It was the best of times, and the worst of times. Well, perhaps not the worst, but a time to pause and reflect on the power and the money. Thus I turn to a Tale of Two Cities.
 
As I depart Chicago and the 47th annual conference of the Healthcare Information and Management Systems Society, I recall two different meeting-experiences: the convention floor, with its mood of upbeat urgency, brightly colored booths and activity; and the education sessions and hallway conversations that featured pragmatic, real-world challenges.
 
ARRA, the American Recovery and Reinvestment Act of 2009, with its $19+ billion worth of health information technology funding, concentrated the collective vendor-minds on sales opportunities. Urgency is the message: buy sooner rather than later to meet the deadline, and muddle through the uncertainty of what constitutes “meaningful use.”
 
In the hallways, I spoke with many hospital CIOs, CEOs and Clinicians (the ‘Cs’) about their mood and take on ARRA and what they’ve tried to accomplish at HIMSS 2009. Most “C’s” believe they’re taking on big financial risks in the current economic environment, coupled with their current state of understanding the finer points of the HITECH funding.
 
One CIO of a mid-size hospital in the deep south told me that her operating margins were nil, Medicare was 60% of her payer mix, and while her institution has a well-oiled inpatient HIT infrastructure, she’s at the beginning of the ambulatory HIT/EHR journey. She’s facing a huge up-front cost of adopting the ambulatory EHR, while the ARRA monies wouldn’t be coming her way for months and possibly a year or two after she makes the investment in the IT. She, like other C’s, sees this investment as being fraught with high risk. Furthermore, she remains unconvinced that there will be much of an ROI anytime on that investment.
 
I heard similar concerns from many C’s. Those who might have a more positive operating margin (although none boasts a rich fiscal profile these days) have concerns about “how to” process issues: how to herd the clinical cats around the project, how to develop the trust to cooperate in communities with other institutions and stakeholders in local/regional health information exchanges, and how to evaluate vendors to get to the right partner for this journey.
 
These tales together mean that vendors from the Sunny Side of the HIT Street need to establish New Rules of Engagement with buyers: new partnership models, new financing models, and new kinds of products and approaches built on open systems.
 
Health Populi’s Hot Points: Based on the tales of these two cities, it will behoove the HIT industry to re-balance the conversation away from the go-go mood of HITECH funding toward a pragmatic approach to moving ahead. First and foremost, there is no need for rushing into purchasing a single seat at the EHR table until definitions get clarified and certification issues get straightened out. A meeting this week convening CCHIT leadership and Open Source proponents got interesting; certification issues aren’t yet clear, and this is a key component of moving ahead.
 
So exhaling after HIMSS and reframing our conversations around HITECH stimulus and the real goals of HIT adoption shape the rational way forward. More listening to DHHS, ONC, and other crucial voices will help us get to clear knowledge and understanding of the practical steps that lay ahead. This will benefit all parties in the HITECH dance. Turning to Dickens, let’s make this an Age of Wisdom and not Foolishness.

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