The Electronic Health Record: Boon or Bust for Good Patient Care?

reat physicians from Hippocrates to William Osler knew and taught about the importance of listening to patients' stories as fundamental to caring for them.Perhaps nowhere does this prescription ring truer than in the use of the electronic health record (EHR).In 2009 the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted under Title XIII as part of the American Recovery and Reinvestment Act.HITECH, as indeed it is, authorized incentive payments through the Centers for Medicare and Medicaid Services (CMS) for both clinical professionals and hospitals using EHRs to achieve specific improvements in health care delivery (www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html).A substantial proportion of the $31.2 billion allocated for this bill is for promoting and expanding the adoption of EHRs, with up to $44,000 available for each professional (primarily physicians) who displays "meaningful use."Also written into the law are financial penalties for those who do not meet this requirement.Because EHRs-along with the carrots and sticks of financial incentives and penalties-have the potential to improve patient care and assist clinicians, this innovation has engendered great optimism.These important gains, however, do not yet seem to have been achieved.According to a recent US Department of Health and Human Services report, the goal for 50% of doctors' offices and 80% of eligible hospitals to use EHRs by the end of 2013 has been met.These numbers represent a substantial increase from 2008, when only 17% of doctors' offices and 9% of eligible hospitals had EHRs (www.hhs.gov/news/press/2013pres/05/20130522a.html).The problem for doctors and patients is the big difference between "having" and "using" or, better, "meaningfully using" EHRs.A recent