There's a lot of uncertainty out there in general when it comes to the economy, next week's elections, and other unknowns, but when it comes to the health care sector, the uncertainty runs a bit deeper, especially when it comes to investments in IT.Regardless of the outcome of the presidential election, there's potential for a lot of change in the health care industry in the next four years. Barack Obama and John McCain have very different visions when it comes to health care reform, but there is one thing they both have in common, and that's an emphasis on using technology to digitize patient records and eliminate paper-based processes that are inefficient, redundant, costly, and potentially deadly.

The uncertainty for health care providers is whether the emphasis on health care reforms (and health IT) by the candidates will ultimately translate into any new programs that help fund the deployment of technology, or at least make it easier to recoup the investment. And with a sick economy, any money the government puts toward health IT programs could be scanty.

Despite the country's economic ills, at least one U.S. legislator thinks health care reform -- with IT playing a critical part -- will happen.

"We need to make money available for direct grants" and via other avenues to promote the deployment of IT in health care, said Massachusetts Sen. John Kerry (and Democratic presidential nominee in 2004) during a keynote speech in Boston yesterday at a technology symposium put on by the Center for Connected-Health, a division of Partners HealthCare, which operates several Boston area hospitals, including Mass General and Brigham & Women's.

Health care reform can't be deferred by the weak economy because health care is such a big part of the economy -- or $1 out of every $6 dollars spent in the United States, says Kerry. Addressing the health care system's big cost issues will "help the economy move," he says.

Of course, Obama and McCain aren't the first presidential candidates to highlight health IT. George W. Bush has been an unpopular president for lots of reasons, but he does deserve some credit when it comes to putting health IT into a national spotlight. Besides Bush mentioning health IT in at least a couple of his State of the Union addresses, in 2004, Bush set out a goal for most Americans to have e-health records by 2014. Four years ago, while up for re-election, Bush also created the position of national health IT czar, a sub-Cabinet level job responsible for coordinating government agencies and private health care providers to create a national infrastructure for exchanging health information.

These high profile efforts to create health information highways have had successes and failures (to see some of them, click here), but at least they've sparked the health care sector into moving in the right direction.

Also, whether "most" Americans will have an e-health record in six years depends on many factors, including whether "most" means 99% -- or only 51% -- of Americans, and whether those e-records are the more complex "e-medical records" used by doctors, or are the less comprehensive "e-personal health records," such as the kind you or I can set up on consumer sites like Google or Revolution Health, or offered to increasing numbers of workers by their employers.

One thing is clear, health care providers (some a lot faster than others) are finally replacing paper-based processes (including writing prescriptions) for computerized systems.

Over the last few years, there's also been a dozen or so health IT bills introduced into Congress that didn't go anywhere. And so the thinking among some in the health care sector is that a big shakeup in Washington leadership might actually translate into the passage of health care IT legislation.

That could mean anything from new legislation that provides grants to help fund deployments of health IT (such as e-medical record systems) to changes in Medicare reimbursements that reward doctors who use health IT tools to keep patients healthier, helping them avoid costly hospitalizations and complications.

In fact, Medicare recently announced a new rule, saying that by 2012, doctors participating in Medicare programs would be required to prescribe prescriptions electronically. Medicare (along with sister government program, Medicaid) is the nation's biggest health care payer, so it has a lot of influence on what other insurers and health plans do.

In fact, today, Blue Cross Blue Shield of Massachusetts announced it was following Medicare's lead: BCBSMA said that beginning on Jan. 1, 2011, it was requiring doctors to electronically prescribe medications in order to qualify for bonus programs. BCBSMA says 99% of primary care doctors and 78% of specialists in the company's network currently participate in the insurer's incentive plans. So, that means there will likely be lots more Massachusetts doctors trading in their paper prescription pads for e-prescribing systems in the next couple of years.

To date, Medicare's new e-prescribing requirement is "the most significant bill to pass" promoting the use of health IT, said Kerry

Programs that push doctors into using e-prescribing systems are important, but it's just one step in a long journey.

"If we had medicine driven by data, we'd be better off," said Kerry.

What do you think?