A provider organization may have themes of improving care quality, reducing costs, and improving patient service. During the course of any given year, IT will have initiatives that are intended to advance the organization along these themes. The mixture of initiatives will change from year to year, but the themes endure for many years. Because themes endure year after year, organizations develop competence in these themes. They become, for example, progressively better at managing costs and improving patient service. This growing prowess extends into IT. Organizations become more skilled at understanding which IT opportunities hold the most promise and at managing implementation of these applications. And the IT staff members become more skilled at knowing how to apply IT to support such themes as improving care quality and at helping leadership assess the value of new technologies and applications.