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A Tale of Two Angels

The Issue: 'Meaningful Use' Payments for EHR Adoption

The federal electronic health record incentive programs, part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, promise extra Medicare and Medicaid payments to eligible clinicians and hospitals that become “meaningful users” of certified electronic health records, or EHRs. So far, the government has paid out more than $10 billion in meaningful-use payments to some 190,000 medical professionals and hospitals. The program has led to a doubling in the proportion of U.S. physicians with basic EHRs and a tripling in the proportion of hospitals with the same.

The Debate: Should EHR Incentives Continue?

In an essay for the Annals of Internal Medicine, David Blumenthal, M.D., former National Coordinator for Health Information Technology and current Commonwealth Fund president, enters the debate over whether the federal government's investment has been justified, or whether the meaningful-use standards are too low and the program has been too slow in promoting EHR interoperability.

Blumenthal's view is that “the debate is premature.” He notes that the program is not even two years old, and that the Secretary of Health and Human Services recently put forth more advanced standards and requirements “that could lay the foundation for major advances in interoperability.” At the same time, Blumenthal acknowledges the legitimacy of calls for proof that health care providers are fulfilling all meaningful-use requirements. "Good governance requires a constant balancing of active innovation and accountability," he writes.


Blumenthal believes that the meaningful-use program "deserves the benefit of the doubt for a few years until the . . . program has a chance to show what it can do." It is true that current EHRs are “imperfect,” but “their installation constitutes the first step toward creating the modern electronic health information system that is essential to health care transformation.” While federal officials and participating health care providers must always be mindful of the need to be "careful stewards of taxpayer dollars," the development of advanced information systems capable of "reengineering health care" to meet growing demand, Blumenthal says, should be allowed to continue.

Publication Details



D. Blumenthal, "A Tale of Two Angels," Annals of Internal Medicine, e-published Feb. 12, 2013.