美国政府机构需要加快数字化改革

There has not been much good news coming out of Washington lately. But here is one nugget: a few weeks ago, the Department of Veterans Affairs announced that it had finalised plans to introduce a new integrated electronic health-record system.

近来从华盛顿传出的好消息不多。但有一个例外：几周前，美国退伍军人事务部(Department of Veterans Affairs)宣布，已敲定计划、将引进新的统一电子健康档案系统。

This marks a big leap forward for the VA, which has hitherto kept its records in a fragmented manner. For the first time, it will be integrating its systems with those of the Department of Defence. This will ensure that, instead of sitting in limbo for months, records will be transferred as soon as servicemen and women leave the military.

这标志着退伍军人事务部向前迈进了一大步，该部门到目前为止一直以一种分散的方式保管健康档案。它将首次把本部门的系统与国防部(Department of Defence)的系统整合到一起。这将确保每名军人一退役，他们的健康档案就可以转移出来，而不必再苦等数月。

“For almost two decades, Congress has been imploring the Department of Veterans Affairs not only to deliver on our promise to veterans, but also to innovate and modernise,” declared Jeff Dunham, a Republican congressman from California, writing in The Washington Examiner recently. “Now under new leadership, following years of frustration, corruption, scandal and abuse, the VA is taking the initiative to deliver the care and services that our veterans [need].”

“近20年来，国会一直在恳求退伍军人事务部，不仅要兑现我们对退伍军人的承诺，也要进行创新和现代化，”来自加州的共和党议员杰夫?邓纳姆(Jeff Dunham)最近在《华盛顿观察报》(The Washington Examiner)上撰文称，“如今，在经过多年的挫败、腐败、丑闻和行为失当后，退伍军人事务部在新一届领导的带领下，正积极主动地提供我们的退伍军人（所需的）关心和服务。”

I dare say some readers’ eyes are glazing over at this point; the finer points of government digitisation don’t normally provoke media headlines or voter passion. But it is worth pondering this story — or, more accurately, the fact that it wasn’t much of a “story” at all for our current Trump-obsessed media.

我敢说，有些读者现在可能有些走神；政府数字化这样的细节通常不会登上媒体头条或者激发选民的激情。但这条资讯值得琢磨——更准确地说，值得琢磨的是如下事实：这条资讯对当前只顾着报道特朗普的媒体来说都算不上一条“资讯”。

That the VA announcement passed without much notice says a lot about what is wrong with our concept of what matters in government today, and the way we are increasingly treating Washington as an entertaining reality-TV show, without noticing the things that government actually could — or should — do.

退伍军人事务部这则声明没有引起太多注意，极大地暴露出我们对当今政府中什么事情重要的认知偏差，以及我们越来越把华盛顿当作一档很有娱乐性的电视真人秀节目，而没有留意政府实际上可做或应该做的事情。

In any rational world, it would seem entirely sensible for the VA to create integrated healthcare records. Many observers might consider it odd that the department has not already done so. After all, America is a place of cutting-edge technology and digital entrepreneurial skills — just think of what Amazon, Facebook and Google have done. It is also a place where companies have been using digital technology for years; where the healthcare system accounts for a sixth of all economic activity; and where there are some 21 million veterans (equivalent to the entire populations of Norway, Sweden and Denmark combined).

在任何理性世界，退伍军人事务部创建完整统一的健康档案似乎都是完全合理的。许多观察人士可能感到奇怪——该部门居然还未完成这件事。毕竟，美国拥有大量尖端科技和数字创业技能——只需想想亚马逊(Amazon)、Facebook、谷歌(Google)取得的成就。美国企业多年前已开始利用数字技术；美国的医疗体系占全部经济活动的六分之一；美国有约2100万退伍军人（相当于挪威、瑞典和丹麦人口的总和）。

For the past two decades, however, the VA has repeatedly failed to implement an integrated record-keeping system (never mind that it has spent about $2bn on feasibility studies in recent years). While these delays can be blamed partly on mismanagement, the issues go well beyond that.

