EHR adoption is inextricably tied to healthcare reform. Unless meaningful healthcare reform passes, even incentives and a recovering economy won't drive EHR adoption. This seems evident in the wake of remarks made by the CEO of the Medical Group Management Association at MGMA's annual conference this week.

MGMA represents more than 13,700 medical groups throughout the country. Many have been hit by the economic recession in the form of decreasing revenues, as a result of declining patient procedures and patients. They are also grappling with increasing bad debt, incurred when uninsured or underinsured patients simply can't pay. This scenario has forced about 37 percent of MGMA members to forego capital expenditures, which could include EHR implementations. With approximately three-quarters of medical groups without an EHR, the horizon looks pretty bleak. Would it really matter to someone if they were promised $44,000 over five years to implement health IT and derive meaningful use out of it if they don't have the upfront investment to pay for the system?

Yes, the current economic environment is forcing that hand. But look at policies that need to be reformed in order to create a better financial situation for physicians. MGMA CEO William F. Jessee, MD, argued that one of the reasons physicians are delaying health IT adoption is the uncertainty over Medicare payment reductions. Under the federal government's SGR (sustainable growth rate) formula, physicians could see a 21.5 percent cut in Medicare payments. In the past, Congress has fiddled with the rate to avoid reducing Medicare payments. While the rate modification last year resulted in a 0.5 percent increase in payments, this annual tweaking only builds anxiety and uncertainty. It doesn't address how we can adequately reimburse physicians, taking into account the cost incurred for taking care of Medicare patients.

MGMA and other healthcare organizations are calling on Congress and President Obama to replace the SGR rate with a "realistic budget baseline" for future Medicare payment updates. That's one change that needs to be made.

Overall, the whole Medicare fee-for-service structure needs an overhaul. Everybody understands that this payment arrangement rewards volume over quality, which increases the cost of healthcare for everybody. One of President Obama's healthcare reform proposals is to bundle payments to providers instead of paying per episode of care. The reasoning is that the focus would be on making sure that the patient recovers and stays healthy, thereby reducing overall cost from, for example, unnecessary hospital re-admissions. While some rightly worry that the bundled payment won't be adequate, overhauling the reimbursement structure is a step in the right direction for addressing the rising cost of healthcare.

And this is where health IT can make a difference. An EHR can efficiently and automatically present a comprehensive patient record. Interoperable EHRs in the hospital, primary care physician, specialists and other provider offices connect all of a patients' caregivers to deliver continuity of care. That's what health IT brings to the table. That is, once we take care of the payment and other healthcare reform issues, such as health insurance coverage for all, that keep providers on the EHR sidelines.