Betting $19 Billion on Digital Docs

What will it take to drive doctors to go digital with electronic health records (EHRs)?

The government is putting down at least $19 billion to start. $2 billion is slated for health IT grants, training and state programs. Starting in 2011, the remaining $17 billion is planned for Medicare/Medicaid incentives that encourage doctors and hospitals to use EHRs. If that doesn't work, penalties would begin in 2015.

The influx of billions of dollars is essential, but not enough to overcome major obstacles. It will take unprecedented participation, cooperation and ingenuity for most patients and America's health system to reap the benefits of EHRs. We have a lot to overcome.

A long path. A 2007-08 NEJM study found that only 4 percent of physicians had adopted a fully functional EHR system. Likewise, a 2009 study found that only 1.5 percent of non-federal U.S. hospitals had a comprehensive EHR system.

A checkered past. Initial forays into EHR did not go well. Many of the first systems were expensive and difficult to use. Many physicians rebelled and then surrendered.

A challenging puzzle. Dozens of vendors have already placed proprietary systems that are not compatible. Setting standards and connecting them into a shared network is a daunting task. 

A fragmented landscape. Getting competing interests to cooperate across shared geography can be difficult. Issues arise around where the data is stored and who has access. 

 A difficult sell. Overtaxed, underpaid physicians say that any EHR that doesn't save them time and help earn them money isn't going to get their attention, let alone the dedication needed to master it.

Betting $19 billion is not enough to win, but it keeps the digital revolution in play.

Expanding successes. Some hospitals are already using EHRs in a powerful way. Regional Health Information Organizations are in the works. A government spotlight will accelerate progress.

Encouraging innovation. Technology companies, large and small, will get a boost to provide solutions demanded by the government. Entrepreneurs will fill the gaps.

Setting a national agenda. If only establishing a nationwide EHR had the cache of landing a man on the moon. Maybe once its benefits are more broadly demonstrated and understood, the whole idea will capture the public's imagination.

The benefits of EHRs are priceless. Connecting our hospitals, physicians offices and other provider sites with a common EHR system that readily shares medical information will revolutionize care. It will take a lot of time and money, but the government is off to a good start. EHRs and healthcare reform could have been off the table in these times of uncertainty. Instead, we're betting on future success. 

—Tom DeSanto

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