I’ll be upfront about something: I’m not writing this from the corner office of a Big Four consulting firm. I’m the founder of a healthcare application rationalization startup. I built it because the more time I spent engaging with CIOs on this topic — and the deeper I got into the research — the more obvious it became that the market is failing them in very specific, fixable ways.
What follows isn’t based on opinion. It’s based on what CIOs are saying publicly, what the data shows, and what I’ve learned building a tool purpose-built for this work. Every claim is sourced. If I’m wrong about something, the footnotes make it easy to check.
The pressure is no longer theoretical. The Gartner 2026 CIO and Technology Executive Survey identifies cost optimization as the most pervasive priority shaping CIO objectives over the next two years — driven by CEO expectations, constrained budgets, and sustained economic pressure.1
Healthcare CIOs are feeling it. A Clearsense/CHIME survey published February 10, 2026 found that 76% of CIOs say application rationalization is critical to their strategy. But only one in five has a fully implemented program. Twenty percent haven’t even started.2
That gap isn’t about knowledge. CIOs know what needs to happen. The problem is that what they’re being offered — sprawling advisory engagements, enterprise platforms that take months to implement, or spreadsheet exercises dressed up as methodology — doesn’t match what they actually need.
Based on everything I’ve read and every conversation I’ve had, CIOs consistently want the same five things from a rationalization engagement. Most engagements fail to deliver at least two of them.
A Number the CFO Will Accept
This is the one that matters most, and it’s the one most often botched.
CIOs don’t need a consultant to tell them they have redundant applications. They know. What they need is a defensible, quantified savings projection they can present to finance — one that distinguishes between hard savings (contracts that can be terminated), soft savings (avoided future spend), and cost avoidance (renewals that can be renegotiated or declined).
This isn’t optional anymore. Gartner’s 2025 CFO survey found that 56% of CFOs rank enterprise-wide cost optimization in their top five priorities. The CFO is in the room now. They’re asking for numbers, not narratives.3
Trinity Health shows what "good" looks like at scale. After moving to Epic, they partnered with Clearsense to build a repeatable, governance-led decommissioning process — what Prokic describes as a supply-chain approach that now retires 20 to 25 systems each quarter.4
The result: roughly $80 million in recurring savings to date, with projections exceeding $100 million. That number didn’t materialize from a one-time inventory exercise. It came from an operational program with measurable financial outcomes that leadership reviews monthly.5
The deliverable here isn’t a slide that says "estimated savings: $4–8M." It’s a financial model with line-item detail, confidence tiers, and a timeline showing when savings actually hit the P&L. If a CIO can’t hand the report to the CFO and have it survive scrutiny, the engagement didn’t work.
A Catalog That Didn’t Exist Before
This sounds almost too obvious to list. But the foundational deliverable of any rationalization engagement is a complete application inventory — and most hospitals don’t have one.
Jeff Tennant of ROI Healthcare Solutions is direct about it: "The key deliverable from phase one is a complete application catalog" — version information, business and technology owners, vendor contacts for every application in the ecosystem.6
The CHIME survey reinforces why this matters: 40% of organizations that have started rationalization efforts review their portfolios only "as needed." When your review cadence is "whenever something breaks or a contract renewal catches someone off guard," you don’t have a catalog. You have tribal knowledge scattered across departments.2
And the fragmentation is accelerating. Symplr’s annual Compass Report shows that shadow IT continues to surge: departments purchasing software outside formal IT governance climbed from 74% in 2022 to 86% in 2025. Every year, the catalog gap gets wider.7
A good engagement doesn’t just list applications. It enriches them — cost data from finance, usage data from IT, satisfaction data from departments, compliance classification from legal. The catalog becomes the single source of truth that didn’t exist before anyone walked in the door.
A Phased Roadmap, Not a Boil-the-Ocean Plan
CIOs live in 90-day cycles. Board meetings, budget reviews, contract renewals — the rhythm of a health system doesn’t pause for an 18-month transformation plan.
