This is the strategy National Coordinator for Health IT David Blumenthal has chosen to pursue, and on it may rest the fate of the whole Obama Administration.
Rather than trying to reform the whole industry, Blumenthal's aim is to create at least one example of doing things right, then bring the lessons of those best practices to other communities.
This effort will start next month through the selection of "beacon communities," but my guess is those cities and towns will really be semi-finalists.
A variety of approaches will be selected, a variety of vendor groups and technologies, but the aim of the "beacon community" plan is to see whether one community, somewhere, can deliver the promise of health IT -- lower costs and high-quality care.
The "how" in this case will be as important as the result, because the next step will be to boil the community's results down into lessons, principles, a curricula if you will, that can be expanded outward to the rest of the country.
In this way he hopes to avoid Moore's Law of Training -- there is no Moore's Law of Training -- and the fears of Gartner analyst Wes Rishel, who delivered a "rant on health information technology asynchrony" over the weekend.
The natural slow adoption of technology and the need for interoperability were Rishel's themes, and when you look at the entire field his concerns are valid.
Small organizations are reluctant to change, and large ones change slowly because many people must be trained to use new tools. This is what I call Moore's Law of Training -- people learn only as fast as they learn.
But if you focus on just a few places, forcing the process with the hope of money and fame, you create industry leaders, best practices, and a road map others can follow.
Businesses fight to create just such practices within their organizations, but then wrap up this "secret sauce" as trade secrets to maintain their hard-won advantage.
Blumenthal is betting that federal money from the stimulus can open up these silos.
I think we should discuss this approach, not just in terms of health IT, but in terms of systemic change generally. If someone shows you they know what they are doing, and then hand you a set of instructions based on their knowledge, will your organization change faster?
I know it doesn't work in real estate. New cities like Peachtree City in Georgia, even when successful, were not copied by the market. Neither were innovative communities like Seaside in Florida or the Rouse marketplaces.
I know it did work in education, long ago. America's great public education system emerged from examples set by Horace Mann and the New York schools. The fastest way to make yourself some money in real estate may be to make your local public school a magnet.
So will it work in health care? Can it? Or is Moore's Law of Training (there is no Moore's Law of Training) absolute?