It's 8 p.m. and you just arrived at the high school dance. You think you've got all night to ask someone to do the fox trot, so you stand around for a while, have some punch and work up the courage to make a move. But by the time you've detached yourself from the wall, everyone has partnered-up. Maybe when this song stops, you think, a few of the couples will separate and you'll get an opening, but something is strange about this dance, as the couples remain on the floor all night.

What went wrong?

You didn't realize that there was one golden opportunity between 8 p.m. and 8:15 p.m. when you had to find a partner; you didn't realize that, once together, the couples wouldn't separate.

Check your watch. It's 8:10 p.m.

As CIO, you must urge senior management that today's window of opportunity for electronic integration with the area's mega-IPAs (MIPA) is quickly closing. This is not just good for business, or great for healthcare in the community, but a matter of life and death for your organization. If you aren't courting the MIPAs in your area, your competitor health system is, and by the time you ask them to dance, they will be attached to another.

But what about HIEs, you ask? “We'll all soon be able to plug into an HIE-utility hub, so point-to-point integration is a waste of money,” you say.

I don't think so.

Ninety-nine percent of HIEs (formerly RHIOs), have no business model and run out of gas as soon as they run out of taxpayer money. These organizations consume grants like Takeru Kobayashi devours hot dogs at Nathan's, leaving little discernable value in their wake. Don't count on them to solve your ambulatory integration problem.

Many organizations embarked on a sound MIPA strategy when the Stark prohibitions were relaxed. In fact, subsidizing EHR purchases is an excellent way to achieve some stickiness with these practices, while controlling the point of integration. “We'll pay for your EMR (one that we've pre-screened), and you'll give better care! (And oh, by the way, you'll probably refer a heck of a lot more patients to us since you'll be able to see their hospital discharge summaries right in your office system and good stuff like that).”

But then HITECH came along, with its direct incentive payments to the practices, taking the hospitals out of the loop. Some CIOs I spoke with said, “To heck with our Stark plans. Why should we pay for an EMR when they'll get the payment for its use?” This made sense to me for a while, as I worked through the issue in my mind.

But then a strange thing started to happen, some CIOs continued with their Stark plans, despite the HITECH monkey wrench. My initial reaction to this was to blame it on inertia - once the Stark programs were in motion, bureaucracy made them more difficult to stop than it was worth. But I kept hearing it - and thought it couldn't all be attributed to red tape.

Slowly I started to get the picture; despite the cost of subsidizing hundreds or thousands of ambulatory EHR licenses, it's still beneficial for health systems to “lock up the docs,” as I'll call it.

When I covered Wall Street, the buy side, or investment management organizations, held the power (think MIPAs); while the sell side (think hospitals) courted the buy side with every legal enticement imaginable (some of which was only semi-legal). In healthcare, it's the MIPAs that everyone wants to dance with; it's the MIPAs imprimatur that can make or break you.

It's 8:11 p.m. now and everyone is partnering up. Make your move.