Barack Obama has invited Paul Krugman to come up with better ideas for the stimulus package. Can anybody play? None of us ‘umble bloggers here has a Nobel, Fields or – much the best money – a godly Templeton. But between us we have already come up not only with an early broad list of initiatives but with nifty specific ideas for a few billions in instant spending:
* 100 million cat’s eyes for safer roads (bonus feature: very labour-intensive to instal)
* best of all, Jonathan’s proposal for a malaria eradication campaign.
Obama’s planned stimulus package includes the electricity grid and road upgrades so we may be partly in luck. However one plan the transition does have is premature. They have not been playing close enough attention on how to fulfil Obama’s campaign promise for electronic medical records (here, here, and here).
From Obama’s Fairfax speech on 8 January – even the URL is on message – my italics:
To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized.
Er, what immediate investments? FWIW, I did suggest that two pieces can reasonably be started right away: a secure e-mail network (VPN) for American health care workers, and regional data warehouses for the results of X-rays and other scans. The data warehouses don’t depend much on the rest of the system; scan files only come in a limited number of formats, and scans are so expensive that writing conversion filters will generally be worthwhile.
But the main course is the actual detailed records of care. Here subsidising doctors and hospitals to rush out and buy lots of incompatible state-of-the-art kit is a bad idea. It’s roughly what happened in England in the 1990s, and they had to start all over again. Down the road you will have to spend even more to put it all together. You have to think out first what you are trying to achieve: a coordinated national EMR network that balances privacy with efficient care. And you have to get the medical practitioners on board, not just IT firms, management gurus and consultants. (Remember Ira Magaziner?)
Let’s walk through a small example from the English NHS project.