In 2008, 17 percent of office-based physicians and just 9 percent of hospitals had basic electronic health records (EHRs) and fewer than 10 percent used electronic prescriptions. This doesn’t mean most physicians were Luddites; rather, there were powerful disincentives to their adoption of health IT.
For example: Installing electronic health records required retraining physicians and staff, exacting months of significantly reduced productivity. Technology from different vendors typically did not communicate with each other, so the free flow of information — referral letters, hospital discharge summaries, lab results, X-rays and all the rest — that would make the investment worthwhile was not there. Then there was the network effect: Until a lot of doctors and hospitals were using electronic health records and a lot of vital information was available electronically — even if the various proprietary systems did communicate — it wasn’t worth it. And finally physicians feared that an expensive new EHR system would soon be obsolete, requiring another big capital investment.
On Feb. 17, 2009, President Obama signed the Recovery Act, which contained a number of healthcare provisions, including the Health Information Technology for Economic and Clinical Health Act (HITECH), which nullified these disincentives. HITECH did this by providing physicians payments of up to $44,000 from Medicare and $65,000 from Medicaid — and hospitals getting millions of dollars, with amounts varying based on how many Medicare and Medicaid patients they cared for — to help defray the cost of EHR adoption. Obviously, this is not free money. Physicians and hospitals receive the incentive payments if their EHRs are certified as capable of supporting “meaningful use.” This, in practical terms, means they can be used for e-prescribing, securely exchanging patients’ health information and electronically submitting data on the quality of care. The law also includes a penalty for physicians and hospitals that do not implement EHRs: Their Medicare payments will be reduced beginning in 2015. It also empowers the government to set technology standards regarding interoperability and the secure exchange of health information.
A lot of naysayers carped that this was not an economic stimulus that would help get the country out of a recession, so it didn’t belong in the Recovery Act. Others complained about the myriad requirements necessary for meaningful use. And not a few physicians were resentful, declaring that they would stop practicing rather than adopt EHRs.
It’s now been a year since the administration released the regulations specifying meaningful use and what it takes to be certified — the nuts and bolts of implementing the law. The results have been nothing short of spectacular.