Woulda shoulda

May 12, 2015 -- In his brand new (this month) book, The Digital Doctor, Chair of UCSF's Department of Medicine Dr. Robert Wachter reports David Brailer's (G. W. Bush's healthcare technology czar) comments on the ambitious Health Information Technology for Economic and Clinical Health (HITECH) program. I think Brailer nailed it.

He told Wachter that "HITECH locked in an existing set of clunky products and led the computer vendors to focus on meeting federal requirements [Meaningful Use] rather than innovating" (p. 18). Existing vendor hegemonies (especially Epic) were thus strengthened by the financial pressure on provider organizations (especially hospitals) to hurry up and computerize, regardless of quality.

Instead, Brailer says, HITECH should have spent its $30 billion (yes, with a B) on:

  • standards,
  • interoperability,
  • a "Geek Squad" to help with training and implementation, and
  • creating a cloud-based "medical Internet".

Perhaps Wachter, Brailer, and other visionaries can guide us in a more productive direction.

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