I received the following news update through many colleagues and RSS feeds that I use.... ---BEGIN STORY The Boston Globe (1/1, Wangsness) reported, "As Barack Obama prepares to spend billions on health-information technology as part of his plan to revive the US economy, some specialists are warning against investing too heavily in existing electronic recordkeeping systems." In fact, David Kibbe, a "top technology adviser to the American Academy of Family Physicians," and Bruce Klepper, a healthcare market analyst, highlight "the challenges confronting Obama's proposal to digitize an enormous and fragmented healthcare system" in "a recent open letter to the President-elect." Klepper argued that "current systems are expensive, cumbersome to use, and cannot easily exchange information about patients' health histories and treatments among different hospitals, labs, and doctors' offices." And, although "Obama and many health-policy analysts support a large investment in electronic health records," Klepper and Kibbe advocated for spending "the bulk of" the package on "simpler and cheaper technology." ---END STORY ---BEGIN RANT Klepper and Kibbe do a great job of stating the obvious: current systems are expensive, cumbersome to use and cannot easily exchange information. Exactly, if they were perfect and cheap, everyone would have them and the President would not need to buy as all an EMR.

The real question at the heart of this open-letter is far more interesting than their contrived recommendation. If President Obama does invest a great deal in healthcare information technology and much of the money is directed at the EMR space, will it spur investment from new players (producing disruptive new solutions on new technical platforms with distributed architectures) or will this be the chance for some of the monoliths of the industry that have gotten us this far to accelerate their move to more nimble solutions? I, for one, don't know if I will continue to spend my money with Epic Systems, but it seems likely. After many years down this path, my clinical users really don't want to switch. We already have numerous technical staff and assets aligned with our Epic investment. The President would have to offer an enormous size carrot/stick to move us off of our current path. On the other hand, as the industry has dabbled with RHIOs in the last decade, we see that there is no financial incentive for everyone to collaborate across institutional boundaries. If we as a society believe that there is value to have a lifetime electronic record that follows us across facilities and care settings, perhaps the President can spur investment in that arena. For instance, a national health information service that keeps track of everyone's chronic conditions/summary medical history, list of doctors they've seen, active medications and allergies. Even then, the question remains will our existing vendors or a new generation of vendors meet the needs of the new marketplace?