Every industry assumes a distinctive culture, which in turn influences the kind of IT infrastructure that supports it. Healthcare is no exception. Led by medical professionals, dedicated to patient care and insulated from common market dynamics, healthcare self-consciously stands apart. The impact on IT is a dichotomy: at best, it leads to shared industry knowledge; at worst, to insularity and resistance to change.\nBut external factors \u2013 regulation, competition and technology \u2013 are combining to make resistance more futile. That\u2019s putting healthcare provider CIOs in a difficult situation.\n\u201cAfter years of successfully implementing systems to meet regulatory requirements, half of them are not sure what to do next,\u201d says Doug Smith, general manager of the WGroup, a peer-led IT management consulting firm, and former CIO of the Cleveland Clinic. \u201cThey say, \u2018I have all this technology debt, my team\u2019s skills are limited, our engagement model is broken, and funding is drying up.\u2019 They are being forced to make some tough decisions.\u201d (Disclosure: the company I work for, NTT Communications, partners with WGroup in healthcare and other industries.)\nFor CIOs willing and able to act, here is a three-part strategy to jumpstart the process: 1) take inventory, especially of vendor contracts; 2) become a co-equal partner with your technology providers; and 3) focus on capabilities that can help you bridge the digital transformation gap ahead.\nAudit, cut and self-fund\n\u00a0Pressure to reduce healthcare costs is growing. For IT departments, this presents a chance to take stock of vendor relations. For some general vendor management advice, see these six tips from my colleague Rich Harper. But if you\u2019re a healthcare IT leader under the gun to cut costs and embrace new challenges, consider these suggestions from the WGroup to help you cross the digital transformation chasm:\n\nReview all contracts with suppliers. If you\u2019re paying twice \u2013 or even once for something that\u2019s unnecessary \u2013 adjust and recover those savings.\nLocate high fees and align them with market pricing.\nReconsider all SLAs and OLAs. Do they meet your needs and add value? Or are they aimed at static and non-strategic targets? Do they align with the business\u2019 targets and strategy?\nEliminate and retire all shelfware.\nDrop any provisions for maintenance that are no longer applicable or appropriate.\nRationalize your supplier lineups. (Redundancies are common following mergers and acquisitions.)\nCancel auto-renewals \u2013 this is especially apt for contracts involving any SaaS or cloud services.\n\nAfter two or three months, these measures should have a two-fold effect. You will have regained more control in your vendor relationships and likely generated measurable savings. If your organization has already created a vendor management office, direct those savings there. If it hasn\u2019t, find the right partners (legal, procurement, etc.) and self-fund a similar effort.\nBecome a focused partner\nAt the same time, you\u2019re auditing vendor contracts, take additional actions to create more efficient\/effective processes, optimize future spending and realize value. A first step is to minimize distractions from non-core activities.\nYour job is stressful enough without a constant barrage of \u201cbright shiny objects.\u201d While CIO of the Cleveland Clinic, Smith says he received many dozens of such \u201cobjects\u201d in emails every week, often forwarded from department chairs, about new business ideas, applications or widgets aimed at solving one or more business challenges. \u201cOver a year,\u201d he says, \u201cthat becomes a whole lot of activity.\u201d\nA mature IT organization driven more by product development than ad hoc projects should find efficient ways to funnel these kinds of solicitations. Again \u2013 think products, not projects. Try to reduce the impact of random actors by assessing any new ideas and requirements against established roadmaps.\nThat is not to discount innovation. There are indeed many current breakthroughs \u2013 from IoT to blockchain to AI \u2013 with great potential for healthcare. One way to handle the more promising applications is to set up centers of innovation or excellence, or joint labs for tests and trials.\nOutstanding healthcare IT leadership today calls for much more than competence in purchasing. The model is not simply to buy but to broker. Finding the right mix of suppliers, setting up best-in-class terms and aligning with market pricing \u2013 those are by no means easy feats. But the goal is to position your organization to better serve internal customers, patients and the business at large.\nAdjust your assets\nA case in point \u2013 more common in other industries \u2013 is working with a managed service provider to host enterprise applications. In healthcare, this could mean transferring an Electronic Health Records (EHR) system \u2013 such as Epic, Cerner or McKesson \u2013 over to a third-party data center. Whether you have the capabilities to do so, however, is another question.\n\u201cIt\u2019s not just a procurement exercise,\u201d says Smith. \u201cYou can\u2019t just hand this off and hope that things go well. You have to be intentional about how you interface and how you collectively set up your governance, so you can have a successful long-term strategic relationship.\u201d\nTo make such scenarios more common, healthcare CIOs will need to recalibrate. That includes focusing on building blocks, such as APIs, cloud integration, standards and other tools that allow their team to run more complex plays with internal customers and external providers. It also includes personnel, even if they regard themselves as untouchable. You may want to reskill EHR system implementers as programmers who can apply today\u2019s devops best practices to solve a different set of challenges.\nEven when jumpstarted, change takes time. Conditions differ in each departmental silo: infrastructure, help desk, field services, security, implementation, support, integration, customer interaction, etc. A transformational CIO, however, should find ways to create agile, cross-functional teams that can not only broker and integrate, but also orchestrate.\nThe endgame is easy to visualize. Medical clinicians who collaborate at a rapid cadence in frequent standups and huddles provide IT colleagues \u2013 just down the hall \u2013 with a ready example of how to join efforts and achieve shared objectives.