Electronic health record (EHR) advocates in Washington don’t seem to get it. They don’t seem to understand that hospitals and doctors aren’t rushing to install EHRs because many EHRs, despite the constant talk that EHRs are a prerequisite for good care. Caregivers are not walking the talk, because in their view, EHRs,

• aren’t ready for prime time
• slow productivity
• decrease revenues,
• show scant returns on investment
• don’t talk to one another
• distract from time spent with patients
• are limited as communication tools

If I may use bureaucratic parlance, EHRs aren’t “meaningful” to clinicians. This may change as EHR vendors, doctors, hospitals, and IT consultants gather at the $27 billion EHR government trough, but it will remain slow because economic and health reform uncertainties.

Washington hopes to overcome resistance to EHRs with a carrot and stick approach. CMS will reward doctors and hospital with bonuses and other rewards for adopting EHRs and penalize those who don’t with lower fees and withdrawal of the Government’s Good House Keeping Seal of Approval.

Unfortunately, the Washington elite overlook the hassle factor. To qualify for the up to $64,000 subsidies for physicians and millions of dollars of handouts for hospitals, providers will have to “qualify” for payouts by meeting 23 to 25 “criteria for “meaningful use.”

The problem is: what is “meaningful” for government may not be “meaningful” for small hospitals and small practices, who are struggling to make ends meet.

Katherine Hobson, who writes the Wall Street Journal’s health care blog, captures the essence of this problem for hospitals in “Only 2% of Hospitals Could Have Met ‘Meaningful Use’ in 2009.”

She says, among other things, that,

• “Despite all the talk about digitizing the health-care world, only 11.9% of U.S. hospitals had adopted at least basic electronic medical records by last year, and only about 2% had done enough to qualify for future government financial incentives, a study finds. The study, published online in Health Affairs, covers responses from 3,101 hospitals surveyed by the American Hospital Association.”
• “It’s actually not surprising that hospitals were slow to adopt new systems in 2009, given the horrible economic conditions, difficulty of raising money for capital investments and uncertainty over what the final government requirements would be.”
• “The study found a widening gap between larger, nonprofit, urban hospitals and critical-access, small or medium-sized, public or rural hospitals in the adoption of digitized records. For example, 7.5% of large hospitals would have met the requirements, compared to 1.2% of small ones.”
• “Of course that gap is only a concern if you believe that electronic medical records are a good thing. For their part, the authors write that electronic records have been associated with the potential to improve the quality of care for underserved patients, improve patient safety via electronic prescribing and improve adherence to evidence-based care.”
• “If you adopt a new technology, and do it badly, you can end up making productivity worse or causing harm. This is not a plug and play.”

Those at the top of the health care tree in government say EHRs are a wonderful thing, but small hospitals and doctors in small practices with limited resources, who provide most care in America, are not ready to go out on the EHR limb.

Yet, despite obstacles and slowness in adopting, a combination of things – widespread “free” or inexpensive EHR systems, speech recognition programs enabling doctors to easily incorporate their thoughts and the patient narrative into EHRs, advances in wireless “touch” technologies, social pressures from patients, and financial assistance from payers – will help make the “inevitable” more “evitable.”

EHRs will eventually evolve from below, but they need not and are unlikely to be forced from above.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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