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Why Do Obama and Newt Gingrich Both Want $19 Billion for Health Technology?

Many politicians fall for the allure of simplistic technical solutions to a complex social problem. But technology is rarely the answer.

Yesterday decision-makers met in a White House summit to chart a way toward health care reform. But the first major health care initiative of the new administration is already in process, and Newt Gingrich -- the leader of the "Republican revolution" that took over Congress in 1994 -- thinks it's great.

Part of the federal stimulus package, the HITECH Act (Health Information Technology for Economic and Clinical Health Act) includes $19 billion to promote health information technology and in particular electronic medical records. Gingrich calls that $19 billion one of only two good things in the stimulus.

And the health information technology vendors are raring to go, ready to cash in on this windfall. Already their websites are full of offers to help health care organizations tap the big pools of funding.

Tech changes in health care will accelerate significantly, and it's taken for granted that this tech infusion will cut costs and improve quality -- without an oversight mechanism, without worker input, without any conversation about the impact on the health care workforce, without a real plan for reforming health care.

As a friend once said: "If technology is the answer, you are probably asking the wrong question." And focusing on the wrong problem.

If Newt Gingrich and Barack Obama are giving the same answer, we know that something is wrong.

Powerful interests, with an eye on markets and dollars, have been successfully pushing technology as the answer for our health care woes for a long time. George Bush mentioned it in several of his State of the Union Addresses, and now President Obama is on the program.

Many politicians fall for the allure of simplistic technical solutions to a complex social problem. They fail to recognize many things.

Technological fixes tacked onto failed organizational structures can just make those structures worse. After the voting catastrophe of 2000, for example, many localities tried to throw technology at the problem. Where are those Diebold electronic voting machines now, and where is the money taxpayers spent on them? Once money is spent on technologies, taking on the real systemic issues can become more, not less, difficult.

IT vendors are looking to get their piece of the public pie, and not looking out for health care . They will be hard at work pushing health information technology designs in directions that meet their needs for profit.

The health care workforce stands to lose out . New workplace technologies are almost always applied in ways that undermine skills, monitor the workforce, eliminate jobs, and increase top-down control and standardization. Standardization is particularly problematic in a care setting. Already, nurses complain that computer systems are poorly designed and difficult to use, and lament that they spend valuable time looking at the computer screen when they should be looking at their patients.

When the workforce is kept out of technology decision-making, two things are ignored: workers' needs and workers' knowledge and understanding of the actual work process.

Threat and Opportunity

The fact that so much public money is being spent represents both a threat and an opportunity. The threat: tech change that's bad for both patients and workers will be massively accelerated. This is almost inevitable. Electronic medical records are so much more than a digital file. They are the digital backbone for a technological transformation of health care delivery, driven by profit rather than care. The HITECH Act mentions, for example, remote patient monitoring, telemedicine (web-based health care) and self-service applications (ATMs for health care), among other technologies.

The opportunity is that, with a labor-sensitive administration, the workforce should be able to have a voice in the policies that will soon be implemented.

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