But for those who haven't begun automating, 2011 is going to come fast, says Aurelia Boyer, CIO of New York Presbyterian, a $3 billion, 2,200-bed healthcare provider.

"We started on this path way before Obama was elected," says Boyer, who is a registered nurse with an MBA. "If you haven't even started, you can't make it." She says her hospital could spend "tens of millions of dollars" when all is said and done. New York Presbyterian recently finished a Web portal based on Microsoft's HealthVault, where patients can access their health records, request appointments and pay bills. Crucial to opening up hospital data to patient access was the support of her C-level peers, she says. It's a major change in mind-set to unlock formerly sequestered, heavily guarded information that many care-givers consider their private domain. That change has to flow from the top, she explains, if staff are to accept new processes and the technology that supports them. "We believe this is the patient's data."

Steadfast Through Rough Patches

Steady confidence from top executives becomes crucial when projects stall. Mount Sinai had expected to be a leader in smart-card use by now, having started a project five years ago to give patients chip-based plastic cards to hold their medical and demographic data. But Mount Sinai's smart-card provider decided to get out of that business.

Matching medical records with the right patients-regardless of whether they are computerized-is an ever-present problem. That's especially true in a big city like New York where many people have the same or similar names, explains Contino, who is also chairman of the Smart Card Alliance Healthcare Council.