For this edition of C-suite Conversations, I sat down with Keith Perry, SVP & CIO at Carilion Clinic, to discuss his journey into technology leadership and the evolving role of CIOs in the healthcare industry. From an unexpected career pivot to leading digital transformation efforts at a major healthcare organization, Keith shares his insights on leadership, governance, AI integration, remote workforce management, and the future of healthcare IT.

Carilion Clinic is a non-profit health care organization serving nearly one million people in Virginia through hospitals, outpatient specialty centers and advanced primary care practices.

Key Takeaways

• The evolution of the CIO role beyond IT management toward strategic business leadership requires close collaboration with clinical and operational leaders and their teams.
• While AI presents exciting opportunities in healthcare, it requires a disciplined approach. Organizations must navigate vendor hype carefully, establish governance processes, and prioritize security and patient outcomes.
• IT can play a critical role in sustainability efforts through initiatives like pull printing, energy-efficient data centers, and optimizing infrastructure to reduce waste and costs.

Q & A with Keith

Judy Kirby: Keith, thank you for speaking with me for our ‘C-suite Conversations’ series. When did you realize that technology leadership was of interest to you, and why?

I had always been interested in technology, so I started my undergrad work in computer programming and business administration. And later on, I got my graduate degrees. The leadership aspect has kind of grown organically over the course of my career. I did not start out thinking that I would end up in technology leadership. I was just interested in technology in general, and midway through my career I stepped into a leadership role. And I guess the rest, as they would say, is history.

Judy: You were with a consulting firm for about six years. How did that influence your approach to your career as well as your leadership style?

Keith: Most of our clients were C-suite executives, so it was a really good opportunity to have exposure to the C-suite and to learn how important relationships are to being successful. Consulting firms are really built around relationships. And I think it also helped me set a work ethos of doing what it takes to deliver for your client. I still carry that with me today, that discipline, that rigor around that process for how we deliver work for our patients and our customers.

Judy: I talk with CIOs who are concerned about the division of technology responsibilities within their organizations. Some have data, some have AI, some have cybersecurity, some have analytics, population health. Some don’t. They’re concerned about the division of it and the siloing effect. How you do work at Carilion?

Keith: I’ve talked about this with my colleagues from across the country, and there doesn’t appear to be a one-size-fits-all model. Even in organizations that are similar in size and structure to us, you see very different organizational structures in technology. Personally, I have overall accountability for information technology, information security, and also clinical engineering, because the medical equipment, for all intents and purposes, looks like all other computer equipment that sit on our network today. Here at Carilion, we’re a physician led organization, and we subscribe to the dyad model. So, there’s a physician leader and an operational leader who are paired to deliver medical services to our patients. I have a very similar partnership here. I partner very closely with the CMIO, we report to the same executive leader, and we form a dyad partnership to deliver technology services to the organization.

The CMIO has health analytics, clinical informatics, and digital health, and I’ve got everything else, but we work together. You see very different footprints across different organizations. Those that are larger that need to compartmentalize have created separate roles for AI, or reporting and analytics. In the end, for me, it’s less about the title that I have and more about what we’re doing to take care of our patients and our internal customers.

Judy: You’ve been in the CIO role for some time now. How do you see the CIO or the CDIO job evolving over the next three to five years? What are some of the new responsibilities and job qualifications that are going to emerge?

Keith: I think we’re continuing to see the CIO become more and more strategic, helping the organization set its strategy and being involved in the business side of things. Technology plays a crucial role in driving the delivery of services within healthcare organizations, as well as across all other industries. I think that is placing an increasing burden on technology teams to deliver and on CIOs to understand all sides of the business, including the care side of it. Establishing relationships and having close partnerships with the other senior leaders in the organization is critical. I spend most of my time doing that, working with the clinical and operational leaders. I spend very little of my time actually running the business of IT. That’s primarily delegated to my senior leadership team in technology.

Judy: How have you worked with your team to make them more savvy on the business side, especially now that we have so many hybrid or remote employees? Has that been a negative for getting to where you need them to be?

Keith: I wouldn’t say that it’s been a negative. I would say that it has posed some interesting challenges. Helping to educate my leaders and encouraging them to become more involved in the business and operational aspects of the work that we do has been critical. One of the first things I did when I got here at Carilion was establish the business relationship management model and embedding our IT folks into the clinical and operational sides of the business. So, my Business Relationship team is embedded throughout the organization. They’re out with our clinical and operational leaders. They’re attending their regular meetings. I don’t think we can be effective in helping them do what they need to do if we don’t understand their work.

There’s a unique opportunity here to connect people in IT with the meaningful impacts we have on people’s lives, their health outcomes, and our communities. The challenge that comes from having remote workers is that it’s not as easy to get those teams engaged and out in some of our facilities. But we have regular team meetings, we bring folks in from remote locations so that they are here onsite to develop that connection to the mission and the work that we do. However, it’s important that my leadership team is all local. We feel that it’s critical to have that face-to-face time with the clinical and operational leaders.

Judy: How has your team learned to lead remote employees? Prior to COVID, most people were in the office. How has your team responded? What lessons have you learned?

Keith: I would say we’re ahead of the curve on leading a remote workforce, or a hybrid one. We had already started moving down the remote work path about a year and a half before COVID. We were doing that because we were finding challenges from a recruiting perspective, and we were looking for ways to offer more flexibility to our existing teams as a retention strategy. We sat down and talked about what that would look like. How do we stay connected with the teams? How do we ensure that we’re still seeing the same quality product, the same level of production, etc? We developed a remote worker agreement that has a lot to do with how we stay connected. For example, we require everybody to have their cameras on during meetings. We also encourage “drop by” meetings, just like you are in the office and drop by someone’s office if you need to chat or work through a problem. We just do it virtually with them.

