The 7 roadblocks to health IT nirvana

Both parties want an integrated IT infrastructure for healthcare. (Image from my favorite Super Bowl commercial of all time.)

Both sides think we can save billions of dollars by "simply" entering medical office data, moving it to hospitals as needed, and integrating it online for actionable wellness advice.

Simply. That's the understatement of the year.

Herewith, the chief technical roadblocks to this vision, roadblocks you won't see listed on anyone's political Web site this month:

1. Structured Databases -- Health databases are structured. That is, a tag for my name, for a specific health condition, for the specific medicine I am taking. Integrating such databases is very, very hard.
2. Diagnostics -- There are a ton of medical devices out there collecting data. Not all have digital output. Not all digital outputs conform to any but a proprietary standard.
3. Vendors lie -- Everyone says they are for integration, but when it comes time to bolt things together objections appear. Many companies are sabotaging open standards for proprietary advantage and lieing about it.
4. Doctors on paper -- Many doctors still keep paper records. They don't get an economic benefit from computerizing them -- it's a hassle. They also lose control of their "customers." No incentives, no deal.
5. Privacy -- HIPAA does not apply when you have your medical data downloaded into a Personal Health Record like Microsoft HealthVault. But how do you guarantee no one else has looked at the record?
6. Insurance incentives -- The biggest databases in the industry are held by insurance companies, whose incentive is to reduce claims and keep the customer's cost of switching high.
7. Illusory savings --  The "savings" from integrating the IT infrastructure won't appear until the system has been in place for some time. The economics are like those of a power plant, with big upfront costs, and no assurance of savings.

All these roadblocks can be overcome. But it will take time, it will take leadership, and it will likely take several political showdowns to do it.

We probably need a "Health IT Czar" whose loyalty is to service, unaffiliated with any vendor, in order to get a handle on all this. Absent someone with a whip, these cats won't be herded.