Some are closer than others and offer bits and pieces. They may largely have the technical and workflow issues but not be CCHIT-certified. Hard to convince a doc to spend even $10k if there is no cash from ARRA coming and they are going to be hard pressed in the future to deal with any real shift in payments schemes with the EHR they adopt. Plus integrating it with their existing PM system can be very problematic.

There are some very nice offerings that are Web-based & remotely hosted and have much cheaper upfront costs than a client-server solution. Still, this model has some severe limitations too including actual larger costs to a practice over a 5-year period in most cases, serious security and privacy concerns (wait until the inevitable larger first breach of a hosted-EMR solution and watch for the failout effect), and ultimately leaving the physician at the whim of the vendor. If I am a physician who is in a smaller practice and independent, I don’t want anyone else controlling 100% of my data because the reality is that transferring to another EMR vendor is almost impossible at this point and its my livelihood.

Maybe their will be a solution that really breaks down the walls in the 1-3 physician segment space but we aren’t there yet.

Frankly, there are two areas that I am really interested in right now in health IT: RCM companies that deal with collecting payment at point of care (we are likely going to a much higher preponderance of higher-deductible health care plans whether or not we get a reform bill passed and collecting at the point of care is going to becoming increasingly important even in the ambulatory world) and BI companies that either already have a solution in the market right now that is revenue-based and having solutions going ahead forward that will be able to better readily marry financial and clinical data. VC money has been pouring into this area and you already see the VC guys hedging their bets accordingly on the HIT stimulus. Some smart fellows will find interesting ways to combine the data and everything points to a world where we are moving to more truly episodic care and efficiency built in.

As for the Health IT money get rescinded, that is next to no shot right now and it becomes maybe a slight reality if the Republicans actually take back control of the Senate & House in the 2010 mid-term elections. They likely win back a bunch of seats in Congress they lost in ’06 and ’08 but they won’t regain both in 2010. More in 2013 if you see a Republican president who gets elected and tries to sweep away/underdo some of what Obama did with healthcare during his term.