By one estimate, only 17 percent of U.S. doctors use electronic records. But the federal government has ambitious plans to create a network in which patient information is shared electronically among medical institutions. As National Coördinator for Health Information Technology, David Blumenthal is writing the rules under which the federal government will spend more than $21 billion in stimulus funds to get the job done (see "Prescription: Networking"). Blumenthal, previously a practicing physician at Massachusetts General Hospital in Boston, spoke with David Talbot, Technology Review's chief correspondent.

TR: How long will it take to create a national health-information network?

David Blumenthal: The president has said that everyone will have an electronic health record by 2014. That is the goal we are working toward right now. We are trying to make the network available as fast as we can.

TR: Can health IT reduce the skyrocketing U.S. health-care costs?

DB: The Congressional Budget Office projected dollar savings from the [stimulus] legislation at about $12 billion over 10 years. I expect that the actual savings will far exceed that amount.

TR: How do we get around the potential problems with electronic systems--such as overwhelming physicians with data or actually causing medical errors?

DB: Electronic health records and other forms of health IT can certainly be improved, and there are examples of bad implementation and other problems. I still think that on the whole, across the country we'd be better off with universal availability of electronic health records. We'd have fewer errors, fewer missed diagnoses, less duplication of tests, and fewer adverse drug events.

TR: If health-IT systems reduce such errors and lead to fewer needless procedures, why haven't the insurance companies stampeded to get them installed?

DB: The insurance companies have been able to pass along the costs of waste in our health-care system to their clients.

TR: You are setting the definitions of "meaningful use"--the criteria hospitals and physicians must meet to collect their cash incentives for installing IT. What will be in these definitions?

DB: I can't speak to the specific criteria at this point. We are in the middle of writing the regulations, and the initial release is anticipated in December.

TR: You're giving out $564 million for states to form health-information exchanges among medical providers. Why don't even the most electronically progressive hospitals--including your own Mass General--already share their data?

DB: There has never been a business case for health-information exchange. As a matter of fact, there has been a negative case: if you give away your information, you may lose it. You may lose the patient.