My apologies to Mr. Dickens, but he really did have a great title.  This little posting is about two cities, two different cities.  Actually, two contrasting reflections prompted by two cities.

It is now a week or so since I returned from the annual HIMSS conference in snowy Atlanta (Yes, it was colder in Atlanta than my home of Denver.  Not what the Chamber of Commerce ordered).  If you don't know HIMSS, it is the big healthcare IT conference.  Along with almost 30,000 of my closest friends, I wandered the exhibit hall, listened to educational sessions and key note addresses, and had serious, furrowed brow conversations over coffee (which required standing in line for 20 minutes, providing evidence of America's real drug problem, but that is another matter) about HITECH and meaningful use and vendor certification and getting physicians to adopt technology and other big topics.

Now that I have had a chance to reflect on the experience, a few thoughts stand out, though in no particular order...

The mood at HIMSS was upbeat and buzzing, very different from a year ago.  Funny what several billion federal dollars  being pumped into your industry will do for the collective mood.  I used my best sales skills and wormed my way into the client event of one big vendor that rented out the new Georgia Aquarium, had food and an open bar, and the entertainment was a concert by Grammy winner Colbie Caillat (if you don't know who she is, ask your kids).    That kind of party is Exhibit A that things are good in healthcare IT (HIT).  Happy cab drivers and full restaurants were further proof that, at least for a few days, this group would ask, 'Recession?  What recession?'

Everything at this conference was about the HITECH Act and the boat loads of stimulus monies that are available to hospitals and physicians who implement a certified EHR and get to 'meaningful use.'  Vendors see this as a once in a lifetime land grab where healthcare will go from relatively un-automated, or at least un-connected, to highly automated and highly connected over the next ten years.    Physicians and hospitals are going to be buying systems, most for the first time.  They'll never get a chance to sell into such fertile ground as this. 

People who know these things are projecting the HIT market will grow 18% in 2010.  A lot of industries would be happy  to stick a decimal point in there and get even 1.8% growth this year.  

The Feds may have gotten this right.  They are offering a lot of money to providers to motivate them to get to clinical systems, but the terms of the deal require that you actually use the system, not just install it.  Specifically, they require providers to use the system beyond the four walls of the practice or the hospital.  They have to be able to share data with other organizations, process transactions electronically, use evidence-based best practices, and eventually collaborate on improving patient care. 

This has huge implications. 

Providers will invest in systems, will invest in people to make their system talk to other systems, will invest in stuff yet to be determined to make this all work to do things yet to be determined.

Walking around Atlanta, you would feel stimulated, indeed.  Overly so at times from the cacophony of the show floor, but a nap would cure that.  Economically, I have not seen that much energy in the past two years combined.

And the stimulus is not just about driving commissions for software sales reps.  The vision of an interconnected healthcare system that uses data to manage care more scientifically is truly transformational.  The Feds are giving this thing a giant multi-billion dollar push and counting on the momentum to carry us to a fundamentally different healthcare system. 

To the faithful gathered at HIMSS, sellers and buyers alike, that vision had an air of inevitability just as Sherman's march to Atlanta had a century and a half ago.  Let's just hope there is not as much devastation left in the path along the way.

Since I have now introduced a twisted Civil War metaphor here, it is probably worth noting that the journey to this grand vision will have people splitting into opposing camps again as well.  Just yesterday I spoke to a group of small practice administrators, giving them an overview of the HITECH Act and what is required to achieve 'meaningful use' and collect some of this free money.  I'll come back and address their thoughts in a future post, but let's just say they were not buying the happy talk of the HIMSS crowd.  The reaction was more along the lines of 'Who was the idiot who thought this was a good idea?'  Granted, there was no open bar or any of the cool give-aways with vendor logos emblazoned on the side at my meeting yesterday, so maybe that is why they were not quite as excited.

But let's not let the reaction of that group bring us down. 

The good news of life in the industry, the excitement of change and innovation, and the expectancy of newly signed deals was palpable in Atlanta. 

More than just commercial testosterone was a real sense that the market, physicians and hospitals working with technology vendors, could really help solve this giant problem; that the solutions being discussed really could help lower costs and improve quality.  It was the American spirit at its best.

That was one city.

Then when I retreated to my hotel room to get out of the uncomfortable shoes and check some email, I'd turn on the TV to catch the news, news that was dominated by either a killer whale gone bad (Isn't that redundant?) or the seemingly eternal healthcare debate in Washington. 

And the feeling could not have been more different.

I don't need to add one more rant about how tired and frustrated we all are with Washington.  Insert your own opinion here.

However, as I compared the energy of Atlanta, when a hospital executive or physician listened to a vendor talk about how their product or service could help solve their specific problem, versus the debates about vote counts and reconciliation and CBO cost scoring, I could not help but agree with Dickens.

It was the best of times, it was the worst of times.