After two years of buzz and hype, this week marks the beginning of attestation for CMS's Meaningful Use EHR incentive program for hospitals, doctors and other providers, and the health care blogosphere is full of discussion on how hospitals can meet at least 19 of the 24 meaningful use objectives for hospitals and, if all goes right, start receiving additional reimbursements later this year.

In my interviews and informal conversations this year, meaningful use is second only to ACOs in frequency as a topic—and in the breadth of opinions I've received from both boosters and skeptics. Unscientifically, I would say a majority of the folks I've talked to take the general view of William Bria, M.D., CMIO of Shriner's Hospitals for Children, who sees meaningful use as a once-in-a-lifetime opportunity for hospitals and docs to invest in IT in a way that will lead to real clinical changes.

"It's a clear signal that there's been enough discussion…that the practice of medicine and the use of information technology should be integrated," Bria told me in a recent interview.

That's the ideal result, of course, and having written about many a tricky or initially unsuccessful IT rollout, I know hospitals will have plenty of challenges to navigate with doctors, vendors and staff as they aim for meaningful use. And that's why, for at least the initial round of attestation that starts this week, many prominent health care systems are opting to wait on applying for meaningful use funding until they're confident of meeting the requirements.

Part of the reason for the caution that I've been hearing lately is the requirement that applicants demonstrate compliance for 365 days. In practice, that means that hospitals and systems seeking to enter the program this year have to be perfect from Oct. 1, 2011, to Oct. 1, 2012. Hospitals are also concerned about meeting Stage II meaningful use requirements, which CMS released in draft form earlier this year and will take effect for 2013 and 2014.

John Frownfelter, M.D., CMIO of inpatient services for Henry Ford Health System in Michigan, told me in a recent interview that concerns about complying for a full year starting in October led to Henry Ford's wait-and-see approach.

"If we were to attest this year and start with a 90-day period this year, which is what's required, the next fiscal year requires we're perfect for 365 days, and that begins Oct. 1," Frownfelter said. By waiting a year, Henry Ford and other systems that decide to wait remain in the program's grace period, and will still qualify for full meaningful use payments.

"Starting this year, it doesn't bring inherent value, as long as we're on a long-term track that's safe," Frownfelter said.

Of course, waiting on a large infusion of federal cash isn't something that all hospitals are in a position to do.

"Mid-market facilities…are really depending on that money to show up in order to fund the technology initiatives they're going after," Spencer Hamons, corporate project manager for the Yukon-Kuskokwim Health Corporation in Alaska and formerly a CIO at San Luis Valley Medical Center in Colorado, told me in a recent interview. Is your hospital system moving ahead with attestation this week, or have has a decision been made to hold off until 2012? Email your thoughts to hbush@healthforum.com.