John Halamka, MD blogs regularly at Life As a Healthcare CIO. - Ed.

It's inauguration day. The energy is palpable.

Dozens of people have emailed me about their sense of optimism, their commitment to personal responsibility, and their "Yes We Can" attitude toward the audacious healthcare reform work ahead.

What's it like to be the Chief Executive of the United States?

My friends Jeff Stamps and Jessica Lipnack have created a Java-based hyperbolic viewer of the Obama Org Chart

He has nearly 20 direct reports and an undetermined number of dotted-line reports - a big job at performance-review time. Hopefully as the first wired president (a computer on his desk in the Oval Office, possibly a Blackberry), he'll be able to keep up with the overwhelming input from all his senior team.

He faces many challenges
1. The economy
2. The ongoing actions in Iraq and Afghanistan
3. A healthcare system that is not a system but a disconnected series of providers, payers, labs, pharmacies and hospitals.

His greatest challenge will be maintaining focus. There is so much to do and so many competing priorities.

In my own field of Healthcare Information Technology, imagine developing a project plan for spending $2 billion in 2009 and 2010, and a total of $20 billion starting in 2011.

My advice is that the journey of 1000 miles begins with one step. A focus on getting the basics right will move us all forward i.e.

1. Roll out electronic health records to each provider in the country, one implementation at a time.
2. Require interoperability for e-prescribing, laboratory ordering/results, clinical summary exchange and quality reporting.
3. Get very specific about the way that interoperability will happen i.e. a set of web services or an appliance in every healthcare data center that can securely exchange payloads for clinical and administrative data sharing with full audit trails/authentication/authorization to protect privacy.

Today my staff at Harvard Medical School and Beth Israel Deaconess are broadcasting the inauguration to all the employees of both organizations. We have large screen televisions in numerous public gathering points so that folks can gather together to celebrate the change ahead.

I am committed to do my part to volunteer my time locally, regionally and nationally. It's my duty and my responsibility.

Hail to the Chief!

Photo by acaben and obtained under Creative Commons license.