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Obama Stimulus Plan: The Audacity of IT

February 17, 2009
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I have read through my share of summaries, white papers and articles on the now passed stimulus plan. “Shock and awe” definitely come to mind when you look at the price tag. The question of stimulus aside, the provisions for Health IT are staggering. As I read the Health IT sections of the summary report on the House website, I was left with only one thought: the audacity of IT. In an industry that has a desperate obsession with hyperbole (any EMR implementation is Clinical Transformation), I don’t use audacity lightly. Specifically, 3 aspects of this legislation seem audacious:

1. Press all the buttons at once.

The amazing part of this legislation is shear multitude of hopes and dreams that have been funded. It almost seems as though the President listened to a confession of everything that is wrong with our industry or we wish we could do better and funded it. Everything from developing better IT medical education and extending medical informatics programs, to technology funding for the underserved; from EMR system certification and interoperability standards, to mandates to use systems and funding to help pay for it. The plan does have one overwhelming incentive in the form of Medicare/Medicaid payments, but beyond that (and including that), it is a bit of everything.

2. Pray for the “invisible hand”

There is a great presumption in this legislation that with the right incentives, we will do the “right thing” (ala Adam Smith). What is unclear is whether this conglomeration of incentives will lead to lasting change or will lead organizations to cut corners and take the path to the minimum necessary IT changes to qualify for the incentives. What the industry truly needs is sustainable investment that we can build on over years. The great hope is that many healthcare systems have already begun the pattern of sustainable investment, and that these incentives will help bring the reluctant to the table, and those at the table to focus on interoperability. The unfortunate reality is that big money often leads to big unintended consequences.

3. Trust us to figure out the details

As with any piece of legislation, the technical details are going to be left to the “experts.” This industry has a long history of success and failure on technical standards. I’m not sure that this legislation will make our efforts any better or worse, but there is always the hope that urgency will drive practicality. This legislation requires us to also figure out the details on the fronts of clinical collaboration and privacy protection. We must put forth some standard business practices that the industry accepts in order to meet the goals of this legislation. These questions cannot be simply answered by vendors and IT consultants looking to make a dime; however, by the same token those that produce the majority of the technology used in the industry shouldn’t be excluded.

These are interesting times for our industry. What is clear from this legislation is that those in Washington that developed and passed this legislation believe in the audacity of IT to be able to affect the future of the healthcare industry. They’ve placed their bet on the table. Now comes the fun part.

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