DOT.GOV ' If the state of u.S. medical technology is one of our great treasures, then the state of U.S. hiT is one of our great disgraces utes, based on his name and Social Security number. In twelve more hours, Joe has burned through the last of his cash. Then the chest pain starts Leaving Las Vegas. Joe is rushed to a community hospital a few blocks from he casino. He is drunk, dizzy, and disoriented and cannot give the emergency room (ER) doctors any information about his medical history. But he is able to produce a tattered insurance card from his wallet, which includes his Social Security number, listed as his"Member ID "The hospital's admissions clerk spends twenty minutes on the phone to confirm that Joe is indeed covered by the health insurer in Pitts- burgh and that she should collect up to $500 from Joe for his visit; but the insurer's "information specialist"cannot say exactly how much, because he cannot tell from the computer"if Joe has met his deductible yet that year. He can tell the hospital ning else about Joe---not his medical history, the names of his physicians, or any medications he might be on-because"the computer"has no other information about him. That information is "in the other computers Joe's condition worsens; the er physician diagnoses a heart attack and cribes intravenous metoprolol, a generic beta blocker. What she does not know that until a month earlier, Joe had been taking 20 milligrams per day of Paxil (paroxetine)for depression. But a month before Joe's trip to Vegas, his employer's health plan had switched to a new pharmacy benefit management( PBM)com- pany, which required Joe and his coworkers to fill their medications for chron onditions via mail order. One of Joe s doctor's three medical assistants had faxed the doctor's usual handwritten prescription for Paxil to the mail-order pharmacy The mail-order pharmacist misread the prescription as "Plendil, "a calcium chan nel blocker often used for the same purposes as beta blockers and commonly dosed at 10 milligrams per day but occasionally at 20 milligrams for patients with congestive heart failure Joe had been dutifully taking the medication for the past few weeks, walking around with dangerously low blood pressure caused by high levels of the unneeded medicine. Joe's depression had also been slowly, impercepti bly returning-hence his unusual appetite for alcohol, which lowered his low blood pressure even further, resulting in wooziness and cognition problems severe enough to render Joe vulnerable to the casino s temptations In the ER, the metoprolol does the trick within minutes of entering Joe's blood stream:His blood pressure plummets, he goes into cardiac arrest, and he dies HIT market failure. The underlying cause of Joe s death is health information technology(HIt) market failure. If the state of U.S. medical technology is one ofour great national treasures, then the state of U.S. HIT is one of our great national dis graces. We spend $16 trillion a year on health care-far more than we do on per sonal financial services-and yet we have a twenty-first-century financial informa- HEALTH AFFAIRS Volume 24, Number 5 1247D o T - G o V "If the state of U.S. medical technology is one of our great treasures, then the state of U.S. HIT is one of our great disgraces." utes, based on his name and Social Security number. In twelve more hours, Joe has burned through the last of his cash. Then the chest pain starts. • Leaving Las Vegas. Joe is rushed to a community hospital a few blocks from the casino. He is drunk, dizzy, and disoriented and cannot give the emergency room (ER) doctors any information about his medical history. But he is able to produce a tattered insurance card from his wallet, which includes his Social Security number, listed as his "Member ID." The hospital's admissions clerk spends twenty minutes on the phone to confirm that Joe is indeed covered by the health insurer in Pitts￾burgh and that she should collect up to $500 from Joe for his visit; but the insurer's "information speciahst" cannot say exactly how much, because he cannot tell from "the computer" if Joe has met his deductible yet that year. He can tell the hospital nothing else about Joe—not his medical history, the names of his physicians, or any medications he might be on—^because "the computer" has no other information about him. That information is "in the other computers." Joe's condition worsens; the ER physician diagnoses a heart attack and pre￾scribes intravenous metoprolol, a generic beta blocker. What she does not know is that until a month earlier, Joe had been taking 20 milligrams per day of Paxil (paroxetine) for depression. But a month before Joe's trip to Vegas, his employer's health plan had switched to a new pharmacy benefit management (PBM) com￾pany, which required Joe and his coworkers to fill their medications for chronic conditions via mail order. One of Joe's doctor's three medical assistants had faxed the doctor's usual handwritten prescription for Paxil to the mail-order pharmacy. The mail-order pharmacist misread the prescription as "Plendil," a calcium chan￾nel blocker often used for the same purposes as beta blockers and commonly dosed at 10 milligrams per day but occasionally at 20 milligrams for patients with congestive heart failure.'Joe had been dutifully taking the medication for the past few weeks, walking around with dangerously low blood pressure caused by high levels of the unneeded medicine. Joe's depression had also been slowly, impercepti￾bly returning—hence his unusual appetite for alcohol, which lowered his low blood pressure even further, resulting in wooziness and cognition problems severe enough to render Joe vulnerable to the casino's temptations. In the ER, the metoprolol does the trick within minutes of entering Joe's blood￾stream: His blood pressure plummets, he goes into cardiac arrest, and he dies. • HIT market failure. The underlying cause of Joe's death is health information technology (HIT) market failure. If the state of U.S. medical technology is one of our great national treasures, then the state of U.S. HIT is one of our great national dis￾graces. We spend $1.6 triUion a year on health care—far more than we do on per￾sonal financial services—and yet we have a twenty-first-century financial informa￾HEALTH AFFAIRS - Voiumc 24, Number 5 1247