Guerra On Healthcare: A Tale Of Two CIOs

The choices Healthcare CIOs make between single vendor enterprise solutions and best-of-breed offerings are driven by budget constraints that often reveal the healthcare haves and have-nots.
In what's become an epic battle for the heart and soul of sound CIO strategy, I continually hear the emergence of two camps -- the enterprise, one-vendor-for-all folks, and the cobble-it-together best-of-breed/suite folks.

In interviews with CIOs of each type, I hear different levels of derision directed at the other camp. None of this, mind you, is extremely overt, healthcare CIOs are too deferential for that. Most of it comes in the form of questions, such as, "I'm not sure that's the most responsible strategy." The funny thing is that this exact barb has been directed by each side towards the other.

For example, when speaking to enterprise CIOs, the trepidation about the other side's strategy revolves around ensuring all those interfaces moving critical data from one vendor application to another stay sound. They also question the financial sagacity of writing and maintaining expensive interfaces that must be tweaked and tested each time one side of the pipe must be upgraded to a new version.

On the best-of-breed/suite side, they question whether their colleagues have been good stewards of the institution's money, as often going "enterprise" means spending upwards of $100 million. In addition, going enterprise means walking down the aisle with one vendor who will be much like a spouse for the next 10 years or more, with divorce being an impractical or impossible option should things go south.

I can tell you one thing about the enterprise folks -- they seem to be happy campers. I have yet to speak to one who didn't sound cool as a cucumber about running their shop, achieving high levels of CPOE and meeting whatever requirements the federal government can dish out.

On the other side, the best-of-breed/suite folks voice more concern about holding it all together, but truly feel they are doing what is fiscally right for their organization, while vowing to make sure robust integration get all the data where it needs to go.

Both sides of the aisle are populated with passionate individuals who want the best for their organization and believe they are taking the right path -- based on available resources -- to foster the highest level of patient safety.

Something down deep, though, tells me the best-of-breed/suite executives are a little envious of their enterprise colleagues, no matter what they say on the record. One enterprise CIO I recently interviewed said he didn't want the kind of leverage that comes with not being completely tied to one vendor, he didn't envy the ability of more diverse shops to threaten severing the connection if a particular customer request isn't granted.

A best-of-breed/suite CIO whom I also interviewed recently directly accused enterprise folks of trading innovation for "safety," and he was talking about the career kind. He found that barter to be unwise at best, irresponsible at worst. At what cost, he asked, had those CIOs obtained their peace of mind - both in terms of financial cost and product flexibility.

To a large extent, I believe that budget determines decision in this area. The folks that have the cash seem to overwhelmingly go enterprise, while those on a tighter budget buy piecemeal and go best-of-breed/suite. CIOs embracing each scenario can run a safe, highly efficient healthcare IT enterprise, but there seems little doubt the future will see one major division of healthcare organizations (IT haves and have nots) followed by a secondary subdivision of the haves (enterprise and best-of-breed/suite). We'll see if a quality chasm in that second division creeps toward the kind we see in the first.

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 [email protected]

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