Beyond ROI: What Healthcare Leaders Get Wrong About Technology Investment

Dr. Bashir Agboola, DBA, MBA, CHCIO, CDH-E, FACHDM, Managing Partner, Interdym.

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​Healthcare now accounts for nearly one-fifth of U.S. gross domestic product, yet hospitals allocate a significantly smaller share of their budgets to information technology than comparably sized organizations in banking or retail. That gap reflects something deeper than purely a resource problem: It is indicative of a persistent misunderstanding of what makes healthcare technology investment succeed.

For my doctoral research published in the Open Journal of Business and Management, I spent months in conversation with senior healthcare technology executives (CIOs, CTOs and chief digital officers at major health systems) across the New York metropolitan area. My focus was a question I had wrestled with throughout my own career as a technology leader at two of the country's leading academic medical centers: Why do so many well-resourced health systems struggle to generate lasting value from their technology spending?

The answer, consistently and clearly, was not about which technologies they chose. It was about how they approached the decision to invest in the first place.

The prevailing orthodoxy treats financial return on investment as the primary measure of success. That framework is not wrong, exactly; it is just incomplete. When a health system invests heavily in a new platform and evaluates the outcome purely through a cost lens, it risks missing critical factors such as the clinician burnout the implementation caused, the patient populations the system failed to reach and the organizational trust it quietly eroded. The numbers may look acceptable, but the system may not be.

The leaders who consistently generate value from their technology investments shift to what I call a value-on-investment (VOI) orientation: a broader accounting of outcomes extending well beyond financial return.

When it comes to these strategies, I've found that four disciplines define the success of the approach.

Governance As A Filtering Mechanism, Not A Formality

One of the most frequently recurring themes I see in these approaches​ is not cloud migration or AI. It is governance. Specifically, evaluating every technology initiative not just on technical merit, but on its fit with organizational strategy.

According to McKinsey, 75% of health system executives report their organizations have not planned or allocated sufficient resources to deliver on their digital ambitions, even as most call it a top priority.

Leading organizations distinguish themselves by institutionalizing governance structures that integrate clinical, financial and operational perspectives early in the investment process. These structures are not only designed to prioritize high-value initiatives but also to rigorously filter out those that lack strategic alignment, applying as much discipline to what is declined as to what is approved.​

Value Measurement As An Ongoing Practice

I've heard leaders describe the same painful pattern observed in peer organizations: an energetic technology launch followed by a slow drift toward underperformance that no one owned.

The solution is to treat technology investments as iterative learning processes rather than discrete projects. Before implementation, articulate explicit value hypotheses and define what success looks like, across what time frame and for whom. After go-live, sustain measurement disciplines to continuously track operational metrics, clinician feedback and patient experience data. Pilot programs should serve as structured learning laboratories where a negative result is considered as valuable as a positive one, enabling leaders to absorb a smaller loss rather than commit to a larger one.

Clinician Experience As A Business Imperative

There is a persistent tendency to treat clinician experience as secondary to functional and financial requirements. I believe this sequencing has it precisely backward.

Executives must understand that technology adding friction to clinical workflows does more than just frustrate physicians. It also drives attrition, reduces care quality and ultimately undermines the return on investment the investment was supposed to generate.

Among the implementations I've seen leaders value most is ambient documentation AI, which captures clinically relevant information from patient conversations and automatically populates the medical record. What makes it notable isn't the technology alone, but that it serves multiple aims simultaneously: reducing administrative burden, improving patient engagement and strengthening documentation quality.

Digital Equity As Core Strategy, Not Aspiration

The fourth discipline is the one most often reduced to rhetorical commitment rather than embedded practice. Research published in the Journal of Medical Internet Research documented that digital health technology adoption has produced health inequities across age, race, region, income and education, with socially disadvantaged groups consistently facing greater barriers to access and benefit.

Leaders must move beyond ​acknowledging this problem to engineering solutions into governance, design and procurement processes. This might include requiring equity impact assessments as part of investment evaluation, designing multimodal access pathways that include phone and SMS options alongside digital portals, and testing tools with diverse patient populations before broader rollout.

One executive I spoke with offered a structural critique worth sitting with: Because healthcare technology investments inevitably follow reimbursement streams, tools tend to be designed first for commercially insured patients, and equity becomes an afterthought. The leaders making genuine progress decide not to accept that default.

​Conclusion

Taken together, these four disciplines describe a maturation in how effective healthcare technology leaders think about investment. Financial discipline remains essential. What changes is the frame within which it operates.

Organizations that expand that frame to include clinical workforce sustainability, genuine patient experience and community equity are not trading financial performance for social outcomes. They are recognizing that the two are inseparable. The health system that cannot retain its physicians, cannot reach its most vulnerable patients and cannot build organizational trust has no sustainable technology investment, regardless of what the ROI calculation shows. That is the case for VOI, and it is a practical one.​​

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