Posted January 29, 2017 by admin in articles

The Hedgehog Concept and HIT interoperability


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The Hedgehog Concept and HIT interoperability

Author: Kevin Puscas, CTO, RosettaHealth

I’m not one to generally read “business” books, but for some reason about ten years ago I picked up Jim Collins’ “Good to Great: Why Some Companies Make the Leap … and Others Don’t.” There were some great lessons from that book that I still find applicable to a wide range of situations, including HIT interoperability.


First published in 2001, it was a best selling business book for years, and the premise is about how different companies cracked the code for becoming “Good to Great” within their respective industries. The author also distilled this concept down to a set of principles that applied to each company he examined.

The one principle that stuck with me was the Hedgehog Concept, which has three core principles:

  1. Recognize what you are good at;
  2. Figure out what you want to be good at;
  3. Determine what it makes sense to be good at.

So what does this have to do with HIT interoperability? Interoperability is playing a bigger and bigger role in a wide-range of healthcare organizations. Whether it is hospitals, practices, ACOs, HIEs, or Big Data analytics, the question is how to have this capability within your organization.

Without a doubt, interoperability has become more achievable. However, as the breadth and volume of what is exchanged has increased, so too has the complexity. This is especially true when trying to exchange information between organizations – with every potential exchange there can exist a number of options and pitfalls. This is where the Hedgehog Concept can provide a useful guide:

  1. Is HIT interoperability something that your organization is good at today? Do you already have an established team of experienced people, the IT infrastructure, the required operations, and it is a proven part of an organization’s daily business? Or is it a reliance on that one person, or that one tool or solution that was put together for that one case?
  1. Do you want to be good at creating and maintaining interoperability solutions? With a myriad of potential approaches, standards, tools, and challenges, establishing a successful interoperability capability within your organization is no small effort. It requires real commitment of both attention and resources over the long term. Maybe it isn’t something you want to be good at, but is critical to support what you are really good at.
  1. Does it make sense to be good at creating and maintaining interoperability solutions? Take a look at the things that are truly core to your business. Is it caring for patients, establishing healthcare communities, or maybe taking vast quantities of healthcare data and finding new insights about a population? Does it make sense then to add to that the ability to develop and maintain interoperability solutions? Knowing that this is a long-term investment, is this something that you want to commit both attention and resources?

If you answered “no” to these questions, what are the alternatives?

You know it’s important, but perhaps it’s not something that’s in your wheelhouse? Then, maybe the best solution is to outsource this effort. With mundane things such as business email to IT infrastructure hosting to a complete cloud based EHR solutions, it is becoming more and more common to tap into the established capabilities of others to support the core business functions.

HIT interoperability can follow this same path. It may be bringing in help for a one-time solution to help set up and run a particular capability. It could be partnering with an organization to develop the full interoperability component of your business.

In either of these examples – and many others – taking advantage of someone else’s Hedgehog can allow you to focus on your own core strengths.

About the Author:

Kevin Puscas, CTO, RosettaHealth:

Kevin has more than 20 years of experience as a software engineer and solutions consultant, working with both government and commercial clients. He is responsible for developing and maintaining the RosettaHealth platform, which makes electronic health record exchange affordable and ubiquitous.

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