Given any thought to how the big health IT stimulus package might play out? Well, here's one set of possibilities proposed by reader Dr. Donald Simborg, below. In it, he proposes a choice "a" and a choice "b", one of which is a happy outcome and one of which we'd all hope to avoid:

Scenario #1: (Written from the point of view of three years from now)

"Disillusionment is widespread over the colossal waste of money that has occurred. Billions of dollars have been paid to doctors and hospitals to adopt electronic health systems and the result has been a set-back for the entire industry. Nearly half of the attempts to install new systems have resulted in abandonment of the projects from lack of appropriate preparation for implementation and installation training personnel. A recent study by the Congressional Budget Office has determined that for those installations that have succeeded, CMS costs have risen 30 percent because of increased billings for E&M codes and other procedures.

"The Office of the Inspector General has determined that fraudulent claims have more than doubled. Newly enacted privacy legislation has crippled the interoperable exchange of clinical information for both patient care and research. The newly formed Health Information Technology Policy and Standards Committees are paralyzed by competing special interest members."

Scenario #2: (Also written from the point of view of three years from now)

"Approximately 35 percent of physician practices either have implemented EHRs or are in the process of implementation--a significant step toward achieving the revised goal of having every American have an electronic health record by the year 2020. Although slower and more difficult than originally envisioned in the HITECH legislation of 2009, the focus on achieving new incentives for decision support and streamlining standards for interoperability have already paid dividends in terms of measurable improvements in both quality and costs as determined by two recent studies funded by AHRQ.

"The newly created Center for the Study of Healthcare Effectiveness has overcome both the technical and political problems in aggregating EHR data in a safe and secure manner. The newly formed Health Information Technology Policy and Standards Committees have adopted a stakeholder representation model that requires an appropriate mix of healthcare IT experts as well as consumer advocates and is fully federally funded to avoid special interest influences."