Writing this on Wednesday, June 27, the day before everyone anticipates that the Supreme Court will hand down a ruling on the constitutionality of the Affordable Care Act, one might think there would be greater controversy swirling around here at the AMDIS Physician Symposium, the annual gathering of CMIOs and other medical informaticist executives, sponsored by the Association of Medical Directors of Information Systems (AMDIS), and being held at the Ojai Valley Inn and Spa in Ojai, California.

Certainly, in today’s proceedings, multiple references have been made to the ACA, to healthcare reform concepts more generally, and even to the anticipated Supreme Court ruling. Yet the reality—one that everyone in this ballroom of about x00 people knows—is that the overall cost-quality trajectory of the U.S. healthcare system is unsustainable over time, and that in the face of a healthcare cost explosion that would see Medicare costs alone doubling in the next decade, serious solutions must be found to improve the patient safety and care quality of healthcare delivery, while at the same time finding humane, effective ways to bend the otherwise-inexorable cost curve our society faces as the aging of the population and mind-blowing, ongoing increases in chronic illness move us towards a terrible utilization/cost cliff in the coming years.

So in fact, AMDIS2012 has proven to be what I had expected—a highly valuable, detail-oriented, conclave of some of the smartest, most dedicated clinician executives in healthcare, who are profoundly serious about their responsibility to help lead their colleagues towards the new healthcare.

So even as little controversies have erupted throughout the day, overall, it would be seriously untruthful to imply that a very broad overall consensus did not exist on where things need to go in U.S. healthcare. And even those controversies that have emerged have been relatively minor ones. Take for example, the just-concluded session this afternoon, a panel discussion entitled “Government Regulation of EHR” (pro or con), with David Classen, M.D., Howard Landa, M.D., Christopher Longhurst, M.D., and Michael Shrift, M.D., of CSC, Alameda County Medical Center, Lucile Packard Children’s Hospital at Stanford University, and Allina Health, respectively.

Classen expressed support for the idea of federal regulation of healthcare IT software products (something that the Institute of Medicine had suggested as a positive development back in November), and Longhurst spoke ardently against that proposition, quoting extensively the article that he and Landa had published in the British Medical Journal in February on the topic, stating specifically that “The concept of the FDA regulating health IT is tremendously scary” (the IOM had suggested that an entirely new federal agency be created to carry out that role). As Longhurst noted, his and Landa’s conclusion after considering the possible models on which such regulation might be based, “Our conclusion was that rigorous and transparent evaluation of the software is crucial, but regulation will stifle innovation.” Longhurst cited the example of blood-banking software, which began in 1994, and which, he noted, “has already led to an exodus of vendors [because] an upgrade of the software requires an FDA approval process.”

The presentations of the four informaticist experts led to a lively debate among attendees and speakers, yet even in that case, there seemed to be a broad consensus that practical solutions need to be found to support IT-leveraged care delivery innovation going forward.

In other words, medical informaticists as a group are realistic healthcare leaders; they see a landscape encompassing a tremendous mix of regulation, free enterprise, control, innovation. And they can work with that landscape.

And whatever happens Thursday in Washington, CMIOs and other medical informaticists will push ahead, working within the policy and industry landscape they’re handed, while doing everything in their power to create positive change. They know that they are in positions of both tremendous responsibility and tremendous opportunity. And all seem determined to move ahead affirmatively, regardless of the specific environmental winds buffeting them in their work going forward.