Stressing the benefits of early action – and illustrating just how much farther ahead in adoption Massachusetts is than many other parts of the country – two significant local users of healthcare IT  offered insights from their experiences in Boston on Tuesday.

Speaking at the Healthcare Stimulus Exchange Roadshow, John Halamka, CIO of both Beth Israel Deaconess Medical Center and Harvard Business School, and the chairman of the New England Health Exchange Network (NEHEN), and David Bates, chief of general internal medicine and the medical director for clinical and quality analysis at Partners HealthCare and Brigham and Women's Hospital, each spoke about their organizations' use of healthcare IT and and efforts to meet meaningful use requirements.

Bates opined that the entire country is on the cusp of a "major transformation of the healthcare information technology landscape." From his own perspective, he said he expected Partners to do well on that "ascension path," and indicated that Massachusetts at large was similarly well-postioned. For some other states and localities, however, he predicted that "it will be a challenge…. we're only in the position we're in because we started early."

Halamka, who professed a "a great sense of optimism" for the country, and a confidence that the billions of dollars in grants disbursed by the ONC "will be spent not only quickly, but wisely," highlighted some of the Bay State's bona fides.

He noted that, in surveying "all the zip code of  Greater Boston," one finds that the penetration of EHRs that are live and in production is 76 percent – that's compared with just 12 percent nationally.

"As a Beacon Community," Halamka said, "we are really quite advanced."

Halamka said that Beth Israel Deaconess has been using CPOEs since 2001, and that "we really don't have any handwritten orders on the patient side any longer, except in some very esoteric corners." The hospital is "also good on e-prescribing," he said, noting that 95 percent of hospitals in Massachusetts could say the same.

But for all the significant strides made in the Longwood Medical Area and beyond, Halamka recognized that many other hospitals nationwide are "just now in the thick of this, and it's going to be a struggle for some."

He cited some onerous and/or ill-defined mandates of meaningful use – for example the patient engagement requirement that called for engagement "via that patient's preference."

What, Halamka wondered, "if that meant Twitter, Facebook, smoke signals, or Morse Code?" (He noted that Beth Israel Deaconess outsources to a company, sending them data which is then communicated to patients via PHR, telephone call, etc.)

Other huge challenges remained, he said, for meeting meaningful use requirements. By way of example, Halamka imagined a patient who demanded: "I have a 4,000 page chart, I've been coming here since 1947, and you have 48 hours to give me an electronic copy."

Would simply offering an abstract of past care be enough? That would be doable, Halamka said. But if the patient is requesting "handwritten progress notes from the '50s, that's going to be pretty hard to put into an electronic form."

Of course, perhaps the most important meaningful use mandates have to do with security. "There needs to be risk assessments done throughout all our organizations to make sure we're protecting this data," Halamka said. "We share so much data, we need to make sure we're doing it in a bullet-proof fashion that protects confidentiality."

For more information about the Healthcare Stimulus Exchange, visit www.healthstimulusx.com.