July 22nd, 2009

Ezra Klein (Yes, isn’t it annoying when the kids do better than you? But our Esteemed Leader is right: Ezra has worked for his deserved success) points to a piece by Phillip Longman explaining how health IT companies risk screwing up an important part of Obama’s health policy.

The RBC hereby claims the Cassandra prize: I was warning about this on election day (clever counterintuitive timing illustrates the difference between me and Ezra) and during the debate on the stimulus package (here and here). All I had to go on was the well-documented and still ongoing troubles of the English NHS IT plan, sold to a gullible Tony Blair by consultants and pressed ahead with £12bn of cash and little consultation. Longman shows that the snake-oil pattern has been replicated with Obama’s team. This stuff is very hard to get right, and needs to be planned like D-Day before you throw money at it.

What’s new to me in Longman is the fact that the successful VA IT suite is open-source software. Any knowledgeable VA employee can look at the code, join in fixing bugs, and contribute new ideas. The VA system can therefore adapt to the priorities of actual medics, nurses, lab technicians, and front-line administrators. The snag is that open-source destroys the monopoly profits and mystique of health IT companies, who are relegated to the humbler service role of installation, maintenance, and training. An honest living, but no big bucks.

The industry is now lobbying hard against using a genuine made-in-America, world-leading, cost-saving success.

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