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Computerworld - The cost of installing and maintaining electronic health rec­ord (EHR) systems in doctors offices has long been described as one of the biggest barriers in the way of President Bushs executive order that most Americans have EHRs by 2014.

Now the federal government hopes to start breaking down that barrier through a demonstration project, under which it will pay higher Medicare reimbursements to up to 1,200 medical practices that deploy EHR systems. The U.S. Department of Health and Human Services announced the plan on Oct. 30, which was billed by HHS Secretary Mike Leavitt as a red-letter day in the push to spur the adoption of e-health technology.

Some doctors and health care IT executives applauded the proposed financial incentives, saying they could ease the cost burden enough to put EHR systems within the reach of small practices. But not everyone was so sure that the plan by itself would lead to widespread adoption of EHRs. Some in the latter group have noted that broader technology hurdles still need to be overcome.

Everyone did agree that the problem the HHS is trying to address is a real one.

Herb Smaltz, CIO at the Ohio State University Medical Center in Columbus, said that for many small medical practices, the cost of installing EHR systems continues to be prohibitive.

If the incentives achieve a utility function for these physician groups, that will definitely spur adoption [of EHRs], Smaltz said. If insurance companies then follow suit and offer similar rewards and incentives, that should achieve the tipping point for adoption on an almost universal level.

Peter Embi, a physician and director of the University of Cincinnati Center for Health Informatics, said that EHR use can improve the efficiency of medical practices and reduce their costs somewhat over time. But those reductions often arent sufficient to justify the expense and short-term disruptions of implementing an EHR system, Embi added.

The real value in EHRs, when used to their fullest potential, is in improving the quality and safety of patient care, he said. Embi, who practices at a U.S. Department of Veterans Affairs clinic and uses the VAs Computerized Patient Record System, spoke during the HHS announcement about a patient who suffers from severe arthritis, gout and congestive heart failure.

Without the VAs EHR system, the care that the patient receives would be slow and delayed, Embi said. At worst, he might actually be harmed by some conflicting medications.