The commentary in the excellent article “Will the Feds Really Buy Me an EHR? and Other Commonly Asked Questions About the HITECH Act” [July/August 2009] deserves more emphasis. A number of problems with the provisions of the current EHR stimulus proposal need critical attention. As pointed out by the authors, EHR adoption “could” cause a reduction in productivity for practices. Perhaps “will” is a better term.

Productivity loss occurs with EHR implementation because physicians implement the technology but continue to work like they did with paper. Worse, group practice managers buy an EHR and pay physicians the same according to relative value units without regard for the workflow changes an EHR requires. Physicians work many more hours doing the same work using the EHR. Change requires education. Unless governmental, professional and insurance organizations begin planning a comprehensive educational program for re-engineering physician practices, the feds' EHR money won't pay for the loss of productivity, let alone the hardware or software costs. The government education program called Doctor's Office Quality Information Technology attempted to educate physicians five years ago, but its budget was cut 50 percent after the first year and eliminated the second year of what was to have been a five-year program. Without fundamental workflow change, it will take a full generation of physicians retiring before 75 percent of physicians' offices are computerized. It took 30 years for the U.S. Navy to remove the sails from steamships. Why exactly is EHR adoption any different? Will we have 75 percent of physicians using real-time EHRs by 2017 or simply scanned paper on a computer screen?