This paper discusses a strategic planning process of a small Canadian hospital necessitated by the continual shortage of physicians and nurses; increasing budget deficit and uncertain financial future; change in community health needs; and the shift towards a regional governance model with emphasis on quality, accountability, and outcomes. Based on the hospital’s documents and interviews with the senior management, we find that the hospital is moving toward a model of integrated health information system in collaboration with other hospitals in the region for quality decision making and resource sharing. This paper discusses technical and organizational issues that are likely to arise in and exert influence on the adoption of such a system in the future.