by Marco Huesch

In the rush toward "meaningful use" and amid the HIT sales pitches, let's pause for a moment to consider strategy.

What, for example, does "interoperability" mean for your strategy? It might mean little now -- even if you're in Boston, and have the planet's best hospital CIO. When Beth Israel Deaconess Hospital gets paid substantially less than Partners HealthCare despite clinical parity or superiority, it's hard to imagine real "interoperability" working out just yet.

But what if "interoperability" does get exploited in all its neat potential? What happens to your strategy when the balance of power in your relationships with other providers, regulators and referrers gets turned?

[More:]

Thought-experiment: HHS rolls out a smartphone app which confidentially aggregates regional provider data, and provides risk-adjusted rankings of some cost-effectiveness measure. There can only be one provider who wins this contest, and everyone else will be on their back feet explaining, justifying, and generally giving ground.

But you're an ethical provider, and pride yourself on your hospital's commitment to quality and access at reasonable costs. Shouldn't you just align yourself with the regulator's well-intentioned efforts to roll out HIT?

If you are already so aligned (e.g., you're the CEO of a rural 50-100 bed hospital) this is an easy call and you have few options anyway. But suppose your hospital adds higher, more costly tiers of medical services to the mix. How do you best align your customers' and your own corporate interests to the largest payor's political and public health interests?

Marco Huesch, MBBS, PhD, teaches Provider Strategy as an assistant professor at Duke University's Fuqua School of Business. He practiced as a physician in Australia before pursuing an MBA at INSEAD; has worked as a management consultant with Booz & Co., and ATKearney specializing in strategy, operations and IT problems an holds a PhD in business administration from UCLA. He recently wrote a commentary, "Payment Policy Based on Measurement of Health Care Spending and Outcomes," which appears in the Journal of the American Medical Association (JAMA. 2010;303(23):2405-2406)