So here's the thing: we would not want to be alarmists or "drama queens" about issues around meaningful use; after all, the heat-to-light quotient in the MU area is already dangerously high, including here at the HIMSS Conference. But having just spoken with Chuck Christian, the CIO at Good Samaritan Hospital in Vincennes, Ind., David Muntz, CIO at Baylor Health Care System in Dallas, and Scott MacLean, CIO at Newton-Wellesley Hospital in Newton, Mass., we're deeply worried.

What remains fogged in confusion right now is a complex set of issues around certification of EHR systems under meaningful use. The way that Christian and Muntz, who are members of a high-level policy committee from the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) understand it, if Hospital A has, for example, a standalone system from Vendor X, but its core clinical system is from Vendor Y, the CIO (and his colleagues) at Hospital A have only a couple of choices: either rip out Vendor X's ED system; or buy the entire set of licenses from Vendor Y (and keep updating its ED component, even while not truly using it), and attest to MU using the Vendor Y umbrella, while also doing so for Vendor X's ED, and while also, it appears likely, having to seek "site certification" from ONC for the entirety of what they're doing.

The implications of this reality, if they turn out to be legitimate, are massive. And here's the real headache: in recent meetings and in meetings this week at the HIMSS Conference with David Blumenthal, M.D., Kathleen Sibelius, and other ONC and CMS/HHS senior authorities, none of this has been clarified. Indeed, ONC appears to be inadvertently sending out mixed messages to industry leaders about what the real situation is and how ONC might resolve it.

Let's put it this way: at least 80 percent of hospital organizations could be in danger of making really devastating strategic or tactical choices quite soon if the ambiguity and confusion around this issue, which we'll call the "umbrella/modular confusion," are not clarified—very soon. And let's put it bluntly, and this way: if industry titans like Chuck Christian (CHIME's current John E. Gall CIO of the Year) and David Muntz are unclear about an issue, then the industry is unclear about it. And in this case, the implications are so massive that the situation calls out for immediate clarification.

Healthcare Informatics will continue to monitor and report on this situation as new developments occur.