When President Obama laid out his tentative budget for the next fiscal year, health technology was conspicuous by its presence. The $3.8 trillion spending plan is ripe with IT-related outlays. The dollars are primarily intended to fund existing obligations, to spur innovation and to crack down on miscreants. Implied but not stated is a monumental and somewhat contradictory mandate: IT needs to make healthcare better while lowering overall costs. So far, the second part of the mandate has been an elusive target.