"Clearly, the nation would not have made the significant progress toward electronic health records adoption and health information exchange that it has without the Medicare and Medicaid EHR Incentive Program authorized by the HITECH Act," says Hodge. "The public dialogue, open consensus-building process, standards-based approach, and phased implementation provided by the meaningful use process have been critical to bringing the country to achieve the current level of accomplishment and rapidly increasing adoption rates."

Healthcare may have eventually decided to join the 21st century and caught up with other industries in the adoption of information technology of its own accord, he adds. "But in the meantime, quality and access to care would have continued to suffer, and the nation would have continued to pay much more for healthcare than necessary."

The U.S. simply couldn't wait for a "casual, uncoordinated approach to this major national problem," says Hodge.

Almost four years later, however, despite the incontrovertible evidence of increased EHR adoption  -  and report after report showing a robust and highly competitive health IT job market  -  HITECH and the technology it champions have attracted some less than flattering attention. 

A much-discussed Wall Street Journal op-ed from Harvard Medical School's Stephen Soumerai and University of Pennsylvania's Ross Koppel argued this past September that the claim that EHR adoption will lower healthcare costs is "little more than hype" from policymakers and technology vendors.

"The most rigorous studies to date contradict the widely broadcast claims that the national investment in health IT  -  some $1 trillion will be spent, by our estimate  -  will pay off in reducing medical costs. Those studies that do claim savings rarely include the full cost of installation, training and maintenance  -  a large chunk of that trillion dollars  -  for the nation's nearly 6,000 hospitals and more than 600,000 physicians...[By] the time these healthcare providers find out that the promised cost savings are an illusion, it will be too late."

Also in September, a controversial study from the Center for Public Integrity charged that EHRs make it easier for some providers to fraudulently "upcode"  -  billing Medicare for more extensive and expensive patient care than was actually delivered. 

More recently, in October, four Republican Congressmen wrote to Health and Human Services Secretary Kathleen Sebelius, asking her to cease any further incentive payments for Stage 2 meaningful use. They charged that some $10 billion in stimulus money could have gone to waste so far because some Stage 2 rules are "insufficient" or "woefully inadequate," especially when compared with Stage 1.

With the "bar for meaningful use set so low," and "a focus instead on trying to pad participation rates," the GOP representatives urged Sebelius to "change the course of direction" of the stimulus program.

National Coordinator for Health IT Farzad Mostashari, MD, chalked up the kerfuffle to a pre-election "silly season" and expressed confidence in the incentive program.