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to $60,000. Yet most of the benefits go
to payers and purchasers---often the U.S.
government. To fix the misalignment,
the government should o er incentives
directly to providers.
We need to be careful, though, about
what actions the government takes. A
recent Congressional Budget O ce
report concluded that imposing penal-
ties for failing to adopt health IT would
be more cost e ective than providing
financial incentives. Primary-care phy-
sicians in the U.S. are already struggling
with high costs and low reimbursement.
Asking them to comply with another
unfunded mandate based on penalties
rather than incentives won't solve the
problem, because it doesn't acknowl-
edge the underlying economic misalign-
ment that has discouraged adoption in
the first place. The result won't be more
EHRs; it will be fewer medical students
choosing primary-care careers, which
will fuel even greater increases in health-
I recommend a three-point plan for
(1) Provide incentives through Medi-
care for the adoption and use of EHRs.
Target these incentives so that cost sav-
ings are shared with clinicians.
(2) Encourage insurers to provide
incentives for hospitals to adopt CPOE
(computerized physician order entry).
This technology, which lets physicians
communicate treatment instructions
electronically, is the most important tool
hospitals can introduce to improve their
safety, quality, and e ciency of care.
(3) Continue to provide federal fund-
ing for technology and policies that
encourage interoperability between
If we coördinate the care of all Ameri-
cans and ensure that every person has a
lifetime electronic record, we will enjoy
safer care at a reasonable price.
JOHN D. HALAMKA IS CHIEF INFORMATION OFFICER
AT HARVARD MEDICAL SCHOOL.
INVEST IN EDUCATION,
RESEARCH, AND INNOVATION,
SAYS CHARLES VEST.
Dear Mr. President:
Your ability to govern e ectively and
provide world leadership will depend
profoundly on advancing and utilizing
the knowledge and tools of science, engi-
neering, and medicine.
In the 20th century, U.S. achievement
in these fields protected our nation's
security, fueled most of our economic
growth, and nearly doubled our life span.
It sent us to the moon, fed the planet,
brought world events into our living
rooms, established instant worldwide
communications, gave rise to ubiqui-
tous new forms of art and entertainment,
uncovered the workings of our natural
world, and gave us freedom of travel
by air, sea, and land. It was a century of
speed, power, and new horizons. We
have come to take all this for granted.
The 21st century will be very di erent.
And nothing can be taken for granted.
To grasp the great opportunities of our
times and to meet our challenges in a
number of areas---from economic com-
petitiveness to energy, from health care
to education, from security to infrastruc-
ture---federal policy and action must be
informed and enabled by a vibrant sci-
ence and technology enterprise.
Indeed, our national comparative
advantage is a strong science and tech-
nology base coupled with a free-market
economy and a democratic society.
We will soon feel the full force of
global competition. Jobs will follow
innovation wherever it is found, and
innovation will follow basic research.
Our children must be inspired and edu-
cated for productive, well-paying jobs in
this knowledge economy.
The bipartisan America Competes
Act was passed and signed into law in
August 2007 but has not been funded. It
would jump-start improvement in K--12
science and math education, strengthen
and sustain long-term basic research,
make the U.S. the best place in the
world to study and do research, and help
ensure that we remain the most innova-
tive nation on the planet. Its cost is about
0.14 percent of the Wall Street bailout or
1.8 percent of the annual farm subsidy.
Mr. President, the federal govern-
ment must invest in our future through
education, research, and innovation. I
therefore believe you should take six
(1) Use your bully pulpit to establish a
public vision of an America that will lead
and prosper in the 21st century through
knowledge and innovation.
(2) Appoint a science and technology
advisor before your inauguration and
include him or her at the highest tables
of counsel and decision making, just like
the national security advisor.
(3) Make full funding of the America
Competes Act a nonnegotiable first-
(4) Establish a bold national initiative
engaging the private sector, academia,
and government to meet our energy
challenge and mitigate the advance of
global climate disruption.
(5) Restore strong basic-research
budgets to the Department of Defense
and increase the National Institutes of
Health's budget in excess of inflation.
(6) Work with Congress to eliminate
My colleagues in industry, academia,
and government stand ready to support
your new administration with fact-based
advice and to provide the knowledge and
innovation required for U.S. prosperity
and improved life around the world.
CHARLES M. VEST IS PRESIDENT EMERITUS OF MIT
AND PRESIDENT OF THE NATIONAL ACADEMY OF
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