With the healthcare industry now pledging to reduce trillions of dollars in costs over the next 10 years in response to pressure from the Federal government, it's pretty clear that IT is going to play a substantial role in helping to reduce those costs.

The real issue with healthcare IT doesn't start with all the big hospitals and medical centers. It starts at the physician's office, which is usually the first point of contact with the patient. There is no doubt that billions of dollars will be spent improving processes and upgrading back-office systems developed by companies such as General Electric, Siemens and McKesson. But the current healthcare crisis starts with all the paper-based processes that still dominate the average doctor office. In order to have an effective set of electronic records on the back end, the part of the process that begins in the front office, otherwise known as the local doctor's office, has to become automated.

Unfortunately, in the rush to spend billions of tax-payer dollars to upgrade these systems, the doctor's office is likely to receive the least amount of IT attention. This is because most doctors don't have the business and IT acumen to appreciate the value of the investment and, even if they did, they would not have the necessary budget resources available to make the required investment.

To solve this problem, both Microsoft and Google are pushing software-as-a-service solutions, while companies such as Orion Health and gloStream have developed systems specifically designed to automate the workflow that surrounds every physician. There's a lot of talk about what's wrong with healthcare IT today. But as any physician will tell you, the biggest ally that most doctors have when it comes to treating patients is the willingness of the patient to fight and be cured. Unfortunately, when it comes to healthcare IT, most physicians don't seem to have the willingness to make the required changes.

That's why maybe instead of focusing on new overly broad regulations such as the Healthcare Information Portability and Accountability Act (HIPAA), maybe the best thing that could be done is simply require that all doctor's eliminate paper-based processes by end of 2010. Every thing else that needs to be done would then naturally flow from there over the next three years to create a more effective bottom-up solution to a problem that will never be solved from the top down.