In just a few short months, electronic medical records have become a hot political issue in the nation's capitol. In the heat of an election year, President George W. Bush has become an enthusiastic proponent of EMRs to improve quality and control spiraling costs. The issue was quickly picked up by Health and Human Services Secretary Tommy Thompson. And a new health information technology czar — David Brailer — has outlined plans to begin driving the nationwide use of digital records. Essentially, Brailer's program rests on several key initiatives. o Gaining agreements by federal agencies to incentivize the providers they work with to adopt health information technology. The Federal Employees Health Benefits Plan, the Veterans Administration and the Department of Defense have all signed on. o Organize a kind of government Good Housekeeping seal of approval to direct the industry to the most effective products on the market - thereby reducing the likelihood of failure. o And working towards a system that is likely to include new Medicare reimbursements designed to promote adoption. Another feature: federal grants to pay for adoption by providers in rural and underserved areas. By rapidly pursuing that strategy, says Brailer, the government can meet its goal of driving universal access to electronic health records within 10 years. Brailer thinks it can be done in less than seven, particularly if he is able to use the full force of the federal government's huge healthcare budget to spur a critical mass of providers into the electronic age. And once more than half of the providers in the country are using EMRs, he adds, the rest will have little option but to follow suit. Says Brailer: "The more aggressively it starts, the less work it becomes. At some point it becomes self sustaining." Physicians, though, have often been only reluctant players in the drive for technology. As Brailer notes, failure rates for new provider systems run as high as 50 percent. And many doctors are chary of investing part of their income in technology without seeing the government and private payers doing more to cover the expense. For physicians used to dealing with the daily realities of healthcare and a system where only 13 percent of the country's hospitals have as yet pursued EMRs, widespread acceptance appears to be a long way away. Providers in the Louisiana area may be more directly affected by the activities of professional physician organizations that are hoping to steer doctors toward successful solutions. The Physicians Electronic Health Record Coalition (PEHRC) was created by the American Medical Association and 12 other associations to educate primary care docs on the best systems available and help guide them to choosing the most effective systems on the market. But nobody thinks it will be easy. Failure rates among physicians adopting electronic health records runs as high as 50 percent by some estimates. And they're not cheap to install. "Our patients deserve doctors who have access to the most modern and connected electronic health record system available," says PEHRC co-chair David C. Kibbe, M.D., of the American Academy of Family Physicians. "While physicians are adopting information technology in growing numbers, there remain substantial economic and technical barriers to full-scale deployment of electronic health records, especially in small- and medium-size medical practices. The PEHRC will allow physicians to address these barriers with a unified voice, and be powerful advocates for putting health information technology in the service of quality of care." Up to this point, much of the argument in favor of health information technology has centered on better quality - EMRs and computerized physician order entry systems have been considered critical for reducing the number of physician errors that harm and kill patients. But politicians of all stripes have been energized by new reports demonstrating that the technology — once widely adopted — can eliminate much of the waste in the system; a figure often estimated at 25 percent to 30 percent of the nation's $1.55 trillion annual tab. For Brailer, the rewards are immense. The first $100 billion in savings are "low hanging fruit." Billions more are there for easy plucking. But a host of experts caution warn that there won't be anything easy about converting the healthcare system to digital records. Unlike the single payer U.K., which recently rolled out a $10 billion plan to mandate electronic health records, the U.S. system will require a host of providers to adopt the new technology from the ground up. Currently only a minority of U.S. hospitals have electronic health records. And between the system we have today and the one envisioned by Brailer, providers will be expected to spend vast sums of capital on acquiring the technology. And in the end they'll help build a system that is designed to cut their income. Under the current system of incentives, many experts note that providers earn more from inefficiency. The more procedures they do the more reimbursements they make. By eliminating duplicative and unnecessary work, their income dwindles. Meanwhile, the health plans that stand to gain substantially from reduced administrative overhead will be benefiting the most from providers' investments. William Jesse, head of the national Medical Group Management Association, has endorsed the government effort, but wants incentives to help cover costs. "While hospitals can usually access the needed capital from reserve funds, bond issues or stock sales, the vast majority of medical groups are small businesses that lack access to these forms of capital," said Jesse. "Accordingly, they must either pay for new information technology from current income or by seeking debt financing from a lender. This is a significant barrier to a group's capital investment in health information technology. We urge the federal government to recognize the administrative, technical and financial assistance needed to overcome this implementation barrier. Necessary changes to Medicare reimbursement must reflect physician investment in health care technology." Up to now, Medicare has focused on technology demonstration projects to help determine the best method for spurring new technology. But if the new government initiative survives the current election year intact, observers are expecting some major reimbursement changes in 2005.