然而，过去20年，退伍军人事务部一直未能建立一个统一的健康档案保管系统（虽然近几年已在研究建立这一系统的可行性上花费了约20亿美元）。不断拖延部分可归咎于管理不善，但问题远不止于此。

Much of the US’s civilian healthcare system is fragmented too: while it is easy to transfer healthcare records between doctors in a country such as the UK, it is very difficult to do so in much of America. And the VA is certainly not the only one with archaic practices: although there are corners of the public sector that are using the latest technology — such as the City Halls in New York and Chicago — most federal agencies have been almost as slow as the VA to introduce 21st-century ideas.

美国的平民医疗系统大部分也不统一：尽管在英国等国家，在医生之间转移健康档案很容易，但在美国大部分地区却很难做到这一点。退伍军人事务部肯定不是唯一使用原始方式的机构：虽然部分公共部门正在使用最新的技术——如纽约和芝加哥市政厅——但多数联邦机构在引入21世纪的理念方面，几乎都像退伍军人事务部一样缓慢。

The good news is that moves to change this are under way. Various private-sector entrepreneurs are launching innovations in healthcare IT, and there are campaigns to upgrade public-sector digital know-how. The non-profit “Code for America”, for example, is campaigning for computer geeks to volunteer to spend a couple of years working for government, in much the same way that the better-known “Teach for America” encourages graduates to work for a time in the country’s public schools.

好消息是，改变这一状况的行动正在进行之中。许多私营部门创业者都在医疗信息技术领域发起创新，还有各种旨在提升公共部门数字技术的活动。例如，非营利组织“为美国编程”(Code for America)正在争取让计算机极客志愿为政府工作几年，这与更为人熟知的“为美国教书”(Teach For America)鼓励毕业生在美国公立学校工作一段时间非常相似。

What’s more, some White House officials, such as Gary Cohn and Jared Kushner, now seem keen to bring better management and tech skills into government. This week, for example, President Trump, Cohn and Kushner convened a meeting of tech CEOs to discuss how to launch a revolution in the way the federal government uses computers — and claimed this could deliver a trillion dollars in cost savings over 10 years.

此外，现在的一些白宫官员，如加里?科恩(Gary Cohn)和贾里德?库什纳(Jared Kushner)，似乎热衷于将更好的管理和技术能力引入政府。例如，不久前，特朗普总统、科恩和库什纳召集科技公司首席执行官们开了一次会，讨论如何在联邦政府使用电脑的方式上发起一场革命——声称这样做将在10年内节约成本1万亿美元。

“We are here to improve the day-to-day lives of the average citizen,” Kushner said, pointing out that the federal agencies are so fragmented they currently maintain no fewer than 6,100 data centres. These, he argues, could be streamlined to create a more efficient structure, just as the VA is now attempting to do.

库什纳说：“我们在这里是为了改善普通公民的日常生活。”他指出，各联邦机构非常分散，目前共维持有不下6100个数据中心。他表示，可以通过重组和优化这些数据中心，来打造更高效的结构，正如退伍军人事务部正尝试做的那样。

This is sensible stuff — exactly the type of common-sense action that governments should take (and that businesses do take every day). But even at the best of times it is hard to get voters — or media consumers — particularly excited by this sort of basic but important reform. And right now it is doubly hard.

这个办法靠谱——正是政府凭常识应该采取的行动（企业每天都在这样做）。但即便情况最好的时候，这种基础但重要的改革也很难让选民或媒体受众感到特别兴奋。而现在更是难上加难。

That is partly because the media are mesmerised by the investigations surrounding Trump and his entourage, including Kushner. But it is also because Trump himself keeps creating distractions with his own deliberately incendiary tweets, making it difficult for voters to pay any attention to the sensible reforms that advisers such as Kushner want to promote.

部分原因在于媒体过于关注围绕特朗普及其团队（包括库什纳）的调查。还因为特朗普本人故意发布煽动性推文、不断制造各种干扰，使选民难以静下心来关注库什纳等顾问希望推进的合理改革。

Therein lies a huge missed opportunity. It would be comic if it were not so tragic; we’d better just hope those VA reforms fly.

这其中蕴含着一个巨大的错失的机遇。如果情况不是如此悲剧的话，看上去还有些滑稽可笑；我们最好还是祈祷退伍军人事务部的这些改革能够成功。