If history teaches us anything, it’s that healthcare does not move in straight lines.  It lurches, leaps, and occasionally gets shoved into its future.  We’ve all seen that firsthand.  I’ve often joked that healthcare’s pace resembles a reluctant mule.  That can be a strength or weakness.  Like a mule confronted by changes, healthcare can be stubborn, durable, and unmoved by most forces until something truly consequential tugs at the reins.

Today, existential threats to healthcare should reduce that reluctance.   Those threats include dealing with a data tsunami, AI, analytics, public policy, market economics, razor thin margins, market competition, and a workforce whose needs are shifting faster than the systems built to support them.  As we approach 2026, expectations of and demands on health information technology (HIT) professionals are more intense than ever.  As always, HIT leaders must architect a world in which change is permanent.

Here are 10 of the myriads of forces that will define our work and relevance in 2026 and beyond.

1. Generative AI and particularly agentic AI have sparked innovation. While 2024 and 2025 introduced tools that assist clinicians and administrators, 2026 will introduce even more agents capable of acting, deciding, and coordinating tasks across systems. These aren’t just calculators with fancy language skills.  They are digital colleagues that already can assemble clinical summaries and orders in real time, triage messages, manage schedules, and optimize revenue cycle denials.

When I was at ONC (Office of the National Coordinator now the Assistant Secretary for Technology Policy (ASTP)), there was and continues to be a push for national interoperability.  AI makes exchange more important than ever.  We imagined machines exchanging data to support humans but didn’t anticipate machines collaborating with one another, negotiating tasks, tracking provenance, and executing workflows.

The question for 2026 isn’t “How do we deploy AI?” It’s: “How do we govern a digital workforce we did not hire?”

2. Governance once felt like seat belts that are annoying until there’s a crash. Now they feel like air traffic control. Emerging guardrails from ASTP, CMS, and the FDA are converging into a new discipline –   algorithmic accountability.  Leaders will need to oversee:

• • provenance logs documenting where data originated,
  • bias and equity testing to promote integrity,
  • explainability standards for clinicians and regulators, and
  • continuous monitoring for model drift.

Regulators always struggle to keep up with technology.  Regulations must become anticipatory.  It’s essential that HIT leaders be policy literate and regulators need to understand the implications of their regulations.  Work with your policy leaders on the state and federal level.  Get involved.

3. It’s past time to deal with technical debt. You must revisit your platform(s) decisions and decide how to move forward. For years, CIOs have been patching legacy systems like sailors plugging holes in a wooden ship.  In 2026, the ship demands a refit, not another bucket of tar.  Many monolithic clinical, financial, and administrative systems cannot scale to an AI-centric model of care.  Health systems face existential decisions about EHR extensibility and ERP modernization.  Health IT professionals must evolve from system builders into solution sommeliers, pairing platforms, models, and data sources like fine wines with the right business use cases.

4. The Healthcare and Public Health Sector and IT Sector are 2 of the 16 federally designated “critical infrastructure sectors” which we should treat like other national security assets. Actions by bad actors have escalated from nuisance to systemic threats that are always evolving faster than technology can respond. Healthcare’s greatest vulnerability is not technology but complacency.  In 2026, complacency becomes indefensible.  You must change your organization’s culture to move cybersecurity from an IT function to a perpetual readiness posture in which privacy, confidentiality, and security are essential elements.

5. For decades we talked about meeting patients where they are, often in the home. In 2026, we finally can. Home becomes a site of care and a digital supply chain node requiring:

• • device identity and integration,
  • remote monitoring and diagnostics,
  • longitudinal patient identity,
  • reimbursement orchestration, and
  • intelligent consumer-grade devices.

We don’t need telehealth v2.0.  We need care decentralization.  The organization that treats home care as a clinical program will struggle.  Get your organization to treat it as a logistics and data architecture problem.  John Campbell, a StarBridge Advisor with healthcare at home experience, posted:

“Thankfully, a new bill moving through the House this week proposes a 5-year extension [of the COVID era CMS waiver for Hospital at Home care] , and it already shows strong bipartisan support.

And it should, because Home Hospital:

• • Is a proven alternative to inpatient care
  • Outperforms inpatient hospitals on every major quality measure
  • Delivers higher patient and provider satisfaction
  • Costs 40% less per admission
  • Requires only a fraction of the investment of new physical beds
  • Is, undeniably, the future of acute care”

6. Healthcare staffing is a skill relevance problem. 2026 ushers in hybrid technical roles:

• • data stewards fluent in semantics and AI prompts,
  • data scientists,
  • clinicians who navigate decision intelligence,
  • governance architects, and
  • digital workflow engineers.

At a recent CIO conference, I heard comments like: “We don’t lack talent. We lack the right talent for what we’re becoming.”  IT leaders must become educators who can help reskill, not just the IT staff, but can work to help evolve the entire workforce.

7. In 2026, health IT leaders should become stewards of evidence pipelines, not just data pipelines. To paraphrase Ginni Rommety, former leader of IBM, “Data is the new natural resource and like all natural resources, it must be refined to be useful.” An organization must learn to transform raw data into actionable data.  Collecting data for data’s sake is useless.

8. Health IT once equated interoperability with data movement. That era is gone. True interoperability requires semantic alignment, computable consent, domain-specific ontologies, and supporting policies – all of which are focused on creating understanding and usability.  Years ago in national policy discussions, we focused on breaking down the walls between systems.  Today, most of those walls have fallen.  Success, however, depends upon treating true interoperability as meaning, not movement.

9. We should help patients and their families become active data subjects who are custodians of their data. They already own the data. They should become contributors as well.  They deserve more easily useable identity solutions, access to audit trails, and should have consent authority regarding how their data are used.  If interoperability unlocked access, digital identity unlocks agency which can restore or provide a sense of control.  Educate the public about more than rights.

10. Healthcare’s carbon footprint is now a newsworthy global challenge. Data centers, GPU clusters, imaging workloads, and edge computing raise questions executives will ask IT leaders to quantify regarding the impact of the IT environment on nature.

• • What is the carbon cost of this model?
  • Why does this algorithm justify this energy?
  • Can we perform inference closer to the edge?

Green computing is important as the energy sector struggles with demand.  Be ready to address this issue.

In conclusion, the CIO, CDIO, CIDO or equivalent of 2026 will not just run an IT shop but must become a practical and pragmatic architect of the future who understands risk, ethics, and the economy and has all the essentials characteristic of a skilled diplomat.

The greatest misconception is that technology transforms healthcare.  It does not.  Leadership transforms healthcare.  Technology merely accelerates the leaders brave enough to demand better.  Be provocative but diplomatic, smart, and courageous.  Treat the future not as a forecast but as an opportunity rich design challenge.

Treat the mule like a thoroughbred.  Grab the reins and move forward.