Has the federal government's investment of more than $10 billion in meaningful-use payments been worth it, or has the program been slow to promote electronic health record interoperability?

That's the question Dr. David Blumenthal, former head of the Office of the National Coordinator for Health Information Technology, addresses in an essay for the Annals of Internal Medicine. In it, Blumenthal positions the argument with the image of Uncle Sam listening to two “angels” in each ear. The first argues that the U.S. healthcare system, fraught with quality problems and unsustainable costs, requires solid information about patients at the time of care—and a paper-based system is unsuited to this task. Meanwhile, the other angel asserts that every federal tax dollar is hard-earned and reluctantly spent, making the case to account for every penny spent.

Blumenthal, currently president of the Commonwealth Fund, concludes it's simply too early to know the answer to that question.

“Debate is now commencing about whether the program has achieved its goals, particularly whether it has been too slow to promote interoperability and whether the EHR technologies are too primitive to justify the federal government's investment,” Blumenthal writes. “I believe that the debate is premature. The ambitious effort is not yet 2 years old and is being continuously recast in light of experience.”

Still, Blumenthal concludes, it's not too early to ask whether the federal government is properly tracking every taxpayer dollar. “The tension is healthy,” he writes of the debate. “Good governance requires a constant balancing of active innovation and accountability.”