The U.S. economic stimulus package is the biggest thing that's ever happened in health IT.

That's what Dr. Mark Leavitt says about the American Reinvestment and Recovery Act (ARRA) of 2009, which promises to spend nearly $20 billion on technology use in health care.

Leavitt, chairman of the Certification Commission for Healthcare Information Technology, which certifies electronic health records (EHRs), recently compared the challenge of creating a nationwide network of interoperable EHRs by 2014 to NASA's manned spaceflight mission to the moon in the 1960s.

The federal government plans to kick its purchasing power into high gear by offering Medicare and Medicaid bonuses to physicians and hospitals that demonstrate "meaningful use" of interoperable, certified EHRs starting in 2011. The stimulus package also provides billions of grant dollars to federal and state organizations for research and the promotion of health-IT adoption.

One ramification is that state CIOs will begin paying much more attention to health projects, predicts Erica Drazen, managing partner of emerging practices at research firm CSC Global Healthcare Sector. The states pay for a lot of care, she noted, and if there continue to be islands of automation that can't share data, states won't see the quality or cost improvements they hope to achieve. "For states that have made progress on health-information exchange, this is their time in the limelight," she said. "For ones that haven't made much progress, it is time to step up."

The sudden flurry of activity has put a spotlight on public-sector CIOs who have been working in the field for years. The following are profiles of five federal, state and municipal IT leaders; their ongoing efforts to make use of health IT; and their thoughts on the stimulus act's impact on their work.

Leveraging IT at the Indian Health Service

Dr. Theresa Cullen remembers a day more than 20 years ago when she saw 80 patients in her primary-care practice on the Tohono O'odham Nation reservation in Arizona.

That day she decided technology had to play a larger role in her practice. "I realized we were pedaling as fast as we could," said Cullen, now CIO of the federal Indian Health Service (IHS). "We had to take better advantage of any resources available to us."

Dr. Theresa Cullen, CIO, federal Indian Health Service/Photo by Cade Martin

The IHS faces daunting challenges: It does cradle-to-grave care for 3.3 million American Indians and Alaska natives in the most remote areas of the country. Its population has the highest disease burden and the lowest life expectancy of any U.S. group, according to Cullen. Although the IHS operates 518 hospitals, clinics and other facilities, about 70 percent of its work is primary care. "We face fiscal and human-resource constraints that forced a recognition that we need to leverage IT," Cullen said.

During the late 1980s and early 1990s, Cullen was involved in piloting the IHS clinical information system called Resource and Patient Management System (RPMS), an open source system that uses the same kernel as the Veterans Health Administration's VistA EHR. As CIO since 2006, Cullen has overseen the continued growth of RPMS, including the 2007 rollout of a clinical decision support aid called iCare.

The tool employs a graphical user interface and easy-to-build templates to help doctors and case managers identify patients who need special attention, and compares their charts to clinical quality measures. The main targets are chronic illnesses like diabetes, obesity and heart disease.