Here is a series of crucial but un-answered questions in the Health IT provisions of the recent American Recovery and Reinvestment Act of 2009:

1. If Health IT training is increased on a large scale, what will be the actual, working system that they train on?
2. How effective can large-scale education and training be when the systems in place in actual practice are very different than training
   ones?

• If privately owned EMR software is an impediment to interoperability, quality, privacy and patient safety, how will federal law remove that impediment?
• In a proprietary EMR world, how will ‘Crossing the Quality Chasm’ be achieved? If the answer is more certification, see 5)
• How are proprietary EMR companies, cartels, and monopolies cost and service efficient?
• What happens when the federal money runs out?
• Beyond software, how will the nation deal with institutional paranoia that is generally against data sharing among fiercely competitive hospitals?
• How does the government explain the Congressional Budget Office report that this expenditure will lose the taxpayer billions over 10 years with no known or even projected break-even point?
• Explain how a mobile workforce deals with multiple, un-alterable and different systems in each location?
• Beyond certification, how will large-scale derivative works, upgrades, innovation and improvement be achieved with proprietary software?
• Why will the taxpayer have to pay multiple times for essentially the same proprietary software? Especially when software that does essentially the same thing is already FOSS licensed?
• How can anyone be sure that privacy and security are safeguarded if 3rd parties are not allowed to review proprietary EMR software in its entirety?
• How can non-superficial, meaningful comparisons be done between different proprietary EMR software? Hint: start with a
  fortune.
• How can anyone be sure that data in proprietary vendor software is valid without being able to examine the source code?
• In a proprietary EMR world, who does the intellectual property of clinical knowledge and workflow really acrue to? The practitioner or
  the EMR company?
• Why is the public going to pay a large amount of money for EMR systems but be forbidden from examining and owning it?
• Other than ‘tough luck’ what do we tell taxpayers, patients, and practitioners who purchased EMR software with federal money that are owned by bankrupt, dead or dying corporations whose ‘code escrow’ assurances are pretty much worthless?