Will EHRs be mandated?

Think you can put off buying an EHR (or EMR, as some still call it) indefinitely? Well, not if the Commonwealth Fund's recommendations to the next U.S. President are adopted. A leading liberal think tank based in Boston, the Commonwealth Fund just issued a report making specific recommendations on health care reform. Among its proposals is one that would require every physician to have an EHR within five years. Doctors would also be required "to participate in a health information exchange network that links information across clinical settings."

While none of the Presidential candidates has advocated mandatory use of EHRs, many of the aspirants in both parties favor the promotion of health information technology.

The Commonwealth Fund notes that universal EHR adoption would lead to better care coordination and more effective use of evidence-based medicine and best-practice guidelines. It's hard to argue with that. But the question is whether its proposal to mandate the use of EHRs is feasible.

Some organizations are already answering that question in the affirmative. For example, Partners Healthcare, a large health care system in Boston, recently told the primary care physicians in its contracting network that they must implement or agree to buy an EHR by Jan. 1; specialists are to follow a year later. While we haven't heard of any other hospital systems doing this, it's likely some dominant players will follow suit as they seek to become more clinically integrated.

But there's still a large gap between the desire and the reality. The Commonwealth Fund, citing its own international data, says that 28 percent of U.S. primary-care doctors have some kind of EHR, and 19 percent have advanced systems. A recent CDC survey, however, found that only 12.4 percent of all U.S. physicians were using comprehensive EHRs, and National Coordinator for Health IT Robert Kolodner says that only 4 percent of doctors in practices of one or two physicians have them.

The Commonwealth Fund experts acknowledge that doctors and hospitals receive only a small fraction of the economic benefits of using EHRs. Therefore, they urge payers to help fund information systems. They also argue that if the reimbursement system rewarded physicians for quality care, the government and health plans might not have to pay directly for EHRs.

As for the electronic networks that the Commonwealth Fund advocates, a recent report from the Information Technology & Innovation Foundation asserts that efforts to build regional health information organizations don't hold much promise. The problem, the report says, is that most RHIOs are financially unsustainable. Also, a paucity of national standards has retarded interoperability among EHRs. The foundation recommends that Congress enact legislation to promote use of EHRs and national data standards, and that it create a legal framework for "health records banks." These are central repositories of data from physicians, hospitals, pharmacies, labs, insurers, and other sources. Patients would pay "modest" fees to the banks to maintain their personal records.