It seems that on the flip side, technology can hold a lot of promise. I'm wondering what you think the biggest promise healthcare IT offers. 

This may not be the typical answer. But, I think actually the biggest promise is we're transforming from a paper record system to an electronic system. So, if you have all the information in a paper file in the doctor's office, you make it pretty hard for the patient to get access to it and to make contributions to it. Just the overall enterprise of trying to get healthcare into the 21st century, the way we've done things with so many other systems – like banking, for example – I'd say that's the biggest upside. And, that presents some of the more specific opportunities that we're talking about. One of the things I haven't mentioned is accessibility for people with disabilities. When you are doing this electronically, you have the ability to incorporate Web-based accessibility guidelines that make it more possible for people with disabilities to see information they need to see in order to be engaged, in order to take care of themselves. 

What about the meaningful use program? How do you see that? I wonder if you see it as an opportunity as well as something you have to watch in terms of disparity.

I think both. It's definitely an opportunity. I am thankful that Congress set a national goal that every American should be in an EHR by the year 2014. I will acknowledge that it's proven to be somewhat of an ambitious goal, but if that important and ambitious goal had not been set, we wouldn't be moving as quickly as we are right now. So that program focuses on the places where the United States is the payer in Medicare and Medicaid. It focuses on setting minimums for EHRs, but if it had not done that, we would not be moving as quickly as we need to be moving. There are more particular things about the meaningful use program, but if your question is about the program overall, I would say it has actually helped the nation to move. You see dramatic increases in adoption rate. You're starting to see some really different kinds of uses like patient online access, which is just beginning to emerge with Stage 2. This is really helping to transform the culture of healthcare.

Why is it important to provide a list of patients by disparity variables?

It's important for the doctor to be able to differentiate inequalities of care and to understand why those are occurring, and you can't do that unless you start stratifying by the different important demographic of variables. So, if you don't do that – at least at a population or at a practice level – everybody looks average. It's when you start stratifying that you notice that perhaps there are higher rates of diabetes in one population than another, and yet you, as a doctor, may think, "well, I'm providing the same care to all of them. Why should the outcomes be different?" If you can't identify the disparity, you're not really well positioned to start to address it and to tease it out. The answers might be different for different populations, and it's very important to note them in the first place.