Harnessing Health Information in Real Time: Back to the Future for a More Practical and Effective Infrastructure (Report‪)‬

Health information technology (IT) is a critical component of a high-performance health care industry. At its best, this technology can not only alert a patient or physician to past medical history to avoid redundant services and diagnostic tests, but also provide new information to save someone's life and offer previously unknown options for health improvement and medical care financing. As a result, calls to action for widespread adoption of electronic health records have come from a broad spectrum of private organizations and public policymakers. The problem is that the calls to action are getting stale, after nearly two decades of national declarations beginning during the presidency of George H. W Bush in the early 1990s. Today the Obama administration has committed itself to widespread use of electronic health records and supported the American Recovery and Reinvestment Act of 2009 (ARRA), which earmarks an unprecedented amount of $34 billion for health IT. This study contends that, while commendable in intent, the current pathway being executed by the Obama administration for creating interoperable medical records will most likely fail to achieve its ambitious vision by 2015. It compares that approach with a U.S. technology deployment effort of comparable magnitude, namely the real-time financial services transaction system and how it relied on identifying and aligning incentives in the private sector rather than using government subsidy and architecture to achieve its ambitious vision. The study concludes with both a vision and a tactical plan for how health IT initiatives currently underway can be adapted so that health IT finally achieves the aims identified by the last four U.S. presidential administrations.