Surprise: Every American Will Not Have an Electronic Health Record This Year

Brian A Jackson/

Both Bush and Obama set 2014 as the deadline.

In 2004, President George W. Bush kicked off a project designed to provide most Americans with an electronic health record in 2014. That was followed by a similar goal set by President Barack Obama in 2009.

 But as the end of 2014 comes nearer, these ambitious goals still have not been met.

“We have made great progress … [but] we have much more work to do,” said Jodi Daniel, director of the Office of Policy in the Office of the National Coordinator Health Information Technology in the Department of Health and Human Services.

So far, about 75 percent of the clinicians and 91 percent of the hospitals who treat patients under Medicare or Medicaid have adopted health information technology under an incentive program in the 2009 Health Information Technology for Economic and Clinical Health – or HITECH – Act, Daniel said.

Since 2011, the Centers for Medicare and Medicaid Service have paid out $23.7 billion to hospitals and medical professionals to adopt electronic health records. This covers 385,158 clinicians and 4,993 hospitals.

But Daniel said her office has no way to determine how many patients cared for by CMS providers actually have electronic health records. CMS provides care for about 105 million people, or roughly one-third of the U.S. population.

As doctors and hospitals that have installed EHR systems also treat non-CMS patients, Daniel estimated a “significantly larger number of Americans” have EHRs than those enrolled in Medicare and Medicaid, but could not quantify the number.

Nationwide Adoption a Moving Target

Daniel said nationwide adoption of EHRs is an elusive, moving target due to “meaningful use” requirements set by CMS, that go far beyond simple adoption of technology.

CMS mandates that providers, among other things, generate and transmit prescriptions to pharmacies electronically; incorporate lab tests into EHRs; electronically order lab and radiology tests; use secure electronic messaging to communicate with patients; and allow patients to view download and transmit their own health information online.

Daniel said adoption of technology will bring about improvements in the health care system and in return make healthier patients.

Bush focused his health IT project on development of a personal health record for – and individually controlled by – every American.

"To protect patients and improve care and reduce cost, we need a system where everyone has their own personal electronic medical record that they control and they can give a doctor,” Bush said in an April 2004 speech.

Critic: 'Meaningful Use' About Providers -- Not Patients

Tom Munnecke, a health IT consultant and an early developer of the Department of Veterans Affairs’ EHR, said the federal health IT office has lost sight of the personal health record goal espoused by Bush.

“This vision would have put the patient in the center of the health care universe, and pushed health care providers on the periphery,” Munnecke said in an email to Nextgov. “Providers that could communicate with the patient and deliver superior care would thrive. It would have created an innovative ecosystem of patients, providers and technology, all intrinsically motivated to improve. It could have ushered in a whole new era of innovation.”

Instead, he commented, “We ended up with a massively centralized, industry-centric framework” that "paves the cowpaths" of the existing players. 

It sends billions to providers, not patients, he said.

“Providers see their information as a proprietary advantage over their competitors,” he added. “They have no intrinsic motivation to spend money to share information with others. They would much rather keep it internal, locking in their patients to their system and their services. It becomes a game: How can they do the least amount of sharing but still earn their incentive payments?”

(Image via Brian A Jackson/