The golden rule of health IT?

Members of the eHealth Initiative, a collection of vendors, insurers, hospitals and other stakeholders, are thrilled beyond measure that the Obama Administration will step up to the plate and make health IT a high priority.

(You can get the group's own roadmap for eHealth technology here.)

I just hope they don't forget the golden rule. He who has the gold must make the rules.

There is a reason why the IT infrastructure of hospitals and insurers is far more mature than that in clinics. Hospitals and insurers gain bottom line benefits, while doctors do not.

It is presumed that the government will gain enormous benefits from buying more IT gear, and this will allow businesses to cut their health care costs.

Is that a reasonable presumption?

Not without standards.

So long as hospital computing systems remain proprietary islands of information, with proprietary drivers and minimum interoperability, the big winners here are going to be vendors, no one else.

Laws like HIPAA are the excuse for a lack of standards, and things like identity and audit trails must exist to assure privacy and protect security.

But an eHealth revolution, like the PC and Internet revolutions, requires adherence to real standards maintained at minimum cost to vendors and customers.

In the PC world this meant the Microsoft standard. The market waited years for this standard to emerge, using DOS windows instead of Apple's point-and-click Macintosh, because the Windows standard would be universal.

In the online world this meant the TCP/IP and WWW standards. Only when questions of financial advantage were taken out would networks interconnect and become ubiquitous.

My 25-year career in computer reporting has been spent following these trends, and the lessons are second nature to me now.

But vendors lose control of customers when they adhere to standards. This makes them reluctant to adopt standards. Something must make them into a business necessity. Someone must demand them.

So far the marketplace has not done this regarding health IT. Peripherals have too much value. Media and networks are overwhelmed by data loads before their standards become universal.

If government is going to step up to the plate, and mandate equipment purchases for doctors and hospitals, it also needs to support structures under which standards can be ratified, and advanced, in an organized way.

The standards effort, as well as the purchasing effort, must become self-sustaining, and as independent of outside forces as the Internet Society and W3C, for this to happen.

It is those structures I will be looking toward over the next year as I follow the money here. And you should look that way too. Because it's likely to be your money that is spent. You deserve a say in how that happens.