With rosy prognostications , encouragement from Leapfrog , the support of our Fearless Leader, and leading healthcare organizations pledging billions for Healthcare IT, the universal adoption of electronic medical records and CPOE seems like a done deal.

But debt and pressures on reimbursement margins could derail even the best-intentioned efforts. Baptist Health System Inc. is pulling the plug on its multimillion-dollar effort to install Siemens Medical Solutions Health Services Corp.’s Soarian software throughout its hospitals in favor of maintaining its 1989-era systems (). Hailed by then-CIO Charles Jones as a tool to” provide our clinicians with the best tools…to enhance care delivery and patient safety,” Baptist has since changed direction.

“Given the substantial investment, resource and time commitment required to participate as a Soarian early adopter, BHS … has decided to halt implementation of Soarian.”

As Sutter announces ambitious plans to spend over $1 billion on IT systems, one wonders if it will be willing to make cuts elsewhere to maintain its plans in the face of reduced reimbursement from CalPers to maintain its decade-long IT vision.

The ever-reasonable Dr. Donald Berwick, president and CEO of the not-for-profit Institute for Healthcare Improvement, calls for the government to provide web-based, downloadable (and inexpensive) IT systems to overcome the high initial capital costs of the technology and cultural change barriers to the adoption of complex integrated systems:

“Berwick called for information standards for coding systems and interoperability among these systems. As a separate effort, the government should sponsor an electronic medical record…that anyone could download online… The record could act as a foundation if users wanted to build more expensive proprietary systems. He likened the free EMR model to the creation of the Internet, which was developed by the government and “essentially given to the public.”

With the present healthcare IT funding proposal not expected to have much of an impact on adoption, perhaps $100 m toward Berwick’s proposal would be better spent!

There’s a long article from CNET about the problems that WebMD is facing:

While the true scope of WebMD’s “lost” or HIPAA non-compliant claims is hard to ascertain from this article, it appears that payers, providers and the AMA are taking the opportunity to shake down the company for more “hand” in negotiating rates on clearinghouse services:

According to Eric G. Brown, vice president and health care analyst at Forrester Research, “WebMD’s problems with customers seem to stem more from attitude–the arrogance of a dominant player–than from technology failures. “They’re perceived as the Microsoft of the health care sector.”

Kimberly Grose, vice president of network services and operations for Harvard Pilgrim, based in Wellesley, Mass. adds that “Thirty-five cents may not seem like much, but it adds up quickly for Harvard Pilgrim because it handles 19 million transactions annually.”

All of this portends bad news for WebMD’s Envoy business:

Forty-eight percent of the plans already exchange claims directly with at least some providers.

“While large providers and payers can bypass middlemen, Envoy is becoming a clearinghouse ‘for leftover claims’ from small providers that don’t want to be bothered by the effort of setting up direct connectivity with hundreds of payers, said Sean Wieland, a research analyst with W.R. Hambrecht.”

At least WebMD has its online content business to drive profitability… right?