Large healthcare systems often duplicate records, too, by starting a new one for a given patient when the system is down or there's an emergency and no time to call up an archived file. These medical-record errors are "an insidious problem that most hospitals don't talk about," he says. If patients came in with unique, secured smart cards in their wallets, at least some of the problems would be eliminated.

But the work came to a halt about three years in when the vendor and development partner, which Contino declines to name, changed its business plan and stopped selling smart cards. Over the past 18 months, Mount Sinai has partnered with TrustBearer Labs, Giesecke & Devrient and Extension to restart the project.

During this "extremely frustrating" hiatus, executive support didn't waver, Contino notes. About 10,000 Mount Sinai patients have a card now; the goal is to reach 100,000 in the next couple of years. C-suite meetings to talk about technology continue, and a committee of technology and business managers meets every week to discuss progress on meeting the requirements of the stimulus package.

Mind the (Maintenance and Support) Gap

Incentive money to get moving is one thing. But the federal government is not offering money to maintain and upgrade EMRs and other e-health applications into the future. Some CIOs worry about where cash-strapped hospitals will get the money for maintenance. How supportive will fellow executives be in the future as ongoing costs mount? And once automation starts, it only gets more complicated, says Frank Sottile, chief medical officer at Crittenton Hospital Medical Center in Rochester, Mich.