Last week, President-elect Barack Obama openly pledged to computerize the nation’s medical records in five years. The promise is ambitious, as I remembered talks about computerized medical records dated as far back as in 1999. Will Obama accomplish this goal?

The first barrier is himself and his administration. I am impressed with his resolve and courage to take on this issue in his first year. But the reality is that the economic recovery is the national priority and if he has too broad an agenda in the first year, he might lose the focus and underachieve on the main goal. This could negatively impact his support from the grassroots up to the Congress, making his future tasks difficult to accomplish. Will this consequence shake his confidence and commitment levels? It remains to be seen.

The second challenge is clearly on the financial side. EMR is not simply a database but the brain of a modernized healthcare system. It reminds me of the SAP-type of ERP systems adopted by America’s largest multinational corporations (try asking any ERP adopters of their experience and see what they say privately). Since its functions touch every aspect of a healthcare system, it does not come cheap given the fact that it will be implemented at the national level. Industry pundits estimate that the cost of computerizing medical record systems can be anywhere between $70 billion to $100 billion. Will federal government have that amount of money in the first place given all the budget deficits and a traumatized economy? Even if it does, how to ensure that this money will be appropriated correctly and not siphoned off for other purposes? We all know that government accountability standard is quite weak. Even with the appointment of the Chief Performance Officer in the Obama administration, many doubt the effectiveness of such a position. Finally, the actual cost can be much higher, which can be caused by the third barrier—implementation.

The healthcare industry is considered one of the most challenging environments for healthcare IT implementation. Not only is it big, but it is complex and extremely fragmented. The first ten years of Internet did not help much, only exacerbating the situation by adding non-standard based, proprietary IT systems on top of the legacy ones that the healthcare facilities inherited from the 70’s and 80’s. The most daunting task is to make each system talk to one another in the same language. Using a more official term, it is called interoperability or more accurately, the lack of it. Do not underestimate the challenge here. The Bush administration created the Office of the National Coordinator of Health Information Technology in his first term (May 2004). After five years, the interoperability standards are still in debate and only a few are adopted in a piecemeal fashion.

I cited these barriers in a bid to lower people’s rosy expectation on Obama’s plan. We need to have a sober recognition of the challenges and advise the incoming administration of the lessons we learned over the last eight years. The five-year plan is good for rallying the industry, but when it comes to the time to roll up your sleeves, a more pragmatic approach should be adopted. President Obama: I would like to see your implementation timetable and approach first before I can agree with your ambition.