Secondly, Scott is right

and lastly, I agree with your assessment that things will not be getting better any time soon.

Budgets and politics. IT and clinical areas have separate budgets for technical acquisitions especially in large single hospital systems. The physicians (which usually have far more clout than most in healthcare IT management) can pick and implement systems that have little or no IT oversight. IT standards are viewed as a hindrance and many physicians have little tolerance for such things. IT gets to hold the bag in the end when it comes time to integrate (which of course was not put in the budget). On the other hand, a lack of IT planning for things that can potentially serve several departments can frustrate physicians so they go rouge.

2. How did they ever get so so big without a cohesive IT strategy?

Healthcare IT can be its own worst enemy in some ways. For example, imaging is an area that begs for better strategy. You can have radiology and cardiology and obstetrics all in the same hospital using different PACS systems that can’t talk to each other. Also, vendors don’t sell these one-off systems to be fault tolerant – they would lose the sale. Classic example, the cardiologist wants to see the chest X-Ray from the cardiology PACS but can’t because it’s on the radiology system. This is where IT can promote integration by moving towards vendor neutral archiving and greater redundancy.

3. Is it possible to reverse both of those AND improve the business.

Yes, and end up with less costly, integrated and redundant systems.