Some of us have now had a moment or two to read parts of the stimulus bill. One of the many stimuli included is the HITECH act, a $19 billion electronic health records funding provision.  This sort of action by the federales was long promised by Obama on the campaign trail: spending federal dollars to jump-start the leveraging of technology in order to improve health care quality at lower cost.  Setting aside the question of whether this piece of the bill will stimulate anything in time to help the economy (it won't), the question of the moment is whether this will be money well spent. 

On the one hand, it's designed to subsidize EHR adoption by physician practices and hospitals that otherwise might not be able to afford them (to the tune of up to $40K per doc).  To the extent that we believe that EHR adoption will promote efficiencies in excess of their costs (and yes, you do detect a note of healthy skepticism), that's a good thing.  On the other hand, it will almost certainly result in further entrenchment of current market leaders, to the possible detriment of providers and patients who do not necessarily need the high-cost offerings now on the market that are characterized by some observers as having limited "data liquidity" — which, if we're looking for interoperability, is a key thing to have.  Consider, for example, John Moore's excellent summary and analysis of the HITECH provisions on his Chilmark Research blog.  He notes that CCHIT certification is cued up to become the de facto template for EHR standards under the new law, and makes a convincing case for why that's not a great idea.  To argue the other side for a moment: if any standard is a couple of years out of date by the time it's adopted, does that mean we should have no standards?  I would think that the nature of the standard needs to be adjusted so that the standards themselves are less technology-specific and more function-centered.  Without some basic standards, we'll be out in the Wild West and interoperability will be a distant dream.

That said, I think John would agree that the standards finally adopted ought to allow for a variety of approaches: full-blown enterprise EHR systems, more compact offerings, and SaaS options as well.  Setting the standards shouldn't result in the ossification of the current selection of offerings out there.

There's an awful lot of money on the table.  Let's hope that it can be spent wisely, on a variety of approaches to an intractable problem: the wiring of this country's health care providers for the benefit of their patients and the collective fisc.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting