Perspective:

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act. The HITECH Act makes available funds for clinicians and hospitals to implement electronic health records (EHRs) and also to become meaningful users of certified health information technology (IT). The HITECH Act authorized the creation of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs that offer physicians payments for meaningful use of EHRs. There are expected to be three stages of meaningful use that physicians must achieve to qualify for the full amount of available incentive payments. Each stage will build on the previous stage, incrementally requiring advanced use of technology. The first stage focuses on structured data entry in the EHR; the second stage will guide clinicians on the use of technology toward advanced clinical processes; and the third stage will be aimed at achieving and measuring improved patient outcomes. The adoption of EHR involves significant changes and challenges for physicians, with resultant dislocations in workflows, investments, and habits of practice. Although the ultimate benefits for both practice management and health care are likely to make this transition worthwhile, the disruption/discomfort for physicians during the transition ought not to be underestimated. Thus, crafting effective policies regarding meaningful use and related incentive payments should be an exercise in balance and moderation. Beyond the federal incentive programs, successful nationwide adoption of health IT will require partnership and assistance from the private sector; recognition of meaningful use as a key capability in readiness for payment reform; and incorporation of relevant competencies into graduate/undergraduate medical education and training.