How are things looking on the health care front, Nelson? Ramos: I think were going to see IT become almost more centralized, in terms of infrastructure and standardization. I think IT is now woven into all of a corporations major initiatives, and thats going to continue. In these transition years, its going to place more of a demand on IT to work on its internal processes, leading to a more transparent use of IT.Do you think theres a charter emerging to undo the uncontrolled dispersion of IT responsibility that took place from, say, 1980 to 2000?Ramos: I think so because, again, for IT to be transparent to an enterprise, its going to require more standardization and more formalization. Is that transparency requirement being driven by governance mandates or just cost-effectiveness? Ramos: I think both cost-effectiveness plus the interweaving of IT within an organization. Especially in health careright now, the major initiatives are going to be in sharing of information. It seems as if theres an awfully powerful collision thats going to be taking place between a) the demand for interoperability and exchangeability, and b) the demand for privacy and confidentiality and access control. Ramos: Right, and its tremendous. Today, its largely driven by regulation, HIPAA [Health Insurance Portability and Accountability Act]. Going by the letter of that law, the consumer is a vital link in that because, in essence, they have to give permission as information is disclosed. There are certain exceptions to that rule related to patient care. I think that will be an area in which, as we get more automated, well be challenged more in the future. As far as the actual adoption of HIPAA is concerned, would you say were at the end of the beginning or in the middle stage of actually making that work? Ramos: Were in the middle. Do you think youll feel like youre done by 2010, or will you still be working on it? Ramos: Well be in the middle stages of interoperability. If I drew a parallel, it would be with the banking industry, where now you can use an ATM card anywhere in the country. I think well get to the point where there will be a means to share information, but I still think the social elements to that still need to be put into effect in terms of disclosure and accountability. Tied to that are all the issues of security. Fran Rabuck, what do you see as a major driver as we head toward 2010? Rabuck: Innovation. Innovation was kind of bordering on lunacy in the late 90s. This time around, its going to be much more methodical. Before, you said, "Weve got to be on the Internet, and heres our initial ante." I dont think thats going to happen this time. People will take more of an incremental approach. Heres a question for the whole group. What kinds of people will you need to be hiring five years from now? How will the skills mix change? Ramos: I think well need people who are more familiar with business processes. Are these people a reinvention of the systems analysts of the 60s and 70s? Or is there something more sophisticated there? Ramos: I think now were looking for people with a broader organizational perspective. Miller: Over time, I try to see more people with skills in analytics that they can apply to all parts of the business. I really see IT staff as becoming more business analysts who are liaisons for different parts of the business and learn the different parts of the business, not just IT. Rosen: I think one of the key things youll need is people who know how to learnnot so much people who know language X, Y and Z, but people capable of learning a lot of different kinds of things. Check out eWEEK.coms for the latest news, reviews and analysis on IT management.