Government // Leadership
10:11 AM
Anthony Guerra
Anthony Guerra
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Guerra On Healthcare: Best Of Breed Vs. Enterprise Health IT

For healthcare CIOs, combining a vision for IT with action is as crucial as choosing between single enterprise solutions and standards-based plug-and-play applications.

Peter Drucker called it "systematic and purposeful abandonment" -- the idea that you can't do everything at once and still do it well. To be more specific, let's consider the question of proper resource allocation in the context of massive change, the kind of change Clayton Christensen discussed in The Innovator's Dilemma. In the book, the author looked at companies that were once king of the hill, but failed to maintain that position. What, he asked, causes the mighty to fall?

It turns out they becomes slaves to their own success -- so beholden to the products and services which took them to the top that they are unable to transition when the time comes. Often, it's the "cash cow" areas that are continually catered to long after the cow has been diagnosed with a terminal disease, and that catering means future growth areas wither on the vine. New organizations not beholden to the old solutions are able to focus 100% on the new fruit and ultimately bring in a bumper crop.

Two areas that are near and dear to my heart are going through massive change -- the first is publishing, where the death throes of print are seeing many organizations unable to cut the cord and fully embrace the future, online. The second is healthcare, where many hospitals are also tied to the paper paradigms of the past. But, in that world, the way forward offers two distinct paths, with no clear indication of which is correct.

On the one hand, we have leaders in the field saying the future is a hodgepodge of applications, with data exchange facilitated by more stringent standards, while on the other side, leaders claim the hodgepodge is dead, unable to yield the information flow now demanded by the government. Those individuals favor an enterprise solution with one vendor for (almost) all.

I've thrown all my eggs in the online basket and no longer spend any time or energy on print. On the healthcare IT side, CIOs must make their own choice about which model will win the future, then pursue that course without hedging. If one is living in a best-of-breed world, but believes that environment is suboptimal, it's time to push full force for an enterprise solution. If one truly believes in a plug-and-play future, integration technologies and open source solutions should be acquired without reservation.

The key is to first have a vision, then pursue it energetically, abandoning that which no longer has relevance. Without a vision, all is haze and fog. With a vision but no action, life is no more than daydreaming. Only when the two are combined in a dynamic, passionate executive does the magical quality of leadership emerge. See the future, pursue it, and your team will follow, then your organization will never be a case study for how the mighty have fallen.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at

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