Fewer than 20 percent of American physicians (that's less than 1 in 5) are using electronic health records (EHR), according to a study published in the New England Journal of Medicine (NEJM).

To talk about why EHR adoption matters, we need to bring the discussion to the level where we talk about it with friends and family.

Do you care whether or not your doctors employ all the tools available to allow them to treat you to the best of their ability?

If you answered yes, then you should care that U.S. physicians are failing EHR 101.

About 80% of our physicians interact with our health care data (add, revise, delete, distribute) via paper only.  That means we're still in the Pony Express phase of health data transfer. In today's world of instantaneous transmission, this lack of adoption is completely unacceptable, but, as we'll see, not completely inexcusable.

Who's to blame? We could scold the physicians. "No wait," the physicians reply. "We're doing the best we can with little money and products that are counterintuitive to use and difficult to install. Plus, they don't talk to proprietary EHR system in place at the community hospital across the county, where half of our patients also go for other treatments."

Ok, so let's blame the hospitals and the physician organizations for not providing EHRs for free to members. "No wait," the hospitals and associations reply. "This isn't our job. We're doing the best we can with too many options that are proprietary. Plus, our payors (insurance companies and the Centers for Medicare & Medicaid Services (CMS)) don't pay our doctors for the time spent installing and using these systems. There is no CMS billing code for "10-minute email encounter" or "5-minute EHR update encounter."

Fine, so we'll blame the insurance companies and Medicare and Medicaid for not paying doctors for time spent using and updating EHRs. "No wait," say the insurance companies. "We're more concerned with improving the safety of our current medical care delivery system, doing things like stopping payment for 'never-events'."

"No wait," says CMS. "We're starting a pilot program to pay small doctor groups (3-10 physicians) in 12 states for EHR implementation and use. We're rolling it out this summer. The only thing is, the systems these doctors use must be certified by CCHIT for them to be compensated." 

Do you have a headache yet?

This is a simple interpretation of the challenges facing large-scale EHR implementation in the U.S. Overly simplistic it may be, but it also illustrates the painfully complex relationships between different players in the health care industry.

It plays out a bit like an episode of Donald Trump's show The Apprentice. When things go right, each high-powered candidate for the job wants to take credit for leading the team to victory. But when a challenge isn't met, no one wants to take responsibility for failure. No one wants to take responsibility for our failure to implement EHRs.