Health Policy Opinion Metamorphosis of Medicine in the United States: Is Information Technology a White Knight or Killer Whale? From: 1 Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; 2 Millennium Pain Center, Bloomington, IL, and University of Illinois, Urbana-Champaign, IL; 3 Mid Atlantic Spine & Pain Physicians, Newark, DE, and Temple University Hospital, Philadelphia, PA; and 4 Massachusetts General Hospital and Harvard Medical School, Boston, MA. Additional author affiliation informaiton on P. ??. Address Correspondence: Laxmaiah Manchikanti, MD 2831 Lone Oak Road Paducah, Kentucky 42003 E-mail: drlm@thepainmd.com Disclaimer: There was no external funding in the preparation of this manuscript. Conflict of interest: Dr. Benyamin is a consultant and lecturer for Boston Scientific and Kimberly Clark. Dr. Falco is a consultant for St. Jude Medical Inc. and Joimax Inc. Dr. Hirsch is a consultant for Medtronic. . Manuscript received: 11-05-2014 Accepted for publication: 11-10-2014 Free full manuscript: www.painphysicianjournal.com Laxmaiah Manchikanti, MD 1 , Ramsin M. Benyamin, MD 2 , Frank J.E. Falco, MD 3 , and Joshua A. Hirsch, MD 4 www.painphysicianjournal.com Pain Physician 2014; 17:E663-E670 • ISSN 2150-1149 H ealth care reform movement aspires to provide cost effective, high-quality health care for most Americans (1,2). The Affordable Care Act was designed to be a comprehensive approach affecting the character, function and appearance of health care delivery. Sadly, the toxic environment of contemporary politics and policies continue to hinder the debate on optimized health care delivery and what that should cost. At times it appears that the health care conundrum has become a surrogate for all the problems of the country (3). The debate has always focused on cost drivers, often inappropriately with the conventional wisdom citing the aging demographic trends and overuse of services in a fee-for-service environment as primary drivers. In contrast, 3 important cost drivers – information technology (IT), consolidation, and the patient consumer movement have often been ignored (3). The Patient Protection and Affordable Care Act (ACA), or ObamaCare, hoped to achieve the laudable triple aim of improving the individual experience of care, improving the health of the population, and reducing the per capita costs of care for various populations (1). The American Recovery and Reinvest- ment Act (ARRA) of 2009 (2), which preceded the ACA, was heavily focused on IT for implementation and improving quality. However, multiple barriers to IT adoption in health care have been described. Many of these include issues related to technology development and costs. Technology entrepreneurs do not necessarily address the is- sues at hand by identifying a problem and working to solve that problem. Practice and hospital administrators are not enthusiastic about paying for tech- nologies that make their limited time more efficient. Too often, physicians believe rather than enabling efficiency, technology takes up too much of their time. More ominously, technology may be creating barriers between physicians and patients. Physicians often see technology as impersonal (4). In fact, so-called technological in- novations have resulted in numerous regulations by the Centers for Medicare and Medicaid Services (CMS) and Congress with assessment of various value-based penal- ties with a cumulative reduction in reimbursement totaling 11% in 2017 and growing to 13% by the end of the decade, with reduced access to services (5). Information technology entities have created health care hackathons which are growing rapidly as described by Garg (6). Innovation within the health care industry conjures up an image of behemoth institutions with the regimented top-down bu- reaucracy and slow-moving progress to many in IT. Garg, however, maintains that it doesn’t have to be that way; it can be cured by hackathons. In another IT manuscript headlined as disruptive technology, Singh (7) states that health care is an unusually difficult market to sell into – between government regulation, consolidation and