Judy: You once told me a story about how your contract negotiation skills came in handy when you were building your house. It was an amazing story. How have negotiating skills been useful in your career?

Keith: I have to say that I think it’s one of my best skills, negotiating contracts and honing in on the parts of contracts that are important. We have hundreds of contracts that are constantly in a state of being renewed or renegotiated. I’ve worked really hard to educate my leadership team who have overall accountability for those contracts and our compliance with those contracts. Every vendor is different in terms of how they leverage licensing models, and the shift to software as a service brings new things we have to be concerned about.

You use those skills not just in contract negotiation with vendors, but a lot of what we do day in and day out is negotiating systems, negotiating problem resolution, negotiating timelines, etc. It’s all about how flexible you can be, and how persuasive you can be.

Judy: What do you see as your organization’s biggest strategic challenge this year?

Keith: I think it’s going to be a challenging year for us. Our organization is transitioning after Nancy Howell Agee retired as president and CEO. Steve Arner, our former COO, has stepped into the role and will likely bring new leadership ideas as well as a new direction for the organization.

We have a half-billion dollar tower expansion that is coming online next month. We’re doing a wholesale replacement of our ERP platform. And just like every other organization, we’re dealing with a significant influx of demands for AI technologies and the work it takes to navigate these requests and distinguish those tools that are useful versus noise is taking a lot of resources. We’ve got our hands full for sure!

Judy: You mentioned AI before. How is AI impacting your organization? What type of work are you leading to evaluate new AI capabilities? Is it changing your IT org chart or your operating model?

Keith: It’s like trying to herd cats. I can’t ever recall a time in my career where there has been this level of interest, and hype, in a set of technology tools. Companies that are months old, rather than years old, are offering some of these solutions. Like other organizations, both within healthcare and beyond, we are working to understand these tools and try and help our leaders strip out the noise.

We’re trying to understand how these technologies can help us provide better patient outcomes and deliver more efficient and cost-effective care. But working through the onslaught has been challenging.

Early on, our CMIO and I realized that we had to have some discipline as we work through this. We put together an AI steering committee made up of our senior leaders. Now we put all requests for AI technologies through a process, looking at the use case, and how it is aligning with our strategy, because every vendor that we have is stepping forward saying, “You need this latest, greatest AI that we’ve incorporated into our platform.” It’s just a lot. And you’ve got to have discipline as you work through it for many reasons, including the cost.

I have some real security concerns about some of these technologies and some of the vendors because many of them are black-box solutions. They don’t want to expose the special sauce behind their solutions because it’s their intellectual property. But we need to understand what they are doing with our patients’ data.

But I will say that some of these tools show a lot of promise and can help us from a security perspective. We’re really interested in Agentic AI in the form of what Gartner calls guardian agents, where you’re deploying AI to watch and monitor AI to be sure that it’s not going outside the guardrails and doing what it’s not supposed to be doing.

Our organization is taking the approach of buy versus build, at least initially. It is better for us to look at some of the solutions that our existing vendors are bringing forward first. Number one, we’ve got a trusted relationship with those vendors already. And if that’s our quickest route to get some wins and get some solutions in place faster that bring value, we feel like that may be the best approach for us.

Judy: What is your best use of AI right now, the most successful one you’re using?

Keith: We have two or three really successful projects. We have deployed ambient co-pilot technology in the Nuance Microsoft space for physicians. That technology essentially records the conversation between patient and physician. It summarizes and creates the documentation for the provider in Epic which takes a lot of the administrative burden off the provider. We have seen increased satisfaction in terms of being able to get that documentation closed more quickly, which certainly helps from a revenue cycle perspective. More importantly, it’s helping with provider wellbeing and is reducing “pajama time” for our providers.

We’ve also deployed a couple of predictive models in our quality area to help identify things like sepsis and early sepsis intervention. We are looking at AI and predictive modeling to predict early deterioration of a patient. Those are examples that have been successful and that we’re continuing to expand.

Judy: A lot of organizations are touting sustainability. Healthcare doesn’t seem to address it as much as other verticals. As a CIO, are you involved in strategic initiatives around sustainability? And if so, what are they and what’s your role?

Keith: We actually have a leader in the organization who is focused on sustainability. She’s done a lot of tremendous work. One of our acute care facilities has a solar array farm that is producing a portion of the energy required to run that facility.

From an IT perspective, we have implemented ‘pull printing’ in the organization. One of the things that we noticed as we walk by any printer is that there is always a stack of unclaimed printouts on it. We determined that people print things they ultimately don’t need or the printouts are auto-generated by a system.

With pull printing, all of our multifunction devices are now equipped with card readers. Folks walk up to a printer when they’re ready and tap their badge to print documents that  are holding in their queue. In some instances, those documents never get printed and after a certain period of time, they just drop out of the queue. We’re seeing an overall reduction in paper and toner use. We’re also looking at our data center footprint and power efficiency in those data centers.

Judy: So, Keith, if you hadn’t become an IT leader, what other career do you think you were cut out for?

Keith: You know, I have always been fascinated with airplanes and the aeronautical industry. I think I would have been a good airline pilot. And given the fact that technology is running those aircraft today, it probably would have been a good fit.

Judy: What’s something you love to do in your free time?

Keith: I love to travel. Especially as I’ve gotten older, I have an even bigger fascination for new cultures and new places. We have a really big trip coming up next year to Japan that I’m really looking forward to. I’m also a hobbyist when it comes to photography, especially drone photography and videography. So, I’ve taken my fascination with airplanes and miniaturized it into drones and combined it with my technology skills and love of photography. You’re able to capture some really unique images from a drone that you can’t get from regular photography.

Judy: What’s your favorite place that you’ve visited?