In the second presidential debate, an audience member asked the candidatesabout the commoditization of healthcare. Neither candidate appeared to understand her question. Each one launched into their healthcare plan. Why they didn't answer her question is probably due to over-preparedness and desire to get into rhetoric mode. However, in their prepared healthcare responses, both candidates discussed as key to reducing costs in healthcare.

What is this health information technology?

We've heard of information technology - or IT. We all know of our IT department at our work. They're the guys that are more likely to be playing World of Warcraft than solving our irritating little desktop computer problem, right? "Have you rebooted?" they shout. Is Health IT this same group of people?

The answer is - sort of. Health IT, or HIT, is made up of all of the technology companies that sell to medical practices. The major focus of the debate language and President Bush's State of the Union Address in 2004 is the software that stores your medical records. Right now, that software (called ) is utilized by only 13% of all medical doctors in the United States. The U.S. lags far behind Europe in adoption of this technology. In that 2004 speech, Bush called for every patient to have a in 10 years. That 2014 deadline is becoming more and more unlikely to occur.

What's the big deal?

Well, storing your medical record on paper is expensive. It costs space in the clinic. It costs toner, paper, and folders. It costs money to manage that paper. Doctors and clinical staff are often searchingfor lost charts or misplaced pieces of paper. Someone has to pull your chart every time your visit the doctor, review it, and then file it away.

So the big deal is cost. The bigger deal, however, is what the candidates are pointing to - bigger costs. They aggregate those costs at the individual physician level, and compare that to the escalating Medicare and Medicaid costs. They look at a hospital that wastes millions of dollars handling paper. They see all of this, and say we could reduce our huge government expenditure on healthcare and our private (that's you) expenditure on healthcare. Doctors could get paid, could still provide high quality service, but wouldn't have to keep charging us more.

Even better (although maybe not as financially beneficial) are the good things that come with . , as the industry calls it, includes medical alerts and warnings that could save thousands of lives. Drug to Drug interactions and drug to allergy warnings come with an . If you neglect to fill a critical prescription or forget to get an x-ray, your doctor could be alerted. If you are due for a mammogram or another critical examination, an alert could advise the doctor.

These automated medical warnings can save lives and more importantly to the U.S. Government (the largest insurance company in the U.S.), provide preventative health. Preventative health and early warnings not only save lives, but they can dramatically lessen the costs of treatment. In addition, if every doctor used , and the government could report on it, the Center for Disease Control (CDC) would be immediately aware of outbreaks. Outcome studies could tell whether medications are working. The FDA wouldn't have to wait for a lawsuit to pull a drug off the market, they could quickly tell that patients are reporting certain side-effects or outcomes and then launch a study.

EHR is good for all of us. So why are only 13% of doctors using it? There are hundreds of reasons, but the top 3 stand out:

1.Too many vendors. There are over 300 . Imagine if instead of choosing between Mac and Windows, you had to choose from 300. Which is better? What should I choose?

2.Cost. These systems can cost hundreds of thousands of dollars for a private medical practice. This money comes directly out of a doctor's personal paycheck in most cases. Your doctor can't spend the same way a publicly traded corporate can. Most doctors are owners of small businesses.

3.Change. Everyone hates to change. The benefits of public transportation are obvious to all of us. So does everyone take the train? Not in my city. Inconvenience of change to daily routines is very complicated, especially if your personal income is at risk.

So how do we resolve the problem? Well, just like the commoditization of healthcare question, we'll just have to see if the candidates will answer that question.