Few understand the intersection of healthcare and technology better than Terri Couts, EVP and Chief Digital Officer at Guthrie. With a career that began in teaching and pediatric nursing, Terri has navigated the complex world of healthcare IT, leading transformative initiatives that enhance patient care, efficiency, and operational effectiveness. In this interview for ‘C-suite Conversations’ Terri covers a range of topics from sustainability to AI’s role in healthcare.

Guthrie is a non-profit, integrated healthcare system offering a comprehensive range of healthcare services across 12 counties in north central Pennsylvania and upstate New York. The organization manages over 1.5 million patient visits annually, providing care to predominantly rural communities.​

Key Takeaways

• Generative AI has the potential to improve patient care, provider efficiency, and operations, but ethical considerations, data security, and governance remain critical to responsible AI implementation.
• In a cost-conscious industry like healthcare you must balance financial constraints with the need for technology-driven transformation. Careful strategic planning, ROI tracking, and platform consolidation are keys to success.
• Strong mentorship and leadership coaching are essential for growing the next generation of healthcare IT leaders. Enabling and encouraging rising IT professionals to do work that falls outside their comfort zones will support their career growth.

Q & A With Terri

Judy Kirby: Terri, you started your healthcare career as a pediatric nurse. How did you end up on the path to becoming a technology leader?

So I interviewed for an analyst role with ASAP, which is Epic’s emergency department information system. I didn’t truly understand what the job was even after the interview, but they offered it to me, and I needed a change, so I took it.

I really loved solving problems through technology. If there was a way to make what they did better it really interested me, so I dove in and got every certification that I could. After some time I was managing the inpatient team at Akron Children’s. Meaningful use had kicked up so I decided to go into consulting. I learned a ton about all kinds of different healthcare systems, big and small, and how we could make EPIC enhance that work.

In 2014 I joined NYC Health and Hospitals, leading their Epic implementation. When our CIO Bert Robles left there and landed here at Guthrie, he recruited me. At that point, I was ready to be off the road. I had a daughter entering high school and she was a little bit in need of some parenting at home, so we made the leap and moved to Pennsylvania.

Judy: Did you have a strong mentor who helped you?

Terri: I’ve had a couple of mentors, starting with a physician at the Cleveland Clinic. He was a renowned pediatric surgeon, and while some surgeons can be socially inept, this one was the opposite. He really wanted you to be engaged in the care he was providing. He wanted you as part of the team. I’ve had some mentors in IT also. Because I was a nurse leading IT, there was constant questioning of my ability. But I know how technology ties to the patient, and I think that’s what my mentors have focused on—the art of storytelling, the art of understanding the why, listening, and relationship management.

Judy: What do you bring from your background as a pediatric nurse that helps you be a strong IT leader?

Terri: I think being able to meet people where they are. As a pediatric nurse, I had to assess the child’s capabilities, you know, their understanding and communication and all those things. I’m a great observer and listener, and I’m able to get to know the audience that I’m talking to. Another attribute that a pediatric nurse has that is valuable as a CIO is patience and a certain level of empathy and compassion. I want to make sure that I’m meeting people where they are, not to always say “yes”, but to make sure that they understand my position, that I understand their position, and we can meet somewhere in the middle.

Judy: Has your lack of hands-on technical expertise been a positive or a negative?

Terri: Honestly I think it’s been mostly positive. The reason I say that is because I can ask all kinds of questions and it requires people to think differently because my questions come from a clinical framework and not from a technical framework. Sometimes I will even ask questions that already I know the answers to just to help the technologists think a little differently. I listen a lot. I want to learn enough to understand the why behind things and make sure that I can pick the right vendors and partners. I don’t need to be highly technical to lead relationships and to drive innovation and serve our patients, but I make sure I have a strong team underneath me.

Judy: One of the biggest concerns I hear over and over again is about the lack of up-and-coming IT talent to fill the CIO positions. There are a lot of CIO positions open right now. What do you see as the reasons for this, and how are you helping your leaders position themselves for career growth?

Terri: You know caregivers are not the only people who burn out in healthcare. With the challenges around cyber threats and infrastructure and audits and rising technology costs, it is a high-stress job. It takes away from time with your family and being able to care for yourself. I have a hard job but I actually like the challenge. I thrive in this kind of environment. But five years down the road I might not want to, so I can understand it.

IT is so diverse, we have to have an EPIC expert, an infrastructure expert, we have a desktop expert. There’s not one person who knows it all and I think that makes it challenging to groom individuals into leadership positions by allowing them to get outside their particular area. I try to connect people with other groups on my team, and have them participate in some of the boot camps and the training that will give them experience but also the peer connections.

I coach people that it’s okay to be uncomfortable. If I were comfortable every day in my position, then something is probably wrong. Four or five years ago, I had somebody who had started out as a lab technologist. She came into the EPIC space and she was managing that really well because she was meticulous in her detail. We didn’t have a project management office at the time so I said to her, “I want you to lead my new project management office.” At first she was like, “What are you talking about?” But she thrived in the role even though she was so uncomfortable at first because it wasn’t what she knew.

Judy: There are a lot of conversations about the CIO position. What should their responsibilities encompass and what should it be titled? You’re a Chief Digital Officer. Others are still CIO, but there are CHIOs, the Chief Data Officers, the CMIOs, the Chief Analytics Officers, Chief AI Officer. They all have different parts of IT. What do you think it should be called and what parts do you have or don’t have, and why?

