During the next decade, the role of the CIO will change in two major areas: 1. The relative importance of the CIO as the person who translates business and clinical needs into information technology ideas will diminish. Although this portion of the CIO role will not disappear, this role will be increasingly filled by senior management, clinicians, and other members of the hospital staff. 2. The CIO role will need to shift from an emphasis on managing implementations and projects to developing and advancing the infrastructure. CIOs need to distinguish between the expression of the asset (the application portfolio) and the information technology infrastructure (the remaining four components of the asset). While being pressured to deliver more applications, they can fail to invest in and manage the infrastructure. This is a mistake. By neglecting management of and investment in the infrastructure (e.g., staff training and data quality) or by failing to take advantage of new technologies, they can hinder the ability of an organization to deliver superior applications. Poor data quality will cripple an executive information system and a too-permissive stance toward hardware and operating system heterogeneity will hinder the ability to deliver a computerized patient record. Although some management of the infrastructure is in place, in general it is insufficient. Few organizations have both a distinct data management function and a technical architecture plan, and also develop and enforce key technical, data, and development standards. This insufficiency will hinder their ability to effectively and efficiently apply their information technology infrastructure. The role of the CIO will evolve due to several powerful forces.(ABSTRACT TRUNCATED AT 250 WORDS)