The American Medical Association reports in an e-mail entitled "AMA Health System Reform Insight" from July 22, 2010, that "early in 2009, Congress passed the American Recovery and Reinvestment Act (ARRA) which created a $19 billion subsidy program to help physicians and hospitals purchase electronic health records (EHR) systems. For many physicians, the cost of an EHR has simply been out of reach. The new program, therefore, provides an opportunity to enter the digital era. As with any government subsidy program, however, there are strings attached."

"While the law broadly laid out the parameters under which physicians could receive these incentive payments, the specific rules that will govern the program are developed by the administration."

"In order for physicians to receive the Medicare incentive payments...they must be a "meaningful user" of a "certified" EHR."

"There are two incentive programs, one for Medicare and one for Medicaid. Congress created different subsidies and parameters for each program. For Medicare, physicians are eligible for up to $44,000 over five years starting in 2011 and incentives are predicated on 75 percent of the physician's Medicare allowed Part B charges."

"For Medicaid, the incentives are based upon a physician's patient volume. For most physicians a Medicaid patient volume of at least 30 percent is required; for pediatricians it is 20 percent. Under the Medicaid program, physicians are eligible for up to $63,750 over six years beginning in 2011."

"Despite CMS's attempt to simplify the incentive program requirements...for many physicians the requirements for receiving the incentive payments are still too steep. This will be especially true for physicians in solo or small group practices who have not previously utilized an EHR."

"Key barriers, include: Product availability: There is no EHR in the market today that does all of the things required for physicians to successfully meet Stage 1 "meaningful use" criteria."

"CMS and the ONC expect "certified" EHRs that support the achievement of Stage 1 "meaningful use" to be available this fall."

"Physicians will only have a couple of months to purchase, implement and assess the usability of "certified" EHR technology prior to January 2011, the start date of the incentive program."

"The volume of measures that physicians must meet totals 20, which is still too high, especially for smaller practices that have not yet adopted or used EHR technology."

"The measures that require physicians to electronically produce, within several days, health information contained in EHRs conflict with HIPAA requirements that allow for a longer period of time (at least 30 days) for the production of medical records."

"Some of the threshold requirements are still too high and some of the measures have narrow exclusions, which will be burdensome for physicians to meet. One measure requires physicians to maintain an up-to-date problem list of current and active diagnoses or indicate that no problems are known for more than 80 percent of patients seen during the reporting period, with no exceptions. Another requirement (a menu option) is to provide a "summary of care" record for more than 50 percent of patient transitions or referrals within three business days, which will be difficult to meet."

"There is no mechanism for physicians to appeal any aspect of the incentive program (e.g., payments or eligibility)."

"The certification process does not take into account whether a product will meet a physician's unique workflow and practice needs; rather, it will only provide the means for meeting the "meaningful use" criteria."