More so than any other issue, Obama staked his presidential run on a promise to overhaul the nation's health care system and lower medical costs for individuals. He's got to deliver on this one.
Obama, the nation's first BlackBerry-wielding president, says himself that IT will be central to the effort. "The Obama plan will lower health care costs by $2,500 for a typical family by investing in health information technology, prevention, and care coordination," he states on his Web site.
Obama wants all Americans' health care records and related information digitized within five years. That will lower costs and create efficiencies by eliminating paperwork, facilitating on-demand patient information for the full spectrum of providers, and making fraud easier to spot. That's the thinking, at least.
Trouble is that the history of e-health initiatives is riddled with failure and unkept promises. Health care integration on a national scale, it turns out, is exceedingly complex given the vast web of stakeholders involved and the implications for service delivery, privacy, and compliance.
For a road map of potential pitfalls, Obama and his team need look no further than the United Kingdom -- a country that's in the midst of a decade-long effort to create a fully electronic, national health system for its 60 million citizens.
To date, the National Programme for IT has seen some successes, but it's also been plagued with billions in cost overruns, life-threatening computer failures, and threats of lawsuits from tech contractors that have lost money on the project.
"It's proving very difficult to link all these systems in a meaningful way," the British Medical Association's Dr. Richard Vautrey admitted to me in a 2005 interview, shortly after the effort was launched.
Billions in cost overruns? Life-threatening data loss? Squabbles with contractors? Obama can ill-afford such boondoggles in a project that could determine the success of his presidency. Other Obama initiatives, like reforming the financial system and developing green technologies, also will have big IT components.
It all points to the fact that IT could, indeed, make or break Obama's White House tenure.
That he has filled a number of key cabinet posts but has yet to name a chief technology officer is a troubling sign that the incoming president isn't fully aware of the extent to which tech foul-ups could undermine his agenda.
Russian Prime Minister Vladimir Putin holds a black belt in Judo. To deliver on campaign promises like health care reform and get a shot at a second term, Obama just may need his own black belt -- in Six Sigma management.