Physician adoption of EHRs has been rising, according to surveys by the Centers for Disease Control and Prevention, the Commonwealth Fund and Kalorama Information. What's driving the trend is not necessarily the promise of ARRA bonuses.
According to the Commonwealth Fund, office-based physicians are not persuaded by federal incentives as much as they are by studies validating their billing efficiencies, which leads to increased revenue. Getting reimbursed for having the ability to do quality reporting and e-prescribe for Medicare and Medicaid patients is also a driver for implementing an EMR.
They're all financial incentives, but I suppose the difference is that the ARRA bonuses are a one-time deal, whereas the other incentives are continuous. More importantly, I think, the other incentives don't have complicated strings attached to them, or meaningful use criteria.
This makes a lot of sense when you come across the data point made in the surveys that the number of physicians who have EMRs but don't use them to their fullest extent hasn't hit double digits. Physicians fear - rightly so - the impact of EHRs and EMRs to their workflow and the all-but-guaranteed initial loss of productivity. Basic systems are more desirable because the impact is minimized and the complexity remains low.
So why would you buy a system that has more functionality if you're not going to use it to its full potential? That's where one hopes ARRA makes an impact. You need those higher-end capabilities to meet the meaningful use criteria, which are tied to improving quality of care and patient safety, and qualify for the federal incentives. But all that is moot if you don't think $44,000 is a good trade for more complexity and objectives that are hard to achieve. If you implemented an EHR or EMR that minimally impacted your office during and after implementation, and helps you increase revenue and provide good basic care, why would you "trade up"?