Gartner’s research on IT cost optimization makes the case for starting with visible, low-risk wins. As Gartner Senior Director Analyst James Anderson puts it, the best way to ensure organizational buy-in is to showcase quick wins that "achieve immediate cash savings without costing anything or are entirely cash-positive." After completing a few, present the portfolio to the CEO and other stakeholders — it "moves the CIO and IT from speculating what the savings could be to demonstrating a foundation of real savings."8
The Federal CIO Council’s Application Rationalization Playbook formalized this as a six-step iterative process — explicitly designed to loop, not to end. Rationalization isn’t a project with a start date and a finish line. It’s a capability you build.9
For a consulting engagement, that translates to three horizons. Quick wins: contracts approaching renewal, shelfware with no active users, actionable within 30–60 days. Medium-term: applications with clear replacements and moderate integration complexity, 3–6 month timeline. Strategic: tightly integrated systems requiring sequenced dependencies, 6–18 months.
CIOs don’t want a 200-line action plan. They want to know what to do Monday morning, what to put in the next board deck, and what to start planning for next fiscal year.
Political Cover for Hard Decisions
Every application has a champion. Every department has a reason why their system is different. Theresa Meadows, Symplr’s CIO-in-Residence and former health system CIO, puts it plainly: application rationalization is "complex, time-consuming, and often politically delicate."7
This is the thing nobody puts in the proposal, but it might be the most valuable outcome an engagement produces.
Trinity Health’s experience illustrates the challenge. In an interview previewing their upcoming ViVE 2026 session, Trinity’s Nick O’Connor described the resistance they encountered when retiring legacy systems — what he called "the tyranny of tradition." Staff were attached to their tools, even when better alternatives existed. But O’Connor noted that those conversations often revealed something unexpected: the familiar tool was actually holding people back. The process required structured engagement with stakeholders, not just a technical assessment handed down from IT.5
This is where methodology earns its keep. A data-driven scoring framework depersonalizes the decision. When an application scores in the bottom quartile across business value, technical health, cost efficiency, and risk exposure — and the data is visible to everyone — the conversation shifts from "why are you targeting my system" to "what does the data say." The methodology becomes the arbiter, not the CIO who has to work with those department heads tomorrow morning.
The deliverable is a transparent, repeatable scoring framework that stakeholders can see, understand, and provide input to before dispositions are finalized. Engagement, not edict.
A Foundation, Not a Binder
This is where most engagements fall short, and it’s the thing CIOs seem most frustrated by.
Trinity Health’s Mike Prokic describes how their effort evolved: "What started out as something that had a beginning, middle and end turned out to be something that lives on in perpetuity." Their earlier attempt at decommissioning retired just six applications over two years. After building a repeatable process, they now retire 20–25 per quarter.5,4
That’s the destination every CIO wants to reach. Most engagements produce a report that gets presented once and filed.
The CHIME survey tells the story: even among organizations that have begun rationalization, governance remains informal, driven primarily by IT leadership with limited cross-functional structure. No operating rhythm. No recurring review cadence. No mechanism to catch the next shadow IT purchase or the next auto-renewed contract that should have been renegotiated.2
CereCore, a healthcare IT advisory firm, explicitly frames the expected outcome as "laying the foundation for a fully realized application portfolio management integrated workflow" — including documentation of realized benefits, future state projections, and plans for ongoing monitoring.10
A good engagement leaves behind more than a report. It leaves behind a scoring framework the organization understands, a catalog they can maintain, a review cadence they can sustain, and a governance structure that keeps rationalization from reverting to "as needed" the moment the consultant walks out.
What This Adds Up To
The data is unambiguous. Seventy-six percent of CIOs say this work is critical. Fifty-six percent of CFOs are demanding cost optimization. Trinity Health proved that a structured, repeatable program can deliver $80M+ in real savings.
And yet 80% of health systems haven’t fully implemented a program.2
The gap isn’t willpower. It’s that most available options require either too much time, too much money, or too much organizational overhead — and too many of them end with a deliverable that doesn’t survive first contact with the CFO’s office.
The CIOs I’ve engaged with aren’t asking for anything exotic. A real number. A real catalog. A roadmap they can execute in quarters, not years. Political cover backed by data. And something that lasts longer than the engagement.
Straightforward asks. Just hard to execute — which is why the methodology and tooling matter more than most people think.