Larry Stofko can paint a very tidy picture of how an integrated information network changes the way physicians and nurses work. If a blood test comes back from the lab showing an increase in cholesterol, the doctor might get that information through a Web browser, along with a warning that the same patient visited an emergency room three days ago complaining of shortness of breath. The doctor might check digital images of the patient's latest scans and current prescriptions, then forward the test results to the patient with a link to information on controlling cholesterol and a request to the patient and the office's administrator to make a follow-up appointment.

Only about half of that is possible today at St. Joseph Health System, a Southern California network of hospitals and doctors' offices. But Stofko, St. Joseph's VP of IS strategy and architecture, has a plan. The hospital has connected its core system for managing tasks, such as admitting patients and scheduling surgery, to the Web for physician access, using a New Era of Networks integration tool from Sybase Inc. Right now, St. Joseph is working on connecting digital radiology to allow the sharing of digital pictures. But the company can't even start to link in complete patient information, such as prescriptions, until it has full digital records, with which the first hospital will go online in July. The goal is to let St. Joseph connect what it can today while it moves toward achieving its broader vision.

Think of it as integrating your integration. The biggest challenge for a business-technology leader today isn't deploying the right applications. It's not even selling the concept of a collaborative business, because any division president who isn't trying to cut costs through better information sharing had better have a resumé on Monster.com. No, the challenge is using all the integration techniques of the day -- whether it's information, data, application, systems, or even business-process integration -- to build an IT platform that can meet the demands of real-time business. The only guarantee is that the employees, partners, and customers with whom business managers want to exchange information will change and that the speed at which they need to do so will increase. "What we're doing is providing a framework for change. That's all," says David Guzmán, CIO for health-care-products distributor Owens & Minor Inc.

Integration means lots of testing, St. Joseph VP Stofko says.

St. Joseph's integration strategy is a three-tiered approach: nurturing integration talent and technology in-house; standardizing as new systems are added; and building links to existing information systems. Getting it right can be a matter of life or death. If the patient with high cholesterol checks in as Beth instead of Elizabeth, the systems need to catch that and merge her records. "That keeps the pressure on our integration team," Stofko says. "We test and test and retest."

At Owens & Minor, the required strategy is clear to Guzmán: Convert every information system -- legacy, off-the-shelf, or custom-built -- into components based on Web services, then integrate them so they can be accessed through OM Direct, the company's Web portal.

It's a clear mission, but it's hardly simple. Owens & Minor is about two years into a three-year project to convert all its legacy systems to a component architecture that can be accessed using Web services. When it comes to integrating the components, Guzmán says, the technology is still immature. Owens & Minor uses off-the-shelf tools to help with the XML conversion and the integration, but its IT staff still does a lot of custom programming. "This isn't Legos," Guzmán says. "You can't go out and buy Web services. It's clear you have to be the one to build that."

	Though Owens & Minor uses integration tools, it still must do some custom programming, CIO Guzmán says.

The goal is to build an IT architecture that lets the information flow change as quickly as the business strategy. That's the IT goal, but it requires a commitment back from business-unit managers. As it becomes possible to change systems more often, a process to manage those changes becomes more important. Owens & Minor senior executives meet regularly to prioritize changes to business systems and discuss how they fit into the broader business and IT architecture. "It's the CIO's job to convince the business that this is important," Guzmán says. "If you want me to be able to deliver at the pace you want to work at, you need an architecture."

James Green, webMethods Inc.'s chief technology officer, knows better than most how much can be stuffed under the umbrella of integration. When it comes to big-picture strategy, Green says, step one is to ignore the terms -- EAI, systems integration, etc. Step two is to look for integration patterns. For example, if a company is doing vendor-managed inventory, the pattern is sequential, because a sale triggers a need for replacement that triggers a need for product, and so on. Once the pattern is clear, it's time to look at products such as webMethods' software.