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Follow The Money
As someone who's worked with electronic medical records since the 1970s, we're making progress, but it's very slow ("Urgent Care," May 28, 2007).

Over the same 30 years, the banking industry has gone from a limited number of ATMs that only supported a single bank's customers to a global financial network with debit cards, credit cards, Internet banking, and ever-emerging new ways to access and spend money. Many of the same issues have been addressed--development of trust, robust infrastructure, privacy, and security. Not perfect solutions, but good-enough ones.

Health care is more personal and complex, but banking and finance are vastly different than they were 30 years ago when banks were locally owned, legally fragmented, and highly regulated.

Of course, it could be argued that we care more about our finances than we do about our health, and that we trust doctors less than bankers. All of which argues against interoperability. Nonetheless, we persist.

LARRY WOLF, Enterprise Architect
Kindred Healthcare, Louisville, Ky.

Too Much Information
Advocates of personal health records and "free market mechanisms" in health care have turned economics on its head by implying that everyone should be reviewing the work of physicians for errors, quality, and price ("Who Gets The Data?" May 28, 2007). Assuming a significant number of patients had the time and interest to do this, there's the matter of medical knowledge and judgment, which most nonmedical people lack. It's inane to spend billions of dollars on PHRs on the assumption that Americans will use them to make health care better when most of us don't even care enough about our health to eat right and exercise.

What's needed is a rational cost-benefit approach to applying IT to health care so as not to drive costs up. Grand systems make for grand fiascoes. Much better to build discrete, standalone systems, the cost of which is comparatively low and the benefits of which can be determined sooner rather than later.

M2 Consulting, Portland, Ore.

IT Incentives
I'm part of an international team of researchers looking at the IT workforce and issues related to outsourcing and the baby boomer retirement bubble ("On The Campaign Trail: Tech Issues That Matter," May 28, 2007).

I've been E-mailing the candidates, trying to get some recognition of the issues you raise, and I'm not getting very far.

We need to adopt some incentives that other countries already have adopted and shown to be successful:

>> India has an "income tax holiday" for students who study IT-related curricula and then become employed in related fields. This is a simple and inexpensive way the United States could en- courage more students to enter IT fields.

>> Countries such as Poland give cash incentives to organizations based on how many IT-related positions they create. Again, easy and inexpensive.

College grads are choosing careers based on where the money is, and they've lost faith in IT after the dot-com bust and the increase in outsourcing.

We're going to have a self-fulfilling prophecy in terms of outsourcing since we don't have the talent within the United States. This pattern can be changed--easily--with these kinds of incentives.

Stevens Institute of Technology, Hoboken, N.J.

Upside Of Outsourcing
It now seems as though the push for outsourcing is going to be felt in all industries, in all jobs that don't require a person to perform a physical task at a specific place ("Offshoring Mania Goes To Ludicrous Extremes," May 21, 2007).

Who didn't understand this 20 years ago? It's been a fact of life in manufacturing for a very long time. Now the service industry is starting to see it. I've worked as a consultant and a direct employee in manufacturing my whole career. I say thank the gods for outsourcing. It's made everyone very responsive, competitive, and efficient. No more 12-week lead times for a quote. No more 12-week material backlogs. I need a part made, I can get it made.

Look at the rise of small specialty manufacturers--agile custom motorcycle firms, auto accessory houses, and the like. This wouldn't be possible without the offshore threat. It keeps everyone honest.

MICHAEL. J CAPOCCIA, Product Development Consultant
Capoccia Enterprises, El Segundo, Calif.

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