Since new systems always introduce unexpected problems, such potentially perverse consequences also need to be part of such a plan. Studies have shown that poorly implemented computer physician order-entry systems actually can increase medical errors, for example. What could happen if a large number of poorly implemented EHR systems get interconnected?

Furthermore, paper may kill, but so does not washing your hands. Hospital infections are a large problem because health-care providers routinely fail to wash their hands in between seeing patients. Why isn’t there an urgent national effort to address this issue? Instead of waiting for an electronic network to be built, resources need to be directed at mitigating the risks and problems that are unnecessarily costing lives and money today.

I remain unconvinced that the approach currently being taken can develop an effective national health information network, let alone one by 2014. The effort is an unprecedented endeavor, yet the office of the National Coordinator for Health Information Technology is chronically underfunded. Neither the government commitment nor the rhetoric about its importance seem commensurate with the risks or rewards involved.

The creation of this network will, with little doubt, foster a revolution in health care in the United States. But this revolution could be especially messy, given the magnitude of the changes it portends and the new health-care covenant it promises Americans. An enterprise risk management plan would add greatly to the national dialogue and let everyone know what is at stake. By understanding the risks better and then investing the necessary resources for attacking them aggressively, maybe we can truly gain lasting and fair health-care benefits at an acceptable cost for all Americans.