DISCUSSION #12
SamanthaJa
Benefitsanddrawbacksofelectronichealthrecordsystems.pdf
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Open Access Full Text Article
DOI: 10.2147/RMHP.S12985
Benefits and drawbacks of electronic health record systems
Nir Menachemi1
Taleah H Collum2
1Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA; 2Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
Correspondence: Nir Menachemi UAB School of Public Health, 1530 3rd Ave, S Birmingham, AL 35294, USA Tel +1 205 934 7192 Fax +1 205 934 3347 email [email protected]
Abstract: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the “stimulus package” represents the largest
US initiative to date that is designed to encourage widespread use of electronic health records
(EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper
is to review and summarize the literature on the benefits and drawbacks of EHR systems.
Much of the literature has focused on key EHR functionalities, including clinical decision sup-
port systems, computerized order entry systems, and health information exchange. Our paper
describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality,
reduced medical errors), organizational outcomes (eg, financial and operational benefits), and
societal outcomes (eg, improved ability to conduct research, improved population health, reduced
costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs,
which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions
to workflows that contribute to temporary losses in productivity that are the result of learning a
new system. Moreover, EHRs are associated with potential perceived privacy concerns among
patients, which are further addressed legislatively in the HITECH Act. Overall, experts and
policymakers believe that significant benefits to patients and society can be realized when EHRs
are widely adopted and used in a “meaningful” way.
Keywords: EHR, health information technology, HITECH, computerized order entry, health information exchange
Introduction Over the past decade, virtually every major industry invested heavily in computerization.
Relative to a decade ago, today more Americans buy airline tickets and check in to
flights online, purchase goods on the Web, and even earn degrees online in such disci-
plines as nursing,1 law,2 and business,3 among others. Yet, despite these advances in our
society, the majority of patients are given handwritten medication prescriptions, and
very few patients are able to email their physician4 or even schedule an appointment
to see a provider without speaking to a live receptionist.5
Electronic health record (EHR) systems have the potential to transform the health
care system from a mostly paper-based industry to one that utilizes clinical and other
pieces of information to assist providers in delivering higher quality of care to their
patients. The Health Information Technology for Economic and Clinical Health
(HITECH) Act of 2009, which is part of the American Recovery and Reinvestment
Act (ARRA) (aka “stimulus package”), was signed into law with an explicit purpose
of incentivizing providers (eg, hospitals and physicians) to adopt EHR systems.
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Menachemi and Collum
However, given that a bare-bone EHR system provides
only partial benefits to patients and society,6 the HITECH
Act requires that providers adopt EHRs and utilize them
in a “meaningful” way, which includes using certain EHR
functionalities associated with error reduction and cost
containment. How exactly do EHRs improve care? And what
is the current evidence that certain EHR “meaningful use”
functionalities will translate into benefits? Answering these
questions is the purpose of this paper. Stated explicitly, the
purpose of this study is to review the literature on the impacts
of EHR. Impacts include both benefits and drawbacks, and, as
such, we discuss the advantages and disadvantages that have
been identified by researchers and other experts. Overall, we
expect that any reader interested in understanding the current
state of the knowledge base with regard to EHR benefits will
find this paper useful.
Why we need EHRs EHRs are defined as “a longitudinal electronic record of
patient health information generated by one or more encoun-
ters in any care delivery setting. Included in this informa-
tion are patient demographics, progress notes, problems,
medications, vital signs, past medical history, immunizations,
laboratory data, and radiology reports”.7 Some of the basic
benefits associated with EHRs include being able to easily
access computerized records and the elimination of poor
penmanship, which has historically plagued the medical
chart.8,9 EHR systems can include many potential capabili-
ties, but three particular functionalities hold great promise
in improving the quality of care and reducing costs at the
health care system level: clinical decision support (CDS)
tools, computerized physician order entry (CPOE) systems,
and health information exchange (HIE). These and other
EHR capabilities are requirements of the “meaningful use”
criteria set forth in the HITECH Act of 2009.10
A CDS system is one that assists the provider in making
decisions with regard to patient care. Some functionalities of
a CDS system include providing the latest information about
a drug, cross-referencing a patient allergy to a medication, and
alerts for drug interactions and other potential patient issues
that are flagged by the computer. With the continuous growth
of medical knowledge, each of these functionalities provides a
means for care to be delivered in a much safer and more effi-
cient manner. As more and more CDS systems are used, one
can expect certain medical errors to be averted and that, overall,
the patient will receive more efficient and safe care.11
CPOE systems allow providers to enter orders (eg, for
drugs, laboratory tests, radiology, physical therapy) into
a computer rather than doing so on paper. Computerization of
this process eliminates potentially dangerous medical errors
caused by poor penmanship of physicians. It also makes the
ordering process more efficient because nursing and phar-
macy staffs do not need to seek clarification or to solicit miss-
ing information from illegible or incomplete orders. Previous
studies suggest that serious medication errors can be reduced
by as much as 55% when a CPOE system is used alone,12
and by 83% when coupled with a CDS system that creates
alerts based on what the physician orders.13 Using a CPOE
system, especially when it is linked to a CDS, can result in
improved efficiency and effectiveness of care.
Once health data are available electronically to providers,
EHRs facilitate the sharing of patient information through
HIE. HIE is the process of sharing patient-level electronic
health information between different organizations14 and can
create many efficiencies in the delivery of health care.15 By
allowing for the secure and potentially real-time sharing of
patient information, HIE can reduce costly redundant tests
that are ordered because one provider does not have access
to the clinical information stored at another provider’s
location. Patients typically have data stored in a variety of
locations where they receive care. This can include their
primary care physician’s office, as well as other physician
specialists, one or more pharmacies, and other locations, such
as hospitals and emergency departments. Over a lifetime,
much data accumulates at a variety of different places, all
of which are stored in silos. Historically, providers rely on
faxing or mailing each other pertinent information, which
makes it difficult to access in “real time” when and where it
is needed. HIE facilitates the exchange of this information
via EHRs, which can result in much more cost-effective and
higher-quality care.
In the following section, we describe the literature that has
examined the effect of EHRs on various clinical and orga-
nizational outcomes. A large proportion of the literature has
focused on one or more computerized capabilities of EHRs,
including CDS, CPOE, and HIE. Many of these studies have
been discussed in previously published literature reviews,16–20
so we further summarize them here.
Advantages of EHRs Researchers have examined the benefits of EHRs by con-
sidering clinical, organizational, and societal outcomes.
Clinical outcomes include improvements in the quality of
care, a reduction in medical errors, and other improvements
in patient-level measures that describe the appropriateness
of care. Organizational outcomes, on the other hand, have
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Benefits and drawbacks of EHRs
included such items as financial and operational performance,
as well as satisfaction among patients and clinicians who
use EHRs. Lastly, societal outcomes include being better
able to conduct research and achieving improved population
health.
eHRs and clinical outcomes Many clinical outcomes that have been a focus of EHR
studies relate to quality of care and patient safety. Quality
of care has been defined as “doing the right thing at the right
time in the right way to the right person and having the best
possible results”,21 and patient safety has been defined as
“avoiding injuries to patients from the care that is intended
to help them”.11 Quality of care includes six dimensions,11
but most EHR research has focused on the following three:
patient safety, effectiveness, and efficiency. In the following
paragraphs we summarize some of the studies that examine
how EHRs or various related components impact these three
quality dimensions. More research is needed on the other
three components: patient centeredness, timeliness, and
equitable access.
EHRs, especially those with CDS tools, have been
empirically linked to an increased adherence to evidence-
based clinical guidelines and effective care. Despite the best
intention of providers, various factors may result in patient
encounters that do not adhere to best practice guidelines.
Some reasons for this nonadherence include i) clinicians
not knowing the guidelines, ii) clinicians not realizing that
a guideline applies to a given patient, and iii) lack of time
during the patient visit. EHR systems try to overcome these
issues, and researchers have focused on preventive services,
including vaccine administration, to examine how EHRs can
improve adherence rates. For example, researchers found
that computerized physician reminders increased the use of
influenza and pneumococcal vaccinations from practically
0% to 35% and 50%, respectively, for hospitalized patients.22
A similar study, but in the outpatient setting, found that
computerized reminders were associated with improved
influenza and pneumococcal vaccination rates among rheu-
matology patients taking immunosuppressant medications.23
Specifically, influenza vaccinations increased from 47% to
65% of patients, and pneumococcal vaccinations increased
from 19% to 41% of patients. Other studies on vaccination
rates found comparable results that computerized reminders
can improve adherence to immunization guidelines.24,25
From the societal public health perspective, adhering to
these guidelines keeps individuals healthy and lowers the
risk of disease outbreaks in communities. Researchers have
also focused on other preventive services and on how EHRs
can improve various outcomes and make care more effective.
Kucher et al26 hypothesized that computerized alerts, as part
of a CPOE system with CDS, directed at physicians may
increase the use of prophylactic care for hospitalized patients
at high risk for deep vein thrombosis. They found a 19%
increase in the use of anticoagulation prophylaxis when using
computer alerts, and this translated into a 41% reduced risk
of deep vein thrombosis or pulmonary embolism at 90 days
after discharge. Willson et al27 found a significant association
between computerized reminders and pressure ulcer preven-
tion in hospitalized patients. They found a 5% decrease in
the development of pressure ulcers 6 months after the imple-
mentation of computerized reminders that targeted hospital
nurses. Other similar studies found comparable results. Rossi
and Every,28 for example, found that computerized reminders
as part of a CDS have been linked to an 11.3% increase in
appropriate hypertension treatment in a primary care setting.
Other studies in the outpatient setting have also found that
an EHR and its components significantly increase adherence
to protocol-based or recommended care.29,30
Although researchers have found CDS tools to be ben-
eficial in most situations, many medical conditions do not
have scientifically based guidelines for providers to follow,
thus reducing the usefulness and effectiveness of these tools
in many clinical situations. More scientific-based guidelines
need to be developed in order to maximize the benefits associ-
ated with CDS. Similar to a focus on adherence to guidelines,
researchers have also found an association between EHRs
and efficiency in health care delivery. Efficiency refers to the
avoidance of wasting resources, including supplies, equip-
ment, ideas, and energy.11 One such form of waste involves
redundant diagnostic testing. Performing redundant tests is
costly and may lead to more false-positive results, which will
then lead to even more costs.31 Evidence indicates that there
is a significant negative (eg, desirable) association between
redundant diagnostic testing and the use of an EHR and/or its
components. For example, Nies et al32 examined the affects
of a CDS on the redundancy of blood tests in a cardiovas-
cular surgery department. They found that point-of-care
computerized reminders of previous blood tests significantly
reduced the proportion of unnecessarily repeated tests. In the
outpatient setting, Tierney et al33 found a 14.3% decrease in
the number of diagnostic tests ordered per visit and a 12.9%
decrease in diagnostic test costs per visit when using an
EHR with CDS and CPOE components. Other, unrelated
studies found an 18% decrease in tests ordered for medical
visits in the emergency department,34 a 27% decrease in
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redundant laboratory tests of antiepileptic medication levels
in hospitalized patients,35 and a 24% reduction in redundant
laboratory tests in a hospital.36
Studies focusing on patient safety have frequently exam-
ined the effect of EHR components on medical or medication
errors. In a widely cited study, experts found that a CPOE
system was associated with a 55% reduction in serious
medication errors in the hospital setting.12 A follow-up
study by the same team found that by adding a CDS system
to a CPOE system, medication errors can be reduced by as
much as 86%.13 A similar, more recent study in the outpa-
tient setting found that computerization resulted in an error
rate reduction from 18.2% to 8.2%.37 Other studies have
concluded that the number of appropriate medication orders
involving dosing levels or dosing frequency can be increased
with the use of a computerized system.38 Specifically, in
one study, the use of a CDS yielded a 32% decrease in the
number of days that antibiotics were prescribed outside the
recommended dosage range and a 59% decrease in the need
for pharmacist intervention to correct a drug dose.39 On
the other hand, a few studies have found an association
between the use of CPOE and increased medical errors.
These increases generally occur due to poorly designed
system interfaces, lack of end-user training,40 or lack of sys-
tems integration.41 Factors such as dense pull-down menus
and text entries in inappropriate areas of an EHR can have
negative consequences for patients.40 Specifically, one study
found that the use of a CPOE was associated with 22 types
of medication error risks.41
Many of the studies described have focused on clini-
cal outcomes at the patient level. Such studies have been
conducted in a clinical setting, frequently by employing a
randomized trial research design. An additional body of lit-
erature has examined, observationally, whether hospitals that
have adopted EHR or other computerized capabilities per-
form better than their counterparts that have not. For example,
Menachemi et al42 found that Florida hospitals with greater
investments in EHR technologies had more desirable rates
on a variety of commonly used quality indicators. In a simi-
lar study of hospitals, researchers found that computerized
records and order entry were associated with lower mortality
rates, and CDS was associated with fewer complications.43
Additionally, the same study found that computerized test
results, order entry, and CDS were all associated with lower
costs. However, despite the results discussed here, other
researchers have found only small positive effects from EHR
adoption44,45 or mixed results.46
eHRs and organizational and societal outcomes Organizational outcomes Studies examining organizational outcomes have focused
on EHR use in both the inpatient and outpatient settings.
