In the new world of healthcare reform, cost reduction requires financial and clinical data integration across the continuum of care. The question should be not whether to pursue a strategy to get there; it should be how best to proceed. Implications of the Affordable Care Act (ACA) and ever evolving technology trends are reshaping administrative, financial and clinical systems and operations. Pressures to reduce operational costs, significant competition and high demands for quality care and outcomes with downward pressures on reimbursements from both public and private payers place even greater burden on margins. These challenges drive even more change as healthcare organizations pursue mergers and acquisitions to find economies of scale and other growth opportunities. IT departments must not only address the system problems stemming from these obstacles, but they also must be strategic in order to capitalize on the opportunities to improve efficiencies and effectiveness.