You can track a package down to the hour online. You can order a pizza online. You probably manage your finances online as well. You can even pay your taxes online! Why can’t you do almost anything with regard to your healthcare online? Why has the IT revolution failed so miserably in the health care industry?

A 2008 nationwide survey found that only 4% of physicians used a fully functional electronic medical records system (EMR). Health care information is certainly complex, but not any more so than information in many other industries. Integrating medical systems and ensuring seamless transfer of patients’ medical information would yield huge benefits, including fewer medical errors, few repeated tests, and less time spent filling forms. The security of modern IT systems has been tested by hackers again and again, but if it’s safe enough for trillions of dollars of financial transactions, it’s safe enough for medical records as well. So why haven’t EMR and health care IT progressed further?

IT Advance	Who Benefits?	Who Pays?
Electronic Medical Records	Patients	Doctors and Hospitals pay for installation, and could lose some revenue due to loss of additional tests, checkups, etc
Medical Record Portability	Patients	Doctors pay to upgrade systems, could lose revenue as above
Billing System Integration	Doctors and Insurers	Doctors and Insurers
Online Appointment Scheduling, Email	Patients	Doctors pay for website and systems, lose time spent on email if not reimbursed

Looking at the table above, it becomes obvious why America’s health care system practically guarantees IT will fail! In almost every case, information technology will cost health care providers money, while primarily benefiting patients (and perhaps payers). Why would any sane business invest in an IT system that has low or negative ROI? If health care were a truly free market, then in some areas IT might flourish, as patients demand conveniences like online appointments and control of their medical records. If US health care were dominated by a single payer, that system would enforce health care IT compliance and integration. But the bizarre no-man’s land of American health care reimbursement makes it difficult to advance IT beyond billing integration between providers and payers.

Can this situation be improved? The Obama administration has decided to get involved by offering carrots initially, followed by sticks later. Time will tell if this approach is sufficient to bring health care into the 21st century.