The HITECH Act, part of the American Recovery and Reinvestment Act, is unclear on the development of health information exchanges, and the deadlines attached to incentives have been reported all over the map.

Regardless, John Halamka, MD, CIO of Harvard Medical School and the CareGroup Health System, sounded the battle cry to a packed room Tuesday morning: "Implement now."

Unless the health information exchange is up and running and providing meaningful use, the money won't be there, he told attendees at a HIMSS09 session titled "Achieving Health Information Interoperability by Leveraging Economic Stimulus."

Halamka advised the audience not to consider the grant and loan program as a business model. It should only be applied to start up an HIE, he said.

"Make a value proposition to stakeholders," he said. Cost avoidance was a significant value proposition to MA SHARE, Massachusetts' collaborative regional health information organization, to be willing to pay for the ongoing operational cost.

Mosaica Partners conducted interviews on HIE efforts in various states. Laura Kolkman, Mosaica's president, said the response to whether the funds would make a difference was "overwhelmingly positive."

"The way to predict the future is to shape the future," she said.

Kolkman entreated those interested in HIE activity and funding to plan now, building on existing state foundations such as telemedicine programs, establish private/public partnerships, coordinate with universities and public health departments and support the development of specific programs to help the individual physicians. States should develop a solid approach to managing and auditing how the funds are allocated and spent, she said.

Organizations should look to states for leading practices, she said. A number of states have different models that support their particular communities.

"The time is now to get started doing something," she said. "Our future, quite frankly, depends on us getting this right."