Jonathan Bush, chairman and CEO of Athenahealth, was interviewed in the Wall Street Journal last weekend and spoke his colorful mind about the state of the healthcare industry and the political forces that are trying to reshape it.

My favorite quote was referring to the HITECH Act's billions of dollars for health IT adoption. It bears repeating and reflection (after the chuckling):

"It is kind of too bad that all these software companies that we're really close to putting out of business, these terrible legacy companies, with code that was written in the '70s, are going to get life support. That's why I call it the Sunny von Bülow bill. What it is, basically, is a federally sponsored sale on old-fashioned software."

I actually agree that there are creaky legacy companies, and a handful of them will likely get life support. But a number of them will get the plug pulled - stimulus funds or not. Why? The market has changed dramatically. Users and potential users are more demanding and vocal about their demands. Technology continues to evolve, or rather it's moving at warp speed. Open source, cloud computing, software as a service. These are the emerging technologies that will make EHRs and EMRs more affordable, accessible, user-friendly. The legacy companies, with their documented failed implementations, can't operate in this new world. They will have to transform themselves as surely as, say, Madonna continually transforms herself with the changing times and new generations to stay interesting and still popular.

It's a small world when it comes to successes and failures in health IT implementations - even more so these days because of the infusion of federal funds. So make no mistake that it's a new world we're operating in and if you can't change, if you can't be nimble, you're not Sunny von Bülow, you're a dinosaur. Period.