Farzad Mostashari's predictions for 2012 naturally accentuate the positive: 100,000 providers receiving Meaningful Use payments, health information exchanges (HIEs) spreading, providers seeing how health IT is connected to payment reform, and consumer e-health tools increasing patient engagement. One would expect no less from the National Coordinator for Health IT. But outside observers take a more nuanced view of the future.

For example, in support of his assertion that 100,000 providers will have gotten incentive payments by the end of this year, Mostashari cites the rapid rise of electronic prescribing among physicians and a survey showing two-thirds of hospital executives are committed to achieving Meaningful Use. There are other positive signs, such as recent data from the Medical Group Management Association indicating that most physicians either have electronic health record (EHR) systems or are planning to implement them.

John Moore, a health IT consultant and founder of Chilmark Research, told InformationWeek Healthcare that it's "unreasonable" to suppose that 100,000 private-practice physicians will attest to Meaningful Use through 2012. But if the physicians employed by hospital systems are included, he noted, that goal might be achieved. He also thinks most hospitals will try to show Meaningful Use of their own EHRs, partly to avoid penalties later on.

Vince Ciotti, a hospital IT consultant who is a principal in HIS Professionals, says that the government is "buying the participation" of doctors, although many don't believe in the value of EHRs. Similarly, he says, hospitals are rushing to get the Meaningful Use dollars, despite their lack of readiness. "Four million dollars for a hospital is a fortune; in a 100-bed community hospital, it's life or death. And if facilities don't qualify for Meaningful Use, they will lose a percentage of Medicare funds, which would sink a lot of hospitals."

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One problem, he said, is that many institutions and practices haven’t assured the security of EHR data, as they're required to. When government auditors spot that, he said, some providers will have to give back a portion of their incentive money. Also, he noted, computerized physician order entry (CPOE) continues to be a major challenge for many healthcare systems, because physicians are reluctant to use it.

Ciotti and Moore agreed that EHR sales will plateau this year, because most providers who aim to qualify for incentives have already acquired or upgraded their systems. In 2010 and 2011, Ciotti said, his firm did twice the number of system selections for hospitals that it normally did; but this year, business has been off. He hopes the release of stage 2 Meaningful Use criteria will help turn that around.

Mostashari was also bullish on health information exchange. "With the foundation we have built in Stage 1 [of Meaningful Use], increasingly rigorous health information exchange requirements in Stage 2 and payment reform as a constant drumbeat, I think exchange will take off in 2012," he said in his blog post.

But neither consultant interviewed by InformationWeek Healthcare believed that public HIEs would overcome their chief barrier: the lack of a business model. "We work with the Vermont and Bronx HIEs, and their big challenge is ongoing funding," Ciotti said. "The initial grants from the government set them up, but when the hospitals get six-figure bills to exchange CCDs [clinical summaries], their eyes pop. And the challenge is that there are no Meaningful Use funds for an HIE. It's pure economics with HIEs: who's going to fund them?"

Although Mostashari mentioned the growing amount of information exchange using the Direct Project protocols, Moore pointed out, "That's just secure e-mail with an attachment. It's not really HIE, or a true exchange of codified data."

Mostashari also stressed the progress that is being made to increase consumer engagement via e-health technologies such as patient portals and personal health records (PHRs). Moore noted that patient portals have caught on in a few big organizations such as Kaiser Permanente and Group Health Cooperative. But PHRs need to become easier for both patients and providers to use, he said. "I think consumers will use them if they have a reason to use them. When we get providers actively encouraging patients to use PHRs, that's when we'll see a sea change."

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