There are certainly potential drawbacks for physicians, but the information they provide would be the cornerstone of a national EHR system, which can't be achieved without their comprehensive cooperation. Some way must therefore be found to encourage the adoption and use of IT by these frontline practitioners. We believe that if smaller providers and physicians are to come on board and thus maintain EHR's current momentum, other parties involved with the industry, including the government, must find ways to help spread the costs and benefits more evenly.

Over time, the willingness of large providers such as Kaiser Permanente and the Veterans Health Administration to invest in EHR and to use electronic records in real care settings will help smaller groups of physicians to follow along. Leading hospital groups and academic medical centers have been investing significantly in IT infrastructure and solutions for more than a decade, laying much of the foundation necessary for a more comprehensive EHR system. Links between academic hospitals—where many specialist physicians already work—and smaller practices could help drive these developments.

The federal and state governments also have a role to play and are starting to play it. For the most part, it will be to help encourage the establishment of basic data requirements and technology standards for the system overall. This point is already a key element of a federal initiative. More directly, Congress and the state legislatures could set directions on policy and privacy issues and mandates on data reporting. They could also choose to subsidize "poorer" industry players: the Medicare system, for example, is experimenting with pay-for-performance methodologies, which if structured properly could offer physicians financial inducements to invest in the necessary technology and information. In addition, legislation recently introduced in Congress would support pay for performance by providing extra payments to hospitals, physicians, and other health care providers prepared to adhere to preestablished IT and data standards. A bill aimed at easing the load on providers would waive certain provisions of the Stark and antikickback laws, thereby allowing hospitals to provide physicians' practices with IT systems.