So, the boys and girls at Cerner and McKesson and Allscripts must be having some pretty wild parties...you know, the "don't tell the spouse," break out the bubbly, lampshade-on-the-head kinda blowouts you only see in sitcoms. Or at least they will be soon, if Wall Street is any indication.

In a huge show of confidence, Wall Street has pumped the health IT stock sector up 30 percent over the second quarter of this year, though the market as a whole only inched up 2 percent. That means, in essence, the Street is pretty darned sure that providers like you and your colleagues are going to go straight to the big public EMR companies with their fat stimulus checks.

And that, my friends, is a bit of a bummer. Why? While some of you reading this probably need all of the complexity a high-end enterprise EMR system can bring to bear on your situation, many of you will just end up buying a sack of headaches. You know, top-down vendor management, sky-high consulting fees, much development time, expense and complexity.

Some of you would probably do much better with a smaller, less-expensive vendor like eClinicalWorks that's on the upswing and eager to work with you. You folks can work together, grow together and most importantly, innovate together.

Others would actually have the structure in place to work with an open source EMR like Medsphere's OpenVista and bend it to your liking. Since most all of you are familiar with the pluses and minuses of open source implementation, I won't go into them here, but suffice it to say that the option's on the table.

Then, there's hosted EMRs like Practice Fusion, admittedly a scary prospect for some providers given security and control concerns that come with a web-based product. Still, it's another option that is emerging out there--and may offer an enormous savings for some of you.

I guess what I'm saying here is that unfortunately, Wall Street is probably dead-on this time. That $20 billion in stimulus money is going straight into the pockets of the "safe bet" vendors that everyone on every IT exec's board will love. I guess I just wish it could foster some new ideas too. - Anne