The health IT stars showed up in Washington to share their delight at having a $19 billion grubstake provided for them in the stimulus legislation passed in February.

Although they gathered for the release of an issue of the journal Health Affairs devoted to health IT, they also were there to celebrate the opportunity just created by Congress.

"It is the beginning of a new era," said Neal Patterson, chairman and chief executive officer of Cerner Corp., a large provider of health IT systems. He compared the situation to the land rush that opened up his birth state of Oklahoma for settlement by farmers and ranchers.

"It's the land rush and the gold rush and the GI Bill of Rights all rolled into one," said Dr. Mark Smith, president and CEO of the California HealthCare Foundation.

"It is now a given that implementation is going to happen," said Dr. Jon White, director of the Health IT Portfolio at the Agency for Healthcare Research and Quality.

Health IT pioneers from organizations such as Kaiser Permanente, the Geisinger Health System, the New York City Department of Health and the Dossia Consortium shared their stories and dispensed lessons learned during their presentations.

But speakers also issued caveats and warnings even as they looked forward to a period of unprecedented progress for health IT.

"Health information exchange will not occur through standards and certification alone," said Dr. Farzad Mostashari, who directs the Primary Care Information Project in New York City. That project has installed e"health records in the offices of more than 1,000 physicians in low-income areas of the city.

He said most doctors need substantial assistance in installing their systems and learning to use them. "There is not enough money in the stimulus bill to get it done," Mostashari said.

Cerner's Patterson said nationwide exchange of health care records can't occur without giving patients unique identification numbers, something Congress has forbidden the federal government to do. "We have to have a systematic way of knowing it's the right person" whose records are being sent from one health care provider to another," he said.

On the other hand, widespread implementation of EHRs will pave the way for the nation to save $500 billion a year, Patterson said. That is one of the largest estimates analysts have produced to date.

Dr. Robert Kolodner, national coordinator of health IT, warned that the $19 billion could be frittered away on health IT projects that do little to improve health care. "We have to make sure it doesn't just disappear," he said.

Lawmakers and taxpayers will demand accountability, predicted Dr. Carol Diamond, managing director of the Markle Foundation's health program. She said they will want to see what they are getting in return for their investment.