Along with good solutions through problem solving and a computer savvy user-base; systems and technology must be top-quality in an organization that is highly effective with IT. Usually in these organizations, you will find leadership committed to providing the best tools possible, regardless of whether or not the tools are computer-related, so people can have the best opportunity to do great work.
Systems must perform reliably, and features and functionality must be rich and ever-improving in organizations that do well with technology. These organizations are always striving to put the best systems in front of their users. They succeed every time financially possible, which is pretty often because systems-related projects compete for capital very well in organizations that are good with technology. The existence of top-quality systems and technology is as much an effect of all the other elements in the "wheel" as it is a part of it.
Considering the necessity of other elements in the "wheel" to ensure effective use of technology, steps can be taken without having the best systems. Organizations that are good with technology do not let a less-than-best-in-class system they own stop progress with information technology. In fact, the absence of the other elements of the "wheel" could make the purchase of technology a waste, and it is a lot cheaper to get everything else in place first.
While the presence of systems that are recognized as "best in class" can be considered one of the hallmarks of an organization that is highly effective with technology. They are also the hallmark of an organization with a lot of money. Time — the ultimate constrained resource — and money will preclude organizations from having the best systems in all areas all the time. There wouldn't be six elements in my "wheel" if great systems were all an organization needed in order to be highly effective with IT. Many positive steps can be taken without the best systems, and an organization can do well with IT, even running systems with less than the best features and functionality.
An organization that is highly effective with technology always gets a lot of value out of systems replacements. The best with IT never take a step sideways with a systems purchase; they take a big step forward. When a system cannot be replaced, due to time or money, the best get the most out of its current systems and attain a clear and shared understanding of strengths and weaknesses. Organizations that are highly effective with technology know how and where to use "workarounds" acceptably and know when to get "all hands-on" deck because an issue has been identified that could lead to a patient safety concern. The best are able to get a lot of good out of systems that don't do a lot to enhance workflow on their own.
What a system cannot do is have failures. It can't have bugs. It can't drop the wireless network. It can't have problems with some middleware or other PC problem.
For example, it is part of the "nursing brain" to deal with less than optimal situations. As a group, these are some of the most capable and adaptable people you'll encounter. A system that takes five clicks to do something that should take two is something Nurses can handle quite readily on the way to a better system. On the other hand, a system that drops them half-the-time in the midst of those five clicks is unacceptable in the context of patient safety and is an unacceptable level of service to users. A system might not have the best features and functionality, but it has to perform solidly.
When able to acquire technology, organizations that are good with technology do not buy or create second tier stuff. When the other elements of the "wheel" are present, a lot of good can be done without a "top-notch" system. A great system is not going to do much for an organization without the rest of the elements necessary to be effective anyway, but when it is time to move, the move is towards "best-in-class." For organizations that are highly effective with technology, the move is usually sooner rather than later, or a lot of times, as soon as funding is ready.