As I reflect on the marathon walk through the Orange County Convention Center at HIMSS in Orlando yesterday and my many conversations with vendors, analysts, financiers, and reporters, the results of the 19th Annual HIMSS survey of hospital CIOs ring like a bothersome case of tinnitus in my mind.

This is in the context of reading the latest issue of Wired, featuring an important story by Chris Anderson on the impact of “free” on business.

While CIOs say that quality, safety, and implementation of an electronic medical record at the 3 priorities for IT spending in 2008, it’s not clear there will be a whole lot more spending going on. A panel of representatives met with the health IT press in the morning to talk with us about the implications of the survey findings — which were heavily focused on security issues as Cisco was the study sponsor. Fair enough — security and privacy are top-of-mind when we use the words “health” and “information” in the same sentence [just Google on, um, “Google” and “Health Information” and “Cleveland Clinic” today and see hundreds of news columns and blog posts with “privacy” in their titles].

In this survey of about 300 CIOs representing 700 hospitals, there was no HIT line item which forecasted increased spending: for each and every category, there seems to be a kind of ratcheting back in IT investments, although overall CIOs say they plan to increase spending.

How to reconcile this? Steve Lieber, President and CEO of HIMSS, explains that while this seems confounding, it may indicate that health IT is entering a maturing phase in the market. There is less hype on the exhibition floor, he believes.

To Lieber’s point, hospitals have made major IT investments in the past decade. Now, it’s a time for tying together, for “unified communications” spending — which is a new category included in the HIMSS survey looking to future IT priorities. This spending is especially important as hospitals look outside of the institutional environment to link up with clinicians and other remote sites. Lieber referred to this as “knitting together and getting more out of what you have.” In fact, this is the business of a growing number of vendors at HIMSS this year. As an executive from BearingPoint, one of the firms in this space, told me, “It’s not about the system; it’s about people and processes.”

Furthermore, CIOs talk about spending to create “new revenue sources.” This speaks to the need to bond more with patients, perhaps through electronic records access, patient health information, and similar consumer-targeted applications.

Health Populi’s Hot Points: While Lieber talked about health IT being “at a more realistic stage” and in a “different era than earlier in the millenium,” I heard Jonathan Bush of athenahealth fame claim the exhibition floor of HIMSS is still a “boat show” (this, at the Mr HISTalk party, which will go down in HIMSS cocktail party history as the outside-of-the-convention-center event of the annual conference). athenahealth is disrupting the Old School HIMSS players’ business models. So what of “free inside?”

Anderson writes in Wired about King Gillette, the razor king. You know the story: give away the razor, make $ on the blades.

So Microsoft told me yesteday how they launched a new strategy for expanding interoperability, which is explained in this press release. In short, they are sharing code and protocols that have been only available through licenses. In a word, they’re making stuff free.

Think about this–it’s not about the technology: it’s about how you knit it together, how you use it. That’s the added value.