First, a bit of transparency: I believe in universal health coverage and don't think the word "socialized," as in socialized medicine, is a four-letter word. How exactly the nation should roll out that universal coverage--without creating a bureaucratic nightmare or bankrupting the country--is beyond my expertise, but in principle it's the right direction.

So in my mind, the U.S. Supreme Court's 5-4 decision to uphold the Affordable Care Act is a step in the right direction inasmuch as it gives most Americans access to sorely needed medical care.

In case you haven't already heard, the Court decided that the law's individual mandate requiring the purchase of health insurance is constitutional, not under the Commerce Clause of the U.S. Constitution, but under the authority granted to Congress to impose taxes on the American people. (The individual mandate compels anyone not covered by his or her employer or by a public insurance program such as Medicare to buy a private insurance policy or pay a penalty, with some exceptions.)

Putting politics and ideology aside, the more pressing issue for healthcare IT managers now is this: How will this decision impact our strategic plans and current initiatives?

[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]

No doubt, IT leaders will have their hands full as each state sets up its own health insurance exchange (HIX). Boston.com provides a useful breakdown of the progress each of the 50 states is making.

California, for instance, has more than 7 million uninsured residents who will need to enroll in an exchange. California is already ahead of other states in offering coverage. As Boston.com explains, "California has worked to be a model for the health care law and has begun implementing parts of it already, including creating the beginnings of health care exchanges to provide consumers a marketplace to purchase insurance policies starting in 2014."

The climate in Florida is much chillier. Despite its 3.85 million uninsured residents, Republican Gov. Rick Scott has refused federal money to implement the ACA law. Florida has its own HIXs, which cover small businesses, but they don't have an individual mandate provision.

As far as the effect that the Supreme Court's decision will have on hospital IT departments, a statement by the American Hospital Association's president, Rich Umbdenstock, offers some clues as to the extra workload ahead. "The decision means that hospitals now have much-needed clarity to continue on their path toward transformation," says Umbdenstock, who then warns that "transforming the delivery of health care will take much more than the strike of a gavel or stroke of a pen. It calls for the entire health care community to continue to work together, along with patients and purchasers, to implement better-coordinated, high-quality care."

The toughest nut for IT managers to help crack is the "better-coordinated, high-quality care" part. Over the last few years, we've seen the push toward better care coordination, as evidenced in the accountable care movement and Meaningful Use rules. But getting hospitals, medical practices, nursing homes, rehab centers, home health agencies, and other post-acute care providers to play nicely together remains a gigantic hurdle.

The other hurdle facing health IT leaders is the mandate to prove beyond a reasonable doubt that all of the systems they're putting in place will actually improve clinical outcomes while reducing costs. We're talking here about much more robust EHRs, patient portals, CPOEs, personal health records, and health information exchanges, which is another way of saying CIOs and CMIOs will be getting even less sleep than they do now.

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