Terri: I think it depends on the organization. I started out as the CIO and we changed it under Dr. Sabenegh’s guidance, our CEO, to add digital because of his beliefs around how technology enables care and how we strive to be more transformative in our care model using technology. I have all the traditional CIO responsibilities and AI now falls into that. We don’t have the type of organization that would need a chief AI officer, but at a place like the Cleveland Clinic that has a lot of funding to invest in building large language models that they could even sell at some point, it makes sense to have that oversight. But there is the worry that having a lot of chiefs can lead to fragmentation. When you have silos, particularly in larger organizations, things start to break down, like security and change control processes, and redundant technology tends to grow out of that. If you have an academic center and a large research center, having a chief data officer makes sense. But we have a small research center. We are building out our own data lake house and keeping it under my purview makes a lot of sense to ensure we have all the security.

Judy: One of the other concerns I hear is recruiting and retaining top talent. It’s long been a challenge for IT, especially during and after the pandemic. What’s one of your most effective recruiting or retention strategies? And what positions are the most difficult to fill right now?

Terri: We’re a hard organization to recruit to for pretty much every role due to the rural location. If you recruit a physician, you have got to make sure their spouse is also happy in this environment. It’s an hour to Starbucks, so for many, it’s a different kind of lifestyle.

But the pandemic really opened it up for us. It allowed my team to work remotely in an organization where that had previously been frowned upon. They have work-life balance and flexibility now and that has been a large retention factor for us. They don’t have to do all that driving and pay for gas. It also opened up the doors to recruit in other states. I have a manager who lives in Utah, and I have a cybersecurity expert who lives in North Carolina. They work our hours and they make it work for their families, but they don’t have to move.

Cybersecurity is probably our hardest area to recruit in right now primarily because those are entry-level positions doing a lot of groundwork that isn’t very exciting. Infrastructure has been a challenge too, because those individuals need to be on site. As the talent ages out, it’s been a little bit harder to recruit for that.

Judy: With continuing financial pressures in healthcare, how do you meet the rising demands of costs of technology? Are you able to track a true ROI for the investments you are making?

Terri: Outside of the traditional EPIC stuff and standing-up servers and those kind of things, pretty much everything technology-driven that we bring in requires a pro forma. That’s a process we started about four years ago. So for example, with the Guthrie Pulse Center, which is highly technology-enabled, we took a five-year outlook. We put down the hard cost, and we put down the savings. The first year and a half was all investment, but now we’re actually seeing savings. But we plan for all of that. But some things you just have to do even when there is no ROI, like replacing aging PCs. You have to spend the money, otherwise, you’re going to have a cyber event.

I think the pro forma process also helps with other things like adoption of the technology because you already know the problem you’re trying to solve and you’re targeting it together with the business owner. It’s not just about deploying the cool thing.

We try to take a platform approach. We have three major platforms, Microsoft, Oracle, and EPIC. Whatever the ask is, we try to make it work through one of those platforms before we look for something new. But for most things we can prove out at least a small ROI. There’s also a lot of soft ROI that comes down the line that may not have a direct correlation. For example, remote patient monitoring tech in the home probably reduces visits to the ER, but that is not necessarily a correlation being tracked.

Judy: How is generative AI impacting Guthrie’s strategy? What type of work are you doing along those lines?

Terri: We don’t have the shop to do any kind of large language model training ourselves, but we’re working with partners on their AI products. We evaluate AI in three key areas: improving patient care, increasing provider efficiency, and enhancing operations. Every AI tool goes through a governance process to ensure that it’s necessary and ethical.

Generative AI is especially tricky since it relies on sensitive patient and organizational data. We’re using it carefully for operational improvements like predicting falls and pressure ulcers (Artisite), capturing provider-patient conversations (Ambient Listening), and strengthening security.

AI won’t replace human interaction; it’s about creating a more personalized, proactive, and connected experience. AI is both exciting and daunting, but if it becomes more affordable, we could see some game-changing advancements.

Judy: As the CDO, are you involved in any strategic initiatives around sustainability?

Terri: Absolutely. We recently held leadership discussions on transformation—not just for a single project, but for the broader goal of sustaining our ability to serve patients, remain financially responsible, and address workforce shortages. Technology is required to make these things work, and I wouldn’t want to be in an organization where I wasn’t part of that conversation.

We’re trying to balance innovation with cost efficiency. For example, we’re exploring ways to offer our call center services to smaller hospitals or rural healthcare centers that lack the resources to build one of their own. They get access to high-quality support without the overhead, and we earn a little bit of profit. Our goal is to control costs while transforming to meet our community’s needs.

Judy: So, as you look ahead to the rest of 2025, what are your biggest challenges?

Terri: It’s the amount of work. I see a lot of change happening and everything is supported by technology. So, keeping my team engaged while not burning them out will be a big challenge.

What’s happening at the federal level impacts us because there doesn’t appear to be a game plan right now, and there’s a lot of change management happening in our organization when it comes to care model redesign. Because we’re being asked to move fast, and change is coming so fast, we need to be able to support our users through these changes. That is something I want to keep my eye on. That and the patient experience in general.

Judy: If you hadn’t become a nurse who then became an IT leader, what other career do you think you were cut out for?

Terri: When I was growing up, I always wanted to be a pediatric physician, but I got my first degree in education. I was a teacher for about four years before I went back to school and got my nursing degree. I guess medicine has always been where I wanted to be. I never thought that I would be sitting in this chair, although I do love what I do most days.

Judy: Outside of work, what’s something you love to do in your free time?