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The federal government plans to spend $19 billion to spur the use of computerized patient records, but two articles in the New England Journal of Medicine point to the formidable obstacles to achieving the policy goal. The studies point to problems of not only installing electronic health records, but also using them to improve care and curb cost.

The industry has seen serious momentum in the health IT field since President Obama took office in January. However, physician resistance toward adopting "clunky" electronic medical records remains strong, and experts say swaying physicians will likely be one of the greatest challenges for David Blumenthal, MD, the newly-named national coordinator for health information technology.

In an industry survey released this month, the American College of Physician Executives found that while health IT adoption is up more than 64% since 2004, physicians' opinions of IT are not. (One survey respondent summed up physician resistance by calling his adoption of electronic medical records the "worst aspect of my 25 years in medicine.")

So what's the problem? First and foremost, money. Nearly 41% of the 1,000 physicians surveyed say funding is their primary adoption obstacle. The government's plan to spend $19 billion (or about $44,000 per physician) on digitizing America's health information could answer some questions about IT costs. It does little, however, to address doctors' other concerns, including lack of support or buy-in from physicians and other medical staff (19.6% in the ACPE report) and difficulty integrating with existing or other computer systems (11.9%).

Most of the physicians' complaints haven't changed much in the past five years. "While the technology may be more advanced, it still prompted plenty of grumbling. The respondents said the systems were still too clunky, too hard to use and just too poorly developed," writes Carrie Weimar, director of public relations at the ACPE.

While Blumenthal is a recognized health IT policy expert, he also has an extensive clinical background, giving him better perspective into the practical problems doctors face when they go electronic, experts say. He demonstrates that perspective in a 2007 New England Journal of Medicine article he co-wrote with Jonathan Glaser, CIO at Partners HealthCare, called "Information Technology Comes to Medicine."

"The idea of health IT transports some enthusiasts to almost a dreamlike world of healthcare perfection in which the work of doctors and the care of patients proceed with barely imaginable quality and efficiency," they wrote. "But for many doctors, especially those in solo or small practices, it conjures a very different image—that of a waiting room full to bursting, a crashed computer, and a frantic clinician on hold with IT support in Bangalore."

It's that level of understanding that has many peer physicians and vendors standing behind Obama's choice in HIT leadership. "I am delighted. I think that in this phase of the HIT movement, what we need to see is a care-centric versus technology-centric approach. Blumenthal is widely hailed as an expert clinician. Because of that I think he'll have a unique understanding of how to use HIT to make care better, rather than using HIT for the sake of using HIT," says Peter Basch, MD, medical director for ambulatory clinical systems at MedStar Health, based in Columbia, MD.

Basch says he hopes that among Blumenthal's top priorities is defining or appointing a body to clarify the "meaningful use" portion of the stimulus package. "I like the inclusion of meaningful use as a stipulation for the stimulus incentives because I've never believed adoption of technology by itself is enough to make care better," says Basch. "Yes, there has to be a change in the way medicine is practiced by making better use of technology, but in order to overcome some of that resistance, there has to be a change in the way physicians are compensated too. I think Blumenthal is someone who can recognize that."

Joel Diamond, MD, chief medical officer at dbMotion and a practicing physician at University of Pittsburgh Medical Center and the Handelsman Family Practice in Pittsburgh, PA, says he expects Blumenthal will face some of the same obstacles as his predecessors when it comes to aligning physician incentives. Diamond says that primary care physicians have borne the brunt of previous attempts to reform healthcare by having reimbursement levels and work-flow disrupted. Efforts must be directed to improving all of these areas in order to make real change, he says.

As for physician complaints about EMRs and other HIT being clunky and slowing workflow, as reported in the ACPE study, Basch says those complaints could be minimized by reforming the payment system. "Maybe slowing down is not such a terrible thing. The reason physicians complain is that they aren't paid any differently. If we had a payment system that rewarded health information management and quality outcomes rather than just volume of services, you wouldn't see these same complaints," he says.