system said her standing came from chairing an AI-specific governance committee, not her reporting line.
Paired CNIO/CMIO review structures govern major capital and technology decisions at several organizations and determine whether nursing informatics is in the room for consequential decisions.
Two leaders separately said no nursing seat currently exists on their organization's AI governance committee — a frontier for proactive positioning.
Executive transitions, not planned policy change, were the most common trigger for formalizing a CNIO title or governance seat.
2. CNIOs are the connective tissue that must shape process before automation.
One organization found nurses' chart-preparation workflows varied meaningfully across staff — requiring the CNIO's team to re-engineer the workflow before deployment could proceed.
One CNIO recruited a human factors engineer directly into informatics after the engineer helped redesign a sepsis alert workflow that had seen limited clinical uptake; the engineer’s simulation-based testing is now used to surface workaround behavior before every go-live.
3. AI strategy needs to shift from adding tools to transforming process, and CNIOs are positioned to lead it.
Leaders distinguished use, adoption, and transformation as three different outcomes, and several organizations are now building that distinction into how they evaluate technology investment.
Layering new tools without retiring old ones was flagged as a risk to data integrity and ROI clarity; identifying what to stop was called as necessary as identifying what to add.
One CNIO-led hackathon drew 150 submissions in a single event; a separate organization’s CNIO-led multi-year hackathon series produced a deployed mobile app and a measurable shift in frontline engagement.
One organization designates specific nursing units as “influencers” using a scoring rubric that weighs demonstrated adoption of past innovations and low staff turnover — a model that gives the organization a defined path from successful pilot to organization-wide scale.
CNEs Build for a Workforce That No Longer Fits One Playbook
Chief Nursing Executives convened at THMA's Spring 2026 CNE Forum in Coronado, CA facing a workforce that no longer responds to one message. Five generations are now working side by side, pipeline investments made years ago are only now showing results, and unionization was the top-ranked workforce threat with no shared playbook to navigate it.
Key Takeaways:
1. The CNE role is expanding, but enterprise influence requires deliberate development.
CNEs are expected to combine clinical experience, operational skill, and strategic alignment simultaneously — a combination leaders said other C-suite roles rarely carry.
Financial fluency was the most commonly cited development gap, including business case development, ROI framing, and articulating nursing's value as a revenue driver rather than just a cost center.
The strongest systems maintain multiple successors per critical seat, described as building “the bench's bench,” two levels down from the current leader.
2. Generational workforce strategy can't rely on one message for everyone.
Gen Z enters healthcare later, with less accumulated work experience, and prioritizes stability, benefits, and a reliable paycheck; the message that tests best is likely a direct, human assurance that the organization has their back.
A majority of Gen Z parents don't view healthcare as a safe or stable career, and parents outsized influence on this cohort's career decisions create what one researcher called two-step recruiting.
Gen X leaders are carrying high levels of work and caregiving stress simultaneously; over the next three years, many will decide whether to stay through retirement or make a final career move.
3. Workforce strategy is moving upstream, before hiring and before onboarding.
One system moved from first-come, first-served clinical placements to a tiered academic partnership model prioritizing partners willing to align curriculum and hiring pipelines, cutting orientation time roughly in half and pushing first-year retention above 98%.
CNEs linked current staffing stability to high school programs, intern cohorts, and PCT-to-LVN-to-RN pathways built over multiple years, not recent reactive hiring..
Nurses in non-clinical roles, retired license-active populations, and students who rotated through a system but were never tracked were named as untapped pipeline segments. Some state licensing renewal surveys collect detailed workforce data most systems aren't using.
4. AI interest is high, but most systems are still building the conditions to use it well.
Multiple table groups reported no unified workforce view and disconnected HR and scheduling systems — leaders said the gap is foundational data architecture, not interest or willingness.
Leaders described getting more value from technology partners willing to learn their specific data environment and build iteratively than from off-the-shelf deployments.
Running technology pilots with finite clinical resources requires tighter strategic alignment than in other industries; several leaders map every technology decision against organizational strategic goals before advancing.
5. Unionization has become a defining workforce threat, and nursing leaders lack a shared framework to navigate it.
When asked to name their biggest new workforce challenge, senior nurse executives ranked unionization first, with pressure accelerating across geographies and system types.
Younger nurses are the primary point of entry for organizing, with recruitment tied directly to compensation, staffing, and workplace grievances.
Most nursing leaders are responding without a shared playbook for assessing risk, engaging frontline teams, or shaping legislative strategy, though some systems are building these capabilities internally.
Leaders pointed to new Joint Commission staffing requirements as a structural lever that could reduce the conditions driving union interest.
Pharmacy Leaders Treat Business Acumen as a Core Leadership Skill
Pharmacy leaders convened at THMA's Spring 2026 Pharmacy Growth Collaborative in Carlsbad, CA with regulatory change, workforce shortages, and capital competition all landing at once. The conversations turned practical: how to operationalize policy shifts, compete for capital like a business unit, and decide what to build versus what to partner on.
Key Takeaways:
1. Operationalizing simultaneous regulatory change is a growing challenge.
Leaders described 340B, the Inflation Reduction Act, site-neutrality, and shifting pricing benchmarks as changes arriving at once, managed through cross-functional governance rather than treated solely as a pharmacy compliance task.
Several leaders said they've lost or downgraded hospital 340B eligibility because of decisions made in payer-mix strategy, service-line closures, or maternal-health tracking — decisions made outside pharmacy.
Reconciliation is broken at many systems, though some are forming cross-functional groups to close the gap.
2. Workforce shortages are likely structural, not cyclical.
Pipeline building is moving earlier in the funnel. One system's scholars program, run with several universities, covers tuition and guarantees employment, producing roughly 16 new pharmacists a year and now extending to technicians.
Leaders described competing on research opportunities, resident involvement, and technician career ladders rather than compensation alone to retain staff.
One system grew its technician-program fill rate from 8 to 90 open positions, reaching zero openings at its children's hospital.
3. Business acumen is becoming a core pharmacy leadership skill.
Pharmacy asks compete for capital against the rest of the system — towers, elevators, imaging equipment — and leaders said framing requests around margin and access drivers tends to land better with CFOs than clinical framing alone.
One leader said they never let their CFO hear about an initiative for the first time in the room, gathering feedback and building support in advance.
Leaders said pharmacy's influence depends more on whether the system views it as strategically important than on its reporting line.
4. Build-versus-partner decisions are getting more deliberate.
Several leaders described a “crawl, walk, run” approach to partnerships, treating them as time-bound bridges with an explicit plan to bring capabilities in-house later.
One system's framework: build only what's core to its identity and can scale, and partner on everything else — citing its own PBM, where it built the specialty and clinical enterprise but partnered on the rebate aggregator.
AI's binding constraint tends to be governance rather than appetite. One leader described strong executive interest in AI for vendor selection and shortage prediction alongside gaps in data-access controls and licensing.
5. Pharmacy is building infusion and revenue cycle into a growth engine.
Several leaders said clean visibility into infusion volume is the prerequisite for capturing it; one identified tens of millions of dollars in annual leakage.
Home infusion runs roughly a 1:1 nurse-to-patient ratio, compared with roughly 1:4 in an ambulatory infusion suite.
One system's eight-year build to a 30-plus-FTE revenue-cycle function earned pharmacy a permanent seat: a new charge master isn't finalized without pharmacy's input.