The Obama campaign is promising to spend $10 billion per year for 5 years to spur adoption of health information technology. However, they give no specifics as to what the money will be spent on. The McCain campaign has similar goals but similarly does not put forward any specifics or dollar amounts. In the absence of specifics other than spending $50 billion over 5 years, let’s analyze that $50 billion expenditure.

First of all, that is a very large amount of money. What is worrisome is that without a viable plan, that money could easily magnify all the current problems with health IT. Instead of hundreds of incompatible EHR/EMR’s with only 14% of the market, you could have hundreds of incompatible EHR/EMR’s with an imaginary 90% of the market in paid-off practitioners that then evaporates once the funding goes away. Another worst case scenario is overnight self-anointed health IT ‘specialists’ coming out of the wood work to feed at the public trough leaving little or nothing to show for the money spent. This would include Accenture, IBM, defense contractors, Microsoft, Google and many, many more. The final worst-case scenario is a small cartel of vendors being the only ones given the financial reins.

The $50 billion dollar amount is worrisome by itself. Who came up with this figure and how? Five years is actually not that much time for so complex an undertaking as medicine. Spending that much money that fast on health IT is likely to result in much waste and abuse while truly viable efforts could be drowned out in the financial noise and haste.

How about a semi-modest proposal written on a napkin for a realistic plan with a good chance of success? My off-the-cuff somewhat-thought-through-plan I will call ‘$10 billion wisely spent’. $5 billion dollars to existing proprietary companies contingent upon those companies licensing their current software under the GNU General Public License or converting to WorldVistA. The other $5 billion to existing efforts like the WorldVistA organization which is taking the already functioning Veterans Affairs VistA software and successfully deploying it in the private sector. WorldVistA would then wisely spend approximately $100 million on development and the rest on becoming a permanently endowed institution as well as incentivizing adoption of the resulting platform.

I know the above would never fly because the blue blood companies lining up at the trough wouldn’t stand for it as well as multiple other mostly political reasons but oh well. What do you think?