Health Care Information Technology Must Come First

President Obama has made no secret of his desire to forge ahead with ambitious health care reform legislation despite the economic crisis and soaring current account deficits with no end in sight. Obama wear's his philosophy on his sleeve: health care reform will be a central and unavoidable precursor to tightening federal spending over the long-term. I believe the president is absolutely correct, but I think he is putting the cart before the horse if he tries to overhaul the marketplace for health care providers before fully investing in and committing to the development of a nationwide health information technology foundation.

Information technology has transformed the fabric of civilization and industry in the US and around the world in ways unimaginable even 10 years ago. For the first time in history information is truly ubiquitous and free flowing. However, the largest US industry, Health Care, has largely failed to adopt IT in any meaningful way to enhance the quality of care received by patients. Despite this fundamental fallacy amongst health care providers, little more than token recognition has been paid to the matter by federal policymakers until very recently.

The recent American Recovery and Reinvestment Act (ARRA) was the first major federal injection of long-term capital ($48B+ over five years) into developing health IT infrastructure that is likely to have a real impact on patient outcomes. Physicians are offered real (though inadequate) incentives to adopt electronic health records and states are provided a true capital foundation upon which the technologies needed to expand coverage and value penetration. The stimulus funds are to be administered primarily by the newly formed Office of the National Coordinator (ONC) for Health Information Technology in the Department of Health and Human Services (HHS). However, it seems unlikely that this communications technology will be quickly adopted by providers and physicians, both of whom still lack any meaningful incentive to change.

I believe strongly that the marketplace for health insurance cannot experience fundamental reform until the broader health care industry has adopted the most basic value-added information technologies into the care delivery cycle and the true impact of this information flow on the quality of care can be quantified. To attempt radical health reform before this has been accomplished would be like prescribing treatment for a disease before assessing the patient's symptoms and issuing a diagnosis.

President Obama has a mandate to make sweeping changes to the way America is governed, this cannot be denied, and he appears to be intently focused on doing just that during the first two year of his presidency. It would be unfortunate if his party's legislative supramajority and his own impatience for gradual reform lead him to lose touch with realities of his capabilities as a mere mortal. Don't forget Mr President, "All glory is fleeting".

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