The $50 Billion Health IT ProjectThe $50 Billion Health IT Project

If there's one thing most presidential candidates agree on, it's that many more doctors must deploy e-health systems to reduce health care costs and improve care in the United States. But one candidate is proposing a whopping $50 billion, five-year investment to make that happen. That would be an enormous shift from what the feds have spent so far on these programs.If you troll through the campaign Web sites, many of the candidates say they want more health care providers using health IT, but leave out specifics for such programs, especially dollar figures.

Rudy Giuliani's site says the ex-mayor of New York City wants to "invest in health IT to reduce medical errors, improve efficiency, and detect health threats." John Edwards' site says he'll "provide the resources hospitals need to implement information systems that improve patient safety and hospital efficiency." No estimates on funding by either candidate.

Hillary Clinton's site (at least from what I was able to find) doesn't mention health IT, but is heavy on details about her universal health plan. However (courtesy of Janet Marchibroda, CEO of eHealth Initiative, a nonprofit, multistakeholder organization) the details of Clinton's plan include an "investment" of $3 billion a year in health IT grants. Funding would come from ending Bush's income tax cuts and exemptions and "redirecting" those savings.

If you think Clinton's $3 billion annual investment sounds like a big figure, check out Barack Obama's site. Relatively speaking, his proposal is eye-popping. "Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT," says the site.

Wow. $50 billion? To date, federal government spending on e-health initiatives has been in the millions of dollars, not billions. Most government money so far has been in the form of grants and demo projects. There also have been a few pilot incentive programs, such as Medicare paying bonuses to some doctors in small or medium-sized practices for using certain e-health applications, like electronic prescriptions.

Marchibroda of eHealth Initiative says that from 2005 to 2007, the federal government (specifically the Agency for Healthcare Research and Quality and the Office Of the National Coordinator for Health IT) spent a total of $374 million on e-health related grants, contracts to support implementation in the field, and other projects, including standards work and research. That's the total for three years -- $374 million.

In 2004, President Bush set out the goal for "most" Americans to have e-health records by 2014. And while deployment of those systems have ramped up, it's estimated that less than 10% of U.S. doctor practices -- and 5% of solo practices -- are using e-health records today. For hospitals, the adoption rate is somewhere between 20% and 30%

Some pundits think it will be more like decades before most physicians drop their paper-based habits for digital records.

One of the biggest obstacles in adoption has been the cost to implement and support those systems. Doctors argue that while they're the ones shelling out the money and dealing with the pain to deploy e-health record systems, they're not the ones that reap the financial return. It's mainly insurers and other payers who benefit from streamlined processes and the reduced costs associated with eliminating unnecessary or duplicate tests and keeping patients safer and healthier by avoiding medical mistakes (and expensive hospital stays.)

Obama's site doesn't specify (nor did his media team respond to my e-mail questions) about where the spending would actually go. For instance, would the annual $10 billion in funding help doctors purchase those systems? Would there be new financial rewards to physicians using e-health records? New grants? And where would that money come from?

Also, when Obama says he'll "phase in requirements for full implementation of health IT," is he suggesting making e-health records a mandate?

There are those who think that a "do it or else" mandate is the only way you'll force doctors into deploying these systems. Others are adamantly against any such mandate, especially if there's no money to back up such a program. Sounds like Obama might have plans to do just that.

Hmmm, $50 billion over five years? I'm sure some critics are already grumbling that Obama's plan is another example of how Democrats love to spend and throw taxpayers' money at private-sector problems.

But wouldn't it be ironic if Obama ended up helping President Bush reach his e-health record goal for 2014?

What do you think?