Everything in health care depends on execution

Without new legal authority the President's ability to make dramatic change is limited. Transformation requires new law.

Having just a vision's no solution.

Every Administration has a vision. George W. Bush had a vision. So did Jimmy Carter.

What matters is how you execute. Changing laws to enable your vision is the first step.

It is against this backdrop that we need to consider the health care bill that passed the Senate Christmas Eve. While most are focusing on what the final bill might look like coming out of conference, the fact of a final bill, signed into law, matters more than its content.

That's because a new law, whether it's a regulatory scheme or a grand overhaul of an industry, is an opportunity for the chief executive to transform government. The President will decide who manages this new enterprise. The President's appointees will write and enforce the new regulations.

Without new legal authority the President's ability to make dramatic change is limited. You can name different people to run things, they can interpret their mandates in different ways, but these are adjustments.

Transformation requires new law.

We have already seen this, in 2009, regarding health IT. The HITECH Act, part of the stimulus, remains mostly unspent. National Coordinator for Health Information Technology (NCHIT) David Blumenthal has spent more of this year consulting with experts and putting together new structures under which the money will be handed out.

This has transformed the industry. The easiest prediction to make for 2010 is that the old-line proprietary suppliers of hospital software, like Cerner and McKesson, are now takeover bait. Mainstream IT is taking over. SaaS is taking over.

The Administration could have done a lot without this new authority. What's now being called the Health Internet was built during the Bush years as National Health Information Network (NHIN)-Connect, using open source tools like Sun's Glassfish.

NHIN-Connect was designed to ease the work of Regional Health Information Organizations (RHIOs), but now it will define it. The open standards and open interfaces of the Health Internet will let doctors get records, not just between Atlanta and Macon, but between New York and Los Angeles.

These administrative shifts, from proprietary to open source systems, toward routine transfers of medical data, could have happened anyway. They have accelerated thanks to Administration statements endorsing open source systems like VistA. The environment has shifted.

A shift, however, is not a transformation.

With new legal authority to spend $19.2 billion over the next few years the industry is being transformed. Thousands of new IT professionals will be trained in junior colleges. Best practices will be developed through challenge grants. Most important, meaningful use will be defined as getting value from systems, not just from installing them and proving they work.

The new definitions would not have come without the new authority the stimulus gave Blumenthal to create them. Now health IT will be defined by functional results, not feature sets. That is transformation.

Look at it this way. It Halliburton had been as efficient a supplier as George W. Bush imagined, it wouldn't have mattered had it not gotten the opportunities it got in Iraq.

Health care is Obama's Iraq. And whatever health care bill he signs will be his war resolution.

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