David Blumenthal, MD, the newly appointed National Coordinator for Health Information Technology, sees "major hurdles" for the HITECH Act, according to a New England Journal of Medicine article.

The HITECH Act, the portion of the American Recovery and Reinvestment Act of 2009 (ARRA) that deals with healthcare information technology, is set to help doctors adopt HIT, specifically electronic health records.

The law uses a "carrot and stick approach" where eligible doctors will receive incentive payments for the first five years for demonstrating "a meaningful use" of EHR technology and demonstrated performance during the reporting period for each payment year. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payment will be made after 2016.

Blumethal says spurring the adoption of EHRs and other HIT will probably require more than financial carrots and sticks.

"Proponents of HIT expansion face substantial problems," he said. "Few U.S. doctors or hospitals – perhaps 17 percent and 10 percent, respectively – have even basic EHRs, and there are significant barriers to their adoption and use: their substantial cost, the perceived lack of financial return from investing in them, the technical and logistic challenges involved in installing, maintaining and updating them, and consumers' and physicians' concerns about the privacy and security of electronic health information."

Blumenthal said these problems will create a "substantial down payment on the financial and human resources needed to wire the U.S. healthcare system."

"First, the DHHS and ONCHIT are operating on a very tight schedule. The infrastructure to support HIT adoption should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses," he said. 

Blumenthal said this will be a challenge.

John Halamka, MD, CIO of Harvard Medical School and the CareGroup Health System, is adamant that implementation should start now. Unless the health information exchange is up and running and providing meaningful use, the money won't be, he told attendees at the 2009 Healthcare Information Management Systems Society's conference this past week in Chicago.

Blumenthal said much will depend on how "certified EHR" and "meaningful use" are defined.

The "meaningful use" of healthcare IT will be determined by HHS Secretary-nominee Kathleen Sebelius. If she is confirmed by the Senate, she will also oversee standards development and select clinical quality measures used to determine providers' worthiness for receiving healthcare IT incentives under the new law.

"Realizing the full potential of HIT depends in no small measure on changing the healthcare system's overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of EHRs," said Blumenthal.