Yet 12 years after HIPAA was enacted, we don't have the instrument needed at its core. So break the impasse and make it happen. It should be a straightforward effort for the American Medical Association and insurance industry to propose a health record standard and for the federal government to mandate its use, with a clear deadline for execution. So get to it. And forget relying on the unwieldy system of regional health information organizations (RHIOs) to lead the health records effort, which were meant to avoid a federal mandate and let regional associations essentially compete to develop the best approaches. RHIOs can be effective in leading the implementation of national standards and extending them for regional purposes (the California RHIO is a good example of that).
A national identity and privacy system
The U.S. today has a fiction that there is no national identity card, which somehow is a good thing. We do have one (the Social Security number), but because we pretend we don't, we have a very inefficient system for maintaining and accessing information on ourselves. Big businesses, the government itself, and spy agencies around the world already have the resources to connect the information stored on each of us for data mining, surveillance, and other purposes. But individual citizens must maneuver through an impossible maze to get and correct financial, employment, health, credit, and other such information. The lunacy of this is the fact that the major credit reporting agencies make us pay for access to the financial information about ourselves, while they are free to sell it to pretty much anyone they want and have few burdens of ensuring its accuracy.
There should be a national identity system, preferably one that uses some sort of secure card so it can be used across various business and government systems. Passports, drivers' licenses, and so on could be replaced with a single card, one that likely would use good old two-factor authentication -- biometric data and a password -- to maintain its security both at the user end and at the transaction end.
Such a card could even be used as a rechargeable cash card, saving the government much of the expense of printing, storing, and transporting cash, and saving merchants the expenses of handling cash or the high fees for debit card transactions. Leave space on such cards for personal and business information, and you could use it in lieu of credit cards and insurance cards. Make card readers available for personal computers, and you can secure online transactions, from voting to e-commerce to tax preparation (imagine being able to access all the relevant tax data and have it downloaded into one place, rather than have to rekey it from paper forms into your tax software).
Yes, this would require a large card-management system to allow password changes and so on, but the financial industry has long used such systems, so the issue is an implementation one, not a fundamental technology one. And it would end the waste in having so many separate systems for drivers' licenses, passports, and so on.
At the same time, we need a national privacy regime. Citizens should own the information about them, so those who gather and trade in such information must follow national standards on privacy protection, such as citizen opt-outs for reselling the information, and provide online access through an at least partially standardized user interface so citizens can view the information, correct it, and monitor who is using it -- at no cost to the citizen. Yes, that means we'll all get fewer preapproved credit offers in the mail, but that's a good thing.
Improved e-government
Where the tech industry can make a big difference is to reduce the friction of citizen interaction with government, which would save the government, businesses, and individuals time and money. Paying taxes, complying with various disclosure rules, and so on should be easy to do, while being secure. Activities such as promoting XBRL for public companies' financial disclosure and requiring electronic submission of tax forms are good examples of what should be encouraged, but the feds could do better in making the information systems easier to connect to and use.
Here's just one example: The Social Security Administration has a powerful retirement calculator for Windows that is impossible for a layperson to use, and a simple Web application that doesn't really help in retirement planning. Why not redo the sophisticated application as a Web app, in a way that most retirees could use? That would be more efficient for them and require less effort in Social Security offices to do the same calculations for those who make an appointment.
The trick is in the systems design and delivery. Governments have had spectacular tech implementation failures, such as the ongoing saga at the FBI. And even successful systems, such as the Veterans Administration's Vista health management system, have been stung by data corruption issues. Part of the blame lies with contractors who overpromise and underdeliver -- a hallmark of the defense industry and an outcome the Obama administration needs to prevent in its tech spending.
But the government itself also deserves blame. Often, regulators overcomplicate such systems, making them impossible to create or at least use. The feds must not repeat the mistake it made with the Electronic Federal Tax Payment System, which makes something as simple as sending a check for your taxes into an amazingly bureaucratic, slow process for electronic funds transfer. In the case of EFTPS, the issue is validating payment account information, which the feds do by making you wait several weeks to get a paper confirmation with new access code -- an excessively inefficient approach compared to how banks and investment firms let people validate payment account information. It's easier to simply mail in a check, which means that EFTPS is a failure.
Obama has hired a national process officer to help streamline government processes. Taking that approach on federal technology initiatives is key to success. Perhaps Apple could lend some help, and companies such as Google and 3M that let employees use work time to explore personal projects could ask employees to use that time to help the feds for the national good.
And the federal government should consider replacing some of its legacy systems to get rid of the integration burden that they cause. The upfront cost is worth the long-term benefits of integration savings and transaction easing.
Research priorities
The high-tech industry has been good about focusing research dollars on key problems. Apple, AT&T, Hewlett-Packard, IBM, Intel, and Microsoft, among others, are well-known examples. Government already knows this, and many agencies work with such corporations and various universities for the joint good of business and the public. Keep it up.
The Obama administration should beware the research priorities it hears from the venture capital community. The VC business is about exploiting tech-based business bandwagons as they start to move -- not about creating new technologies, as popular mythology has it -- and so VCs reward the likely winners after someone else has done the hard work. VCs follow, not lead, and when they appear to lead, it's typically in service of their own investments (example: the several efforts by VC Vinod Khosla to get voter approval of ballot initiatives that would essentially have the state fund his environmental tech startups' products).
The near-term research priorities where government funding is useful are fairly obvious: wide-area network design (especially wireless), sensor technology, analytics technology, materials reuse and reduction technology (especially for the often toxic materials used in high-tech products), and the trio of battery, alternative energy, and energy-efficiency technologies. The industry will take care of the core product-oriented technology areas such as storage, semiconductors, user interfaces, speech and voice recognition, network management, and software design.
Finally, the federal government should further invest in basic research programs such as DARPA that have kept U.S. computer science advanced for decades and led to the Internet and other now-common innovations. DARPA, the Defense Advanced Projects Research Agency, is obviously skewed to military research, so I urge the Obama administration to consider a civilian counterpart that would be as effective in nonmilitary research as DARPA has been in its sphere. The whole point of basic research is long term investigation, not to address specific problems, so a tech agenda that focuses only on specific problems starves us of the resources for addressing the opportunities and problems we don't yet know about. Carve out a bigger space for the unknown.