The biggest challenge and most critical success factor in reengineering projects is persuading the people within the organization to cooperate. This task becomes much more difficult when the major players have a tradition of high independence,are often confrontational to management, and are irreplaceable independent contractors. CIO's in major health care organizations face exactly this situation; further complicated by the fact that the reengineering effort is crucial to the continued existence of the organization. The current health care environment is transforming from a cottage industry made up of specialized craftsmen, into a more industrialized model requiring reporting standards and statistical outcomes for quality and cost improvements. Collaboration with these artisans, call them "doctors," entrepreneurs who prided themselves on their individuality, presents a formidable challenge in the development of new organizational information systems. This paper addresses the changing health care climate and the collaborative efforts by a number people in establishing a working environment for the implementation of a physician-driven clinical information system