We see it so often in healthcare it starts to seem normal, but it's not. I'm talking about organizations ripping out the hodgepodge of disparate applications they call a clinical information system and replacing it all with a single vendor. Only in the rarefied and cash-flush world of academic medical centers could such extravagant behavior have almost become the norm.

Now, mind you, I'm not talking about "perfect world" scenarios because, in that case, the rip and replace may be just what the doctor ordered. But most organizations don't have that luxury. In most healthcare institutions, especially the 200-bed-and-under community hospitals that provide the majority of acute care in this country, it's all about leveraging existing investments to the best of one's ability -- that's the role of the IT director or CIO.

And though I mostly associate vendor M&A with disruption to existing customers, that's not always the case. Take Kim Larkin, CIO of Washington County Hospital, a small critical access facility on a tight budget. She'd been stuck between a rock and a hard place for just the reasons I cited above. First off, the vendor of her financials package didn't offer an acute clinical system to match, and no vendor of clinical inpatient systems would sell her just that piece.

That left Larkin out of luck with HITECH bearing down on her little hospital. Thankfully, some timely vendor M&A saved the day, with her financials vendor snapping up an acute clinical system to match. Not only were her purchasing problems solved, but now her main vendor will handle all the integration. If Larkin had made the purchase herself, she'd be on the hook to tie it all together.

Larkin's situation is representative of hundreds of CIOs and IT directors. They desperately want to create a sophisticated IT shop that provides great patient care, is attractive to clinicians, and meets both the spirit and letter of HITECH, but sometimes they just don't have the resources to do it. With HITECH's back-ended funding, it's still a challenge to find a financial way forward, especially if that means cutting investments made in the past.

The government needs to remember that the big software purchases announced in the trade press are often not representative of what's going on in the healthcare community at large. Most people on the front lines of IT are making the best of what they have, adding to it, and stitching everything together on a shoestring. They're also doing a lot of relying on their vendors to bring it all together.

Those are the same vendors that will be pouring their time and money into achieving certification in this new HITECH world. I'm hopeful they'll continue to give some attention to the real-world problems of small-facility IT leaders like Larkin. Her organization, by definition, represents the backbone of healthcare. In that world, it's not about ripping and replacing, but patching, leveraging and surviving.

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