Such outcomes have frequently included increased revenue,
averted costs, and other benefits that are less tangible, such as
improved legal and regulatory compliance, improved ability
to conduct research, and increased job/career satisfaction
among physicians. Increased revenue comes from multiple
sources, including improved charge capture/decrease in
billing errors, improved cash flow, and enhanced revenue.
Several authors have asserted that EHRs assist providers in
accurately capturing patient charges in a timely manner.47,48
With an EHR system, many billing errors or inaccurate
coding may be eliminated, which will potentially increase a
provider’s cash flow and enhance revenue.18,49,50 Reductions
to outstanding days in accounts receivable and lost or disal-
lowable charges can potentially lead to improved cash flow.50
In addition, EHR reminders to providers and patients about
routine health visits can increase patient visits and therefore
enhance revenue.49
Many averted costs associated with EHRs are the result of
efficiencies created by having patient information electroni-
cally available. Some of these include increased utilization of
tests, reduced staff resources devoted to patient management,
reduced costs relating to supplies needed to maintain paper
files, decreased transcription costs, and the costs relating
to chart pulls. The use of EHRs can reduce the redundant
use of tests or the need to mail hard copies of test results to
different providers.35,51 By making patient information more
readily available, EHRs reduce costs related to chart pulls52
as well as supplies needed to maintain paper charts.53 Studies
have also shown that having an EHR as opposed to a paper
file can result in reduced transcription costs through point-
of-care documentation and other structured documentation
procedures.50 One author found a significant decrease in staff
resources dedicated to anemia management for hemodialysis
patients when a CDS was used for medication dosing.54
Other, less tangible benefits have been associated with
EHR use. In a study conducted by Bhattacherjee et al,55
Florida hospitals with a greater adoption of health informa-
tion technology had higher operational performance, as
measured by outcomes of Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) site visits. It has also
been pointed out that EHRs can facilitate improved legal
and regulatory compliance in terms of increased security of
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Benefits and drawbacks of EHRs
data and enhanced patient confidentiality through controlled
and auditable provider access.50 In addition, researchers in
Massachusetts have found that physicians using an EHR had
fewer paid malpractice claims.56 Specifically, they found
that 6.1% of physicians with an EHR had a history of paid
malpractice claims compared with 10.8% of physicians with-
out EHRs. This reduction is potentially the result of increased
communication among caregivers, increased legibility and
completeness of patient records, and increased adherence to
clinical guidelines.
Societal benefits Another less tangible benefit associated with EHRs is an
improved ability to conduct research. Having patient data
stored electronically increases the availability of data, which
may lead to more quantitative analyses to identify evidence-
based best practices more easily.57 Moreover, public health
researchers are actively using electronic clinical data that
are aggregated across populations to produce research that
is beneficial to society. The availability of clinical data is
limited, but as providers continue to implement EHRs, this
pool of data will grow. By combining aggregated clinical
data with other sources, such as over-the-counter medica-
tion purchases and school absenteeism rates, public health
organizations and researchers will be able to better monitor
disease outbreaks and improve surveillance of potential
biological threats.58
Researchers have also found an association between EHR
use and physician satisfaction with their current practice,59 as
well as their career satisfaction.60 According to many stud-
ies, physician satisfaction should be a priority in health care
organizations, because it is associated with better quality of
care, better prescribing behaviors, and increased retention
in medical practices, particularly those in underserved
areas.61,62
To balance the generally positive findings of the afore-
mentioned studies, Chaudhry et al16 noted that a large pro-
portion of the studies that found benefits from EHR were
conducted in a select number of academic medical centers.
This raises the question about whether or not many of the
benefits identified can be generalized to other settings of care
that do not have similar financial and human resources nor a
decades-long commitment to health information technology.
More research on the varying types and degrees of benefits
associated with EHR is warranted, especially in community
settings such as physician practices and nonacademic hospital
settings.
Potential disadvantages of EHRs Despite the growing literature on benefits of various EHR
functionalities, some authors have identified potential dis-
advantages associated with this technology. These include
financial issues, changes in workflow, temporary loss of pro-
ductivity associated with EHR adoption, privacy and security
concerns, and several unintended consequences.
