About 100 people in the United States of America die each day because the current paper-based health-care system introduces errors (e.g., indecipherable handwriting) or delays treatment (how long will it take those X-rays to get here from the warehouse?) or limits what a doctor or nurse can know about a patient at the time critical treatment must be given (allergies?). Another symptom of this ailing and archaic system is the extensive financial hemorrhaging taking place in hospitals, doctors' offices, outpatient clinics, and patients' homes. Here's the question: If the U.S. health-care community could create a secure network that would make health records and prescription orders available online nationwide, how much money could this country save every single day?

A) $400 million
B) $4 billion
C) $25 million
D) Less than zero: the paper-based system is more cost-efficient

The answer is A: just under $400 million per day, or $140 billion per year, according to government estimates. More important, that's 100 people per day--or 36,500 per year--whose loved ones would not have to receive the worst possible news.

But where would you start? While all of you deal each day with complex projects that feature stomach-wrenching requirements and timetables that seem to have been set by your absolute worst enemy, this is one massively ugly problem to try to get your arms around. Let's take a look at some of the basic questions:

Other Voices "Once interoperability standards are in place to make the systems more usable by the physicians, the elimination of the greatest barrier, lack of financial resources, will likely ensue. Simply stated, standards will drive physician utilization, and physician utilization will drive an ROI. Our logic then is that a stronger ROI will fund further standardization and development in the industry, perpetuating the cycle further." -- W.R. Hambrect & Co. research report by Sean Wieland: "David Brailer, M.D.: A Man With A Plan"

With regard to investment capital, most hospitals are, at best, strapped for cash: How will they pay for what they have to do?

What systems do they currently have, and will those work within the proposed new system, or will they have to be scrapped?

While many hospitals don't have even outdated networks, those that do face staggering problems regarding integration, interoperability, scale, and dependability. How will they all work together?

HIPAA and other patient-privacy initiatives are terribly complex and require enormous planning and analysis to ensure that all compliance and governance mandates are met. How can these standards be locked down airtight across hundreds of thousands of hospitals, pharmacies, insurance companies, HMOs, doctors' offices?

How can such a system be rolled out in a way that's equitable to all Americans, regardless of whether they live in a major city or in a remote area?

In an industry with such intense competition, who will lead and who will follow?

While those and a long list of other questions would be enough to rattle most mortals, America's new health information technology czar, Dr. David Brailer, seems to have somehow been able to put together the right set of skills, experiences, achievements, and outlooks whereby he not only accepts this daunting challenge but also relishes it. Given a deadline by President Bush of 10 years for widespread deployment of electronic medical records, Dr. Brailer--an M.D. with a Ph.D. in economics who served for 10 years as chairman and CEO of a health-care technology-services company--quickly cut that timetable to seven years. Offering a view into how he plans to create this immensely complex national resource, Dr. Brailer spent a full day last week touring the University of Pittsburgh Medical Center to view what that institution--which placed No. 5 overall in the InformationWeek 500 annual rankings released this month--is doing with its own initiatives for electronic health records. UPMC's efforts to be a national leader in electronic health records are part of its $500 million commitment to a wide range of IT initiatives that are helping to optimize business processes that will improve patient care, reduce costs, and allow more focus on innovative new services.

Dr. Brailer described UPMC as "an early adopter and industry leader in health information technology" and said it has "already operationalized many of the goals we set out to achieve in the strategic framework that was released earlier this year." In so doing, he said, UPMC "is a current living example of the positive business case for [electronic health records] adoption."

The goal is certainly a worthy one, and here's hoping Dr. Brailer can find other health-care organizations around the country that stack up to what UPMC is achieving. Because 36,500 families each year are counting on it.

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