As providers ready for meaningful use Stage 2 attestation and policymakers start designing Stage 3, CMS announced that the Medicare and Medicaid EHR incentive programs have paid out just shy of $17 billion to spur adoption thus far.

As of the end of October, more than 430,000 eligible hospitals and professionals have achieved meaningful use, with 93 percent of eligible hospitals and 80 percent of eligible professionals registered for the program.

[See also: Stage 2 changes may be rude awakening]

More than 236,000 Medicare-eligible physicians and 139,000 Medicaid-eligible physicians have attested so far, along with more than 4,600 or 85 percent of all eligible hospitals.

The incentive program "has allowed 1,000 flowers to bloom," those being EHR companies, said Rob Tagalicod, director of CMS’s eHealth Standards and Services office, during a meeting of the Health IT Policy Committee.

"The question remains: which of these blooms will be hardy enough to meet the challenges of summer," he asked, referring to Stages 2 and 3.

It's worth asking, Tagalicod said, because "not all providers are satisfied with their current system," and about 30 percent of office-based physicians are poised to change vendors.

[See also: Stage 3 goes for more rigor]

While attesting for meaningful use is the challenge for providers, for HIT companies, the challenge is to offer providers integrated solutions for the new realities in healthcare — interoperable EHR systems that support not just basic digital documentation, but also population health and payment reform.

Indeed, this point in time in the meaningful use program and the winter season is a good time to reflect on the future, said Jacob Reider, MD, the acting national coordinator for health IT.

"I found myself talking about one of my favorite books, 'Tribal Leadership,'" said Reider.

The book considers the culture and behaviors of different organizations, categorized by stages. For stage 1 organizations, "their unifying theme might be 'life sucks,'" Reider said. "Stage 2 might be, 'My life sucks.'"

Stage 3 in the book is, "'I’m great and you're not," he continued. "Lots of academia is this way: They’re individual contributors who don’t operate all that well in teams."

Stage 4 is, "'We’re great.' As a team they recognize we can accomplish extraordinary things." Stage 5, meanwhile, is, "'Life is great.'" They "can see the pinnacle of what we’re trying to achieve," Reider said, "but they need to work together to get there and function."

While there are more stages in "Tribal Leadership" than the meaningful use program, the analogy holds because many different sectors of the healthcare delivery continuum, some of them competitors, are working together.

"This group continues to be the guiding light for this industry," especially as the HIT Policy Committee works on Stage 3 "to make it less prescriptive and focus on outcomes, so providers aren’t struggling so much," Reider said.