Financial issues, including adoption and implementation
costs, ongoing maintenance costs, loss of revenue associated
with temporary loss of productivity, and declines in revenue,
present a disincentive for hospitals and physicians to adopt
and implement an EHR. EHR adoption and implementation
costs include purchasing and installing hardware and soft-
ware, converting paper charts to electronic ones, and training
end-users. Many studies have documented these costs in both
the inpatient and outpatient settings.47,50 In a 2002 study con-
ducted in a 280-bed acute care hospital, the projected total cost
for a 7-year-long EHR installation project was approximately
US$19 million.47 In the outpatient setting, early researchers
estimated an average initial cost of US$50,000–US$70,000
per physician for a three-physician office.50 However, as EHR
technologies have become more commonplace over the past
decade, the initial cost of systems has come down dramatically.
One industry group estimated hardware, software, services,
and telecommunications cost of approximately US$14,000
per physician in the initial year of implementation for a six-
physician practice and US$19,000 per physician with three or
fewer physicians.63 Similarly, a recent study estimates initial
costs of software, training, and installation of US$22,038 and
hardware costs of US$13,000 per full-time-equivalent (FTE)
provider in a solo or small-group primary care practice.64
Lastly, another study estimated costs during the first 60 days
of launch of US$162,047 (or US$32,409 per physician) for a
five-physician practice to implement an EHR system.65
The maintenance cost of an EHR can also be costly.
Hardware must be replaced and software must be upgraded
on a regular basis. In addition, providers must have ongoing
training and support for the end-users of an EHR. According
to one study conducted on 14 solo or small-group primary
care practices, estimated ongoing EHR maintenance costs
averaged US$8412 per FTE provider per year. A total of
91% of this cost was related to hardware replacement, vendor
software maintenance and support fees, and payments for
information systems staff or external contractors.64 Other
estimates of ongoing maintenance costs for the first year
after implementation were about US$17,100 per physician
in a medical group of five.65
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The costs of EHR adoption, implementation, and ongoing
maintenance are compounded by the fact that many financial
benefits of an EHR generally do not accrue to the provider
(who is required to make the upfront investment) but rather
to the third-party payers in the form of errors averted and
improved efficiencies, which translate into reduced claims
payments. This misalignment of incentives for health care
organizations, along with the high upfront costs, creates a bar-
rier to adoption and implementation of an EHR, especially for
smaller practices. In fact, physicians frequently cite upfront
costs and ongoing maintenance costs as the largest barriers
to adoption and implementation of an EHR.66
Another disadvantage of an EHR is disruption of work-
flows for medical staff and providers, which result in tem-
porary losses in productivity. This loss of productivity stems
from end-users learning the new system and may potentially
lead to losses in revenue. One study involving several internal
medicine clinics estimated a productivity loss of 20% in the
first month, 10% in the second month, and 5% in the third
month, with productivity subsequently returning to its origi-
nal levels.52 In that study, the loss in productivity resulted in
lost revenue of US$11,200 per provider in the first year. In
a study of solo and small-group primary care practices of
one to six FTE providers, revenue losses from reduced visits
during the initial stages of an EHR averaged approximately
US$7500 per FTE provider. This depended on whether
physicians worked longer hours during this stage or reduced
patient visits.64 Lastly, researchers have estimated that EHR
end-users spent 134.2 hours on implementation activities
associated with getting and learning a new system. These
hours spent on nonclinical responsibilities had an estimated
cost of US$10,325 per physician.65
Other declines in revenue are possible following EHR
implementation. Because EHRs are often associated with
fewer redundancies, fewer errors, and shorter lengths of stay,
it is conceivable that a given provider may avert certain bill-
able transactions that, although superfluous, may have gener-
ated reimbursements from third-party payers, especially in
a fee-for-service payment system. Although reimbursement
rates may differ for each organization, these declines could
be offset by increased revenue that is generated as a result of
efficiencies achieved with the help of an EHR system.64
Another potential drawback of EHRs is the risk of
patient privacy violations, which is an increasing concern
for patients due to the increasing amount of health informa-
tion exchanged electronically.67,68 To relieve some of these
concerns, policymakers have taken measures to ensure
safety and privacy of patient data. For example, recent
legislation has imposed regulations specifically relating to
the electronic exchange of health information that strengthen
existing Health Insurance Portability and Accountability Act
privacy and security policies.69 Although few electronic data
are 100% secure, the rigorous requirements set forth by the
new legislation make it much more difficult for electronic
data to be accessed inappropriately. For example, all EHR
systems are required to have an audit function that allows
system operators to identify each individual who accessed
every aspect of a given medical record. Many hospitals and
physicians are implementing strict, no tolerance penalties for
employees who access files inappropriately. For example, a
hospital in Arizona terminated several employees after they
inappropriately accessed the records of victims who were
hospitalized after the January 2011 shooting involving a US
Congresswoman.70 Although privacy will likely continue
to be a concern for patients, many steps are being taken by
policymakers and individual organizations to ensure that
EHRs comply with the strict laws and regulations intended
to ensure the privacy of clinical information.
