Health Care IT a promise too far?

Here is one promise it seems almost certain will not be met.

Both Barack Obama and John McCain think we can save billions of dollars by automating health care. (This voting booth was found on the Contented Cow blog.)

Obama wants to invest $50 billion in it, which The Lewin Group insists will save $111 billion. McCain says partnerships between government and institutions "doing it right" would be a top priority.

Lewin's own analysis of the candidates' health plans, released October 8, indicates McCain's plan would cost more federal dollars but save families more, while Obama's would cost employers more but leave fewer uninsured.

Still, the task of truly automating U.S. health care seems daunting from a technical perspective. Just 13% of records are electronic now, the databases don't match up well, and the field is riddled with proprietary standards.

When vendors are just sitting down to create an interoperability road map, it's hard to see everyone singing from the same hymnal in just four years.

So here is my non-partisan prediction based on these promises. Consolidation.

The only way we are going to get to a national system which interoperates is through an enormous amount of vendor consolidation. And without government involvement I don't see that resulting in a truly open environment.

This is because most major health IT vendors are very proprietary (Microsoft is considered the open one), and the equipment makers are even more proprietary.

The last decade has been marked by vendors offering better equipment with proprietary formats that break standard-issue medical office systems, which is then called progress. I don't see that changing soon.

The only possible solution is to translate those scans to standard formats for use in record-keeping, while maintaining the new scanners as client-based devices you have to get close to in order to read.

Then we have to deal with the problems of structured databases, give everyone health ID numbers, make professionals participate in consumer social networks, and bring mainstream technology into the doctor-patient relationship.

Oh, and I haven't even gotten into the idea of open source vs. closed source.

Each one of these challenges is enormous, rife with problems of vendor jealousy, professional pique and institutional reluctance. It will take enormous leadership to make breakthroughs.

And it will take more than four years to find real success and a positive return on investment.