Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, said the money that will go out in 2011 isn't really incentive money for large hospitals that have already rolled out EHRs -- or for those about to roll such systems out. "There's going to be a windfall, because they're basically going to get paid for not changing their behavior all that much," Tripathi said.

For smaller health care operations, the gusher of money could lead to a groundswell of technology adoption with little rhyme or reason. "For those who are about to implement [EHR systems] now, one of the issues is, essentially, that this isn't a thousand points of light. This is more like 10,000 bonfires," he said. "Who helps the solo practitioner, the two-person group, the small hospital?"

For many smaller hospitals and private practices taking a wait-and-see approach to EHR Rollouts, money will not be available, and "for those who do implement, we still have the problem that 30% to 40% of retail implementations fail. So we haven't solved that problem. All you've done is given them money and said, 'Go out and implement in the same crazy ways we're implementing now,'" Tripathi said.

Instead, Tripathi suggested, technology adoption should be linked to regional HIT extension centers that can coordinate health care data exchange and promote quality care. "To me, the better protection of the investment is to say: 'You need to link those incentives with implementations either conducted by or certified by those extension centers,'" Tripathi said.

But Glaser argued that the Obama plan does take into account the need for state and community involvement to ensure greater continuity in the rollout of EHRs.