EHRs may cause several unintended consequences, such
as increased medical errors, negative emotions, changes
in power structure, and overdependence on technology.40
As mentioned previously, researchers have found an asso-
ciation between the use of CPOE and increased medical
errors due to poorly designed system interfaces or lack of
end-user training. Additionally, end-users of an EHR may
experience strong emotional responses as they struggle to
adapt to new technology and disruptions in their workflow.
Changes in the power structure of an organization may also
occur due to the implementation of an EHR. For example, a
physician may lose his or her autonomy in making patient
decisions because an EHR blocks the ordering of certain
tests or medications. Overdependence on technology may
also become an issue for providers as they become more
reliant upon it. Organizations should ensure that basic medi-
cal care can still be provided in the absence of technology,
especially in times when the downtime of the system may be
critical. Although there are many unintended consequences
of EHRs, when balancing the advantages and disadvan-
tages of these systems, they are beneficial, especially at
the society level.
Conclusion In this paper we discussed several advantages and disad-
vantages associated with an EHR adoption. Many of the
benefits accrue to patients and society overall. For these
benefits to be realized, the US Government has embarked
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Benefits and drawbacks of EHRs
on an ambitious journey to transition a maximum number
of providers toward EHR adoption and “meaningful use”.
Without ubiquitous use of EHR technologies, experts believe
that many efficiencies in the US health care system cannot be
realized.15 The financial incentives built into the HITECH Act
are designed to defray some of the costs associated with EHR
adoption, especially for smaller organizations where these
expenses serve as a major barrier. The financial incentives
in HITECH, which are made available through the Medicare
and Medicaid programs, are also an attempt to correct some
of the misalignment of incentives associated with EHR as
discussed previously, especially because the US Government,
through the Medicare and Medicaid programs, is the largest
insurer in the country.
Incentives made available to physicians through
the HITECH Act differ among Medicaid and Medicare
physicians.71 Medicaid offers more generous incentives
than Medicare and has less stringent requirements for the
first year. Physicians with more than 30% of their patients
paying with Medicaid are eligible for up to US$63,750 in
incentives over a 6-year period. They can begin earning these
incentives as they adopt, implement, or upgrade an EHR.
The last year to begin participation in the Medicaid incentive
program is 2016, and physicians do not need to begin prov-
ing “meaningful use” until the second year of their program
participation. On the other hand, physicians accepting more
Medicare patients are eligible for up to US$44,000 over a
5-year period as long as they can meet the “meaningful
use” criteria starting the first year. Physicians not meeting
the “meaningful use” criteria by 2015 will be assessed for
penalties in the form of reduced Medicare reimbursements.
Physicians are allowed to participate in either the Medicaid
or Medicare incentive program, but not both. Those who are
eligible are expected to participate in the Medicaid program,
because its benefits are more generous. Hospitals are also
eligible for incentives under the HITECH Act. The amount
of the incentives they receive depends on a number of fac-
tors, but the base amount to each hospital that complies with
the meaningful use criteria will be more than US$2 million.
Both physician and hospital incentives are structured so that
those immediately achieving meaningful use of an EHR will
receive larger payments.
Providers are also expected to face technological and
logistical obstacles on their quest to achieve meaningful
use of EHRs.72 To help combat the technological problems
faced by providers, the federal government, through the
HITECH Act, has committed approximately US$650 mil-
lion for the establishment of a network of up to 70 regional
health information technology extension centers. The primary
purpose of these organizations is to offer advice to physi-
cians on which information technology systems they should
purchase and assistance on how to become meaningful
users of EHRs. To address some of the logistical problems
associated with EHRs, the federal government has entrusted
US$560 million under the HITECH Act to state govern-
ments for the development of infrastructure to facilitate the
exchange of health information.
Nationwide implementation of EHRs is a necessary,
although not sufficient, part in transforming the US health
care system for the better. EHR adoption must be consid-
ered one of many approaches that diversify our focus on
quality improvement and cost reduction. The current major
legislative and political support for EHRs represents the
greatest investment in health information technologies in
US history. Over time, providers and researchers will be
eager to quantify the returns that are expected from these
investments.
Disclosure The authors report no conflicts of interest in this work.
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