Re Dcastro:

I do agree on what you're saying about the potential IT solutions can provide in health care. No doubt. I am wondering if the system could be built to last by using open source ideology to the extent that the users could upgrade the system 'organically'?

Markus:  The government absolutely needs to understand health IT is not a one-time investment like "sending a man to the moon" where you plan, build and then execute a project that afterwards can be marked "complete".  There are larger issues at work here, as KMT568 pointed out, America still needs to fix its health care system.  Fixing health care will involve an IT component, simply because technology allows us to do more things and do them more efficiently.  But it is certainly not the entire solution.  Neither will the first, second or even third-generation of health IT systems be the perfect solution for health care.  We will constantly need to improve these systems to get the most out of them.  That is one reason why a national strategy is needed so we invest in health IT systems that not only meet short-term goals, but move us closer to longer-term objectives.

Re: Daniel Castro

Interesting to read your post from a Finnish welfare state point of view. Eventhough the Danish, Dutch and Finnish examples undoubtedly makes an interesting and exotic read from an American point of view, the reality is not necessarily that peachy. It's true that we have the councils looking at these issues from various angles, but the systems are often regardingly huge compromizes, that require constant updating and maintenance, which makes it a huge business opportunity for the IT companies. What's the problem then?

Say the GOV. makes a decision to purchase a nation wide system. The system then adopts new generations of healthcare workers to use it. In five years the system has dropped off the trek of the devolopment, but the GOV. hasn't got the earmarked money to update it. Since the purchase of the system was a politcal compromize in the first place, and a triumph for some lobbying party, they have had their share in the political realm. Another five years go by. People are still treated according to the old system that doesn't have the human capasity to react to change. Still no politcal champions to fix the system. Healthcare workers become immersed with the outdated system and care for people through it. Another five years go by... And another?

Granted this is no reason not to do anything or not to use IT, but it is healthy to keep in mind when designing new systems, that these systems effect the way people conduct their daily duties with them and that the systems have a lifespan that does not often reflect the human condition and need.

I agree about the range and severity of the problems as you've highlighted them -- all the way up to your last phrase: "welfare state." Look at that word "wel...fare." We should be so lucky! We're more likely, if we fail, to end up like some 3rd world country, rich in resources that go to the top, and a vast unserved population.

modza you are right that it should be all of the industry players involved in setting standards.  And government right now has a very large carrot (stimulus money) to get all of the right players to the table.

Plagued by corruption, lobbyest, special interest groups, religious zealots and six presidential administrations, now armed with stimulus funding to dangle in front of the healthcare debacale,  I am thoroughly convinced the U.S.A. has found it's biggest challenge.  If not resolved it will be the undoing of the greatest 20th century power and reduce it to a welfare state, incapable of caring for its citizens or run away costs. 

When any one side of a multi-sided issue gains dominance, you're going to have problems. Government's best role is to force reluctant competitors and antagonistic buyers and sellers and NGOs with the consumers interests at heart to sit together. Well, let me modify that. In the U.S., where money more often than not directs the government, this is the best govt. can do. In more sensible countries like Netherlands and Denmark, govt. can do much more, and much better.

Electronic Medical Records are widely unused in the United States. I recently read an article published by a major medical journal citing that less than 10% of emergency trauma centers in the United States have full, streamlined electroncal medical record system. Many places are starting to make the transition to electronic, but the software is expensive and the manpower to transfer data is not available in most places. I've even worked in a physical  therapy facility where everything is electronic from patient records to billing, but the therapists still wanted to keep a paper file for each patient.

I agree that the private sector should be able to help the government make the transition. After all, these are qualified companies, but I can see how playing that card could become problematic for competing companies. On a higher level (and totally off topic here), I think America needs to fix healthcare in general before worrying about health records being paper or electronic.