Uncle Sam's Guiding Hand

That's likely to change once the program is up and running, since then it will necessitate the government's dictating specific IT approaches for government-airline interactions. U.S. carriers spend more than $4 billion a year on security-related matters, says a spokesman for the Air Transport Association, an airline trade group. And it's the IT mandate that will be the biggest factor in how much this latest effort raises those costs--ranging from the government's estimate of a couple million dollars to airlines' estimates that run into the hundreds of millions, he says. Airlines would like a secure server to which they could push transactional data in batches that TSA would then directly access. Another possibility is real-time data feeds that transfer passenger information with each transaction.

The government's interest in radio-frequency identification technology shows another way the public sector can guide the private sector's use and adoption of a technology. One obvious way is with its influence as buyer--the Defense Department and the Office of Management and Budget are developing RFID specifications for Defense suppliers to follow for tagging all cases and pallets of supplies to U.S. troops.

Through the Food and Drug Administration, however, the federal government is playing more of an activist role in trying to get RFID moving quickly up the agenda of drugmakers. The FDA earlier this month released its Compliance Policy Guide for drugmakers to create pilot programs that use RFID tags on bottles and packaging material, with the primary goal of thwarting counterfeiting. So far, the FDA appears to be offering more of a pat forward than a shove. The government isn't mandating that the pharmaceutical industry adopt RFID, though many are eagerly working with the agency to craft industrywide guidelines. Purdue Pharma LP, maker of the theft-prone painkiller OxyContin, has begun using RFID to track shipments. Pfizer Inc. next year will begin placing RFID tags on all bottles of Viagra intended for sale in the United States, while GlaxoSmithKline plc says it will start using RFID in the next 12 to 18 months on at least one of its drugs that's susceptible to counterfeiting.

This is the role in which business most welcomes Uncle Sam--to clarify fractured standards. It's why the Controlling the Assault of Non-Solicited Pornography and Marketing Act (Can-Spam), for example, generally was welcomed by business, trumping a confusing myriad of state laws.

The health-care industry is facing a potential array of government-driven mandates to spur adoption of electronic medical records. The government leader of that initiative, national health IT coordinator Dr. David Brailer, seems determined to play the role of clarifying and spurring private adoption, rather than setting IT mandates. In November, his office issued a request for information asking for health-care industry and public input on how the country can best create a national electronic exchange for patient health data.

It's an approach much different from the government's ANSI X12 4010 data standard mandated as part of the 1996 Health Insurance Portability and Accountability Act. "The best balance is for standards to be mandated by the government but implementation of the standard left to each participant," Dr. John Halamka, CIO of CareGroup Healthcare System, says in an E-mail interview.

Health-information data exchanges already are sprouting up throughout the health-care system, so many are optimistic that Brailer's initiative will be embraced. "Current best thinking is to build XML servers around existing clinical data sources and a communitywide master patient index which links these XML-enabled sources of clinical data," Halamka says. "Once the infrastructure is built for a community, only a modest amount of IT resources is required to add new exchange participants."

Brailer comes from the business side, as a doctor and former health-care CEO, but he--as well as others around the industry--understands politics enough to know that Uncle Sam will use his gentle, guiding hand only so long. In one of his first speeches in his new role, Brailer made it clear that the only way IT pros can avoid a HIPAA-like dictate was to make progress on interoperable electronic records and solve problems that policy makers see. Brailer told an audience of medical and IT executives in June: "Following right behind, if we don't succeed in a relatively short period of time, will be many people itching to do something like [HIPAA] again."

--With Tony Kontzer

Illustration by Robert Neubecker