I think the gist of your post is that we need to make sure the horse is in front of the cart so to speak; i.e. that health care information technology (HIT) must be informed by measurable and explicitly targeted quality improvement metrics. I totally agree. If we don’t proceed as you argue, I fear the old joke will emerge anew: “The HIT was a success, the patient died.”

However, I do think it is extremely important to note that is raining more than cats and dogs. There are other animals in the zoo. To see this, we need to state our ultimate goal. I follow the path set by the World Health Organization more than 30 years ago where it was stated we must reach “the highest possible level of health (Alma Alta Declaration, September 12, 1978).

To do so, we cannot discount other significant consideration that may or may not be part of the Obama stimulus package and HITECH. Let’s call these other significant contributions, Lions, and Tigers, and Bears. Below, I’ve tried to visualize this menagerie in a scientific inspired hypothesis where: C=Cats, D=Dogs, L=Lions, T=Tigers, and B=Bears; the arrows signify causality.

I could provide some examples, of L’s, T’s, and B’s, but I will leave it to you and your readers to come up examples on your own for now. I end with an expansion of Earnest Hemingway’s immortal words: “The road to hell is paved in unbought stuffed dogs, [cats, lions, tigers, and bears].” (bracketed items are added).

Thomas Wilson, PhD, DrPH
Epidemiologist