Back from HIMSS 2010. It's hard right now to write "meaningful use" without flinching, even harder to think about it. Never has there been so much talk about something that so little apparently is known about. And that's after 500-plus pages from the federal government and approximately 2,000 HIMSS sessions.

That, incredibly, wasn't the only HIMSS topic. ICD-10 sucked the joy out of every room where it was mentioned, and attendees develop facial tics at the mention of crosswalks. Health Information Exchanges are sprouting up like spring corn. When I lay down Monday night there were about a hundred operational; when I woke up the next morning I heard about at least another thousand. But the one's I got details about have a business model beyond cashing state and federal grant checks.

The Stark Law exceptions are back in play: a lot of hospitals are or plan to quickly ramp up HIEs by subsidizing EHRs and related services for local practices and, more importantly, specialty clinics in their orbit. A few years ago I would have heard that building out was purely altruistic; now I'm being told that HIEs are being built primarily to protect referral business. Something to watch is how quickly these HIEs are expanding. Some CIOs told me they're building big because their competitors are doing the same because HIEs will give them a chance expand beyond their traditional geographic spheres.

Ground-shaking news was in short supply. ONCHIT is breaking up the monopoly in the EHR certification business (click here). In a shocking development, there's a lot Medicare fraud.

Educational sessions: There were a lot of them. Many looped back around to stimulus, which seemed to exact a heavy toll on attendees. Some were great venues to play Tetris on my cell phone. Others demanded attention. During the Financial Systems Symposium, Henry Chao from CMS said the agency has some questions about how HIEs will sort out reimbursements, and how provider financial systems will handle incentive payments. And there was a bit of a CMS punt about where that health plan identifier is. C. Matthew Curtin, founder of Interhack Corp. which does forensic computing, gave an true account of the absolute worse way to handle electronic data during litigation to a packed room. A Bronx health center is using iris scanning technology in a big way. A presentation about how U.S. Bank and Luther Midelfort Mayo Health System partnered to create some cool revenue cycle management apps also went into just how tough that project was.

Also, News Editor Joe Goedert did a great interview with Christopher Clarke from UC-San Diego Medical Center. The medical center came up with some pretty draconian physician documentation requirements. Clarke and other administrators were told they were "evil" and "stupid," but things seem to be working out.

I.T. vendors this year weren't pitching their next-generation, turnkey clinical and financial suites that make you breakfast in the morning and put you to bed at night, and in between put another man on the moon.

Not for lack of bravado, which always is in abundance on the show floor. I get the sense that CIOs and other decision makers, after stumbling away from another stimulus/meaningful use discussion, are effortlessly poking holes in that pitch. That's a pretty EHR, but show me the analytics and quality reporting. Show me the data exchange, show me how the order-entry system links with labs and ORs and EDs. All this stimulus/EHR talk is driving home the point that electronic records now must be the center of a spider web that spreads out across a community and points beyond.

That's the reason why many vendor booths were overflowing--with other vendors. Companies I spoke with said they were inundated with inquiries from other vendors about piecing together packages of EHRs, analytics, hardware, security, infrastructure--real soup-to-nuts suites. It'll be interesting to see how this shakes out, since it seems every vendor, when you shine a harsh stimulus light on them, has holes to fill in their product menu.

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