I could not sleep last night. Not because news has been strange lately such as a real-life Weekend at Bernie’s but because of the Health Information Technology version of Brewster’s Millions. Specifically that the tidal wave of ARRA health IT money is hitting.

Privately some of these large grant awardees confide that they have structural concerns about successfully completing the goals and missions assigned, especially in the time-frames required. In the absence of direct and explicit taxpayer funding of open source EHR software, as well as no explicit exclusion of funding for proprietary EHR software, the goals and missions of Regional Extension Centers(RECs) and training programs go from ‘difficult but somewhat possible’ to merely cheer leading and extended sales force for proprietary EHR software companies. Meaningful roles and sustainability is a fantasy for RECs and training programs with proprietary EHR software.

There is a real possibility and a likely political calculus that these public goods type organizations such as RECs and training programs are structurally set to fail or claim a type of illusory ‘success’. Proprietary EHR companies will be all too happy to point to such failures as proof that they can get the job done.

With proprietary EHR software, it can all be boiled down to one question: How can allowing taxpayer funding of more opacity (proprietary licensed EHR’s) and not directly funding more transparency (open source licensed EHR’s) in a health care system be a good thing?

Health information technology is complex and it takes a great deal of time to structure and re-structure local work flows and train staff for even one entity, let alone an entire country. To complete such a task in 2-3 years on a large scale is extraordinarily difficult with potentially deleterious, long-lasting and un-wanted side effects. Especially when proprietary EHR software is allowed to be funded and questions of long term cost and sustainability are un-examined.

Some, many, or most of these funded training programs, proprietary EHR’s, and enormous grants may become ‘exploding offers’. Especially in the brief super-nova like time frame in which they are funded. Similar to the stories of lottery winners that many years later are worse off than before they won millions. The history of CHIN’s–>RHIO’s and now HITRECs are a warning.

One hopes that this taxpayer funded largess and Brewster’s Millions-like environment does not become Weekend at Bernie’s. See you at the movies.