Will health IT be Obama version of the Iraq War

Amid all the excitement over health IT's place in the Obama Administration stimulus package, Scot Silverstein (right) is the skunk at the picnic, the quiet voice in the corner saying "it'll never work."

Dr. Silverstein is no crank, nor Luddite, nor troll. He is in fact a specialist in medical informatics, on the faculty at Drexel University in Philadelphia (go Dragons), and a regular contributor to the Health Care Renewal blog. (See our blogroll.)

His problem, described in this 2007 paperongoing summary of his work, is that health IT is being driven by vendors, not doctors, that standards are not yet in place, and thus that systems can't scale to the level the Obama Administration wants.

Writing under the nom de blog MedInformaticsMD, he writes extensively about systems that fail, saying the horror stories prove the industry is conning the government.

While some conservatives have been using his skepticism for their own purposes, his real argument is that medical informatics needs to be directed by physicians, not just sold by vendors.

In particular Silverstein has been a big critic of HIMSS and CCHIT, which he considers joined at the hip, and calls present vendor offerings experimental technology.

In a December "open letter" to the new Administration, Silverstein argues that the field is divided between people who know what they are doing and are left out of decisions, and those he calls Health IT (HIT) Industrialists.

He concludes:

Push as strongly for HIT reform as for healthcare reform itself, lest our HIT initiatives suffer the same delays – and the same costly failures – as the UK’s national electronic medical records program. 

There is irony here, of which he seems well aware. The nation's political divide may be between ideologues and technocrats, yet it's possible that in health IT we've just put $20 billion into an industry's ideology.

If Silverstein is right health IT may be Obama's Iraq War. If he is wrong industry needs to prove him wrong, and not just try to discredit him.

A lot will be riding on whoever the Administration picks to be its "health IT czar." Will it come from the industry, from the medical-industrial complex, or will it be someone who knows what they are doing?