Now is the time to revisit our month-old piece about Craig Barrett: "Intel Chairman Has Harsh Words for Healthcare Industry".

As expected his ideas provoked a spirited response. Modern Healthcare, which originally reported on the speech received and published a flood of reader letters. This represents a broader cross-section of the healthcare world than you could get (today) through blog comments.

Taken together, these letters represent "zeitgeist" of modern attitude towards healthcare IT (pun intended):

First, a reader notes that you cannot expect healthcare to adopt technology as a free-market industry, because it is not one:

Barrett must have forgotten that the industries he is referring to are free to charge market rates -- not so for physicians; insurance companies and the government decide what to pay physicians. Maybe Barrett ought to take his case to the insurance companies.

Janet McAllister
Mill Valley, CA
Management consultant

Next a physician comments that the real cost is coming from the public's expectations for end-of-life care and medical liability:

I totally agree that we need to convert to electronic health records in order to bring public health into the 21st century and provide for easier continuity of care. His argument that this will change consumption of healthcare services is without merit. We spend a majority of our healthcare dollars on the last six months of life. We also spend an exorbitant amount of healthcare dollars on defensive medicine.

Sean White, MD
Kingsport, TN

Another physician points out the problems with interoperability and conflicted interests between the stakeholders (similar to what we noted in the report from CalRHIO Summit):

What he fails to recognize is that the lack of interoperability and agreed-upon standards in terms of the widely divergent software applications out there is the main hindrance. There are multiple entities with their own momentum and divergent interests that inhibit the small-practice physician from making a commitment to large investments in IT. I will not buy an expensive piece of software and then invest the time in the training necessary to use it if I believe that it will be supplanted in the future at significant increased costs to me.

Michael D. Bryan, MD
Southlake, TX 

Fingers are also pointed back to health IT industry saying no one has invented the magic bullet. Hard to disagree with this too:

Like any other business, deeper IT automation in healthcare will be embraced when solutions actually make a difference in improving workflow and reducing costs of operation for the small practice. This is especially true in small physician practices. How many years did it take for the average small- to medium-sized enterprise, or SME, to seriously consider the large-corporation enterprise-resource-planning model of automating business operations?
...
The spoils will belong to those service/product vendors who can make a sound business case to physicians and their patients and those practices that embrace IT wisely. If healthcare IT vendors lean on government regulations, grants, etc., to subsidize and drive the adoption process, then it is a sure sign that the industry has not made a viable business case to the small-practice owners.

Ricardo C. Davis
Business Systems Analyst, Regency Hospital
Alpharetta, GA

But another reader retorts that the adoption incentives will become natural, as pay-for-performance emerges:

The savings from improved information, less redundant testing and disease management for chronic conditions benefit the payer and the patient. Physicians have to be brought into this loop. The game is not "Play IT or don't participate," the rules of the road should be "Play and be rewarded." Otherwise be prepared for fee reductions with the IT physicians getting the difference. That requires leadership! Is anybody listening?

Mark Rosenblatt
Senior vice president, National Health Resources
Great Neck, NY

This is the silver lining. The stakeholders will continue to argue and point fingers at each other. But as Deep Throat advised the reporters who brought down Nixon, we should simply "follow the money".

Pay-for-Performance is what will make the difference in health IT adoption. Adopt and earn more. Avoid and be cut. Simple as that.