Smart Technology, Stunted Policy: Developing Health Information Networks

PROLOGUE: As the information revolution takes off, the health care sector remains startlingly behind the times. There is no Microsoft market giant in the world of health information technology to move the industry toward standardization and cost efficiency. And government policymakers hold mixed views about regulating data collection and information systems. Some government decisionmakers, such as former Agency for Health Care Policy and Research chief Cliff Gaus, argue that we have but a couple-year window to get health care information policy up to speed, before falling so hopelessly behind that research on quality of care outcomes is seriously compromised. Others are concerned about protecting the public's privacy and fear raising the spectre of “Big Brother.” In this paper Paul Starr details the evolution of health information policy and practice and offers his prognosis for the future. Starr is professor of sociology at Princeton University and author of The Social Transformation of American Medicine. He served in the Clinton White House as a key staff member of the president's health care reform task force. He is also coeditor and cofounder of The American Prospect, a magazine about American politics and society, public policy, and ideas from a liberal point of view. An information-nik himself, Starr recently launched the Electronic Policy Network, a new network of policy and advocacy organizations on the World Wide Web. He is currently working on a book on the information revolution—a subject on which he has published articles for twenty years. ABSTRACT: Ideally, computer networks should help raise the quality of health care, reduce its cost, and enable consumers and providers to make smarter decisions. But government and the private sector have failed to resolve such critical problems as the protection of medical privacy and production of reliable comparative data on plans and providers. While individual enterprises are building information networks, community networks serving public purposes have lagged. An information revolution in health care is in the making, but the hope that it will allow consumers and providers to make smarter choices is still